Fertility treatment

This factsheet is for people who are having fertility treatment, or who would like information about it.
Fertility treatments increase the chances of pregnancy in couples who are having difficulty conceiving.

About fertility
Diagnosis of fertility problems
Treatment of fertility problems
What are the risks?
 

About fertility

Eight out of 10 couples who have sex regularly (every two or three days) will get pregnant within a year of trying. The majority of other couples will get pregnant within two years of trying.

However, some couples continue to have difficulties. According to the Human Fertilisation and Embryology Authority (HFEA), about one in seven couples in the UK have difficulty conceiving. This is sometimes called subfertility.
There are a number of reasons why you and your partner may have trouble getting pregnant. If you have been trying to get pregnant for a year without success, speak to your GP. He or she can arrange for you both to have some basic tests. If you have been having regular unprotected sex for two years without success, one or both of you may have fertility problems.

Diagnosis of fertility problems

Tests and treatments are available for both men and women with fertility problems. Both you and your partner will need to be tested.

Initial tests of your fertility can be started by your GP, who can give support and lifestyle advice. Other tests will need to be done by a team of doctors and nurses who specialise in fertility.

For women

You may be asked to have blood tests to check your hormone levels and to see whether you’re ovulating. Your GP may also refer you for an ultrasound scan of your womb, fallopian tubes and ovaries. Depending on the results of these, you may need to have other tests.

For men

You will need to take a sample of your semen to the clinic for testing. The test will examine the numbers of sperm, how they move and whether they have a normal structure.

Treatment of fertility problems

There are a number of different treatments available that will increase your chances of getting pregnant. The treatment that is best for you will depend on the reasons why you can’t get pregnant. It’s important to understand that there are no guarantees that pregnancy will happen with any of the fertility treatments available. Your doctor can give you more information about the success rate of each treatment.

Some treatments can help to improve your fertility and the chances of a natural conception.

For women

If you aren’t ovulating (eg if you have polycystic ovary syndrome), you can take medicines that can stimulate your ovaries to produce eggs. This is called ovulation induction.

There are two main medicines used for this; they are called clomifene (eg Clomid) and tamoxifen. You will take these medicines for five days each month. You can continue to take them for a maximum of 12 months. After this, your doctor will discuss other treatment options.

If you have polycystic ovary syndrome and are overweight, your doctor may also prescribe a medicine called metformin if the clomifene or tamoxifen hasn’t been effective on its own. 

You can have keyhole surgery to make tiny holes in the surface of your ovary to stimulate it. This is known as laparoscopic ovarian drilling. It's as effective as hormone injections, and it might be an option for you if clomifene or tamoxifen doesn't make you ovulate.

Hormone injections with human gonadotrophin hormone (a mixture of luteinising hormone and follicle-stimulating hormone) may be offered if clomifene or tamoxifen hasn’t worked for you.

For men

There are a number of treatments that can help to improve the quality of your sperm, or help it to reach your partner’s womb.

If your sperm quality is affected by hormone problems such as male hypogonadism (where your pituitary gland doesn't produce enough of certain hormones called gonadotrophins), then medicines may help. An operation may be able to remove any blockage in the epididymis (this is where the sperm are stored in each testicle). If you have ejaculation problems, then medicines and other treatments may help.

Assisted conception

Other treatments give you more help to conceive by controlling the way that the sperm and the egg are brought together. This is called assisted conception.
There are three main types of assisted conception.

Intra-uterine insemination (IUI)

IUI involves taking fast-moving sperm and placing them inside the womb close to the time of ovulation. This is usually the first method offered to couples who have unexplained infertility. It can be used for women who have mild endometriosis. Endometriosis is a condition in which the lining of the womb grows somewhere else inside the abdomen, such as on the ovaries, behind the womb or on the bowels or bladder.

IUI is also useful for men who have ejaculation problems or mild problems with the quality of their sperm. IUI can be combined with ovulation induction. 

In vitro fertilisation (IVF)

IVF is a procedure where eggs are removed and mixed with sperm in a laboratory. Once the eggs have been fertilised, they are placed in the womb. IVF can be carried out with your own sperm and eggs or with donor sperm or donor eggs. The sperm and embryos can also be frozen for future use, although there are strict legal rules, supervised by the Human Fertilisation and Embryology Authority, to regulate these procedures. You will need to discuss these methods with your specialist.

You may need IVF treatment if:

• your infertility is unexplained
• your fallopian tubes are blocked
• other techniques such as fertility drugs or intrauterine insemination (IUI) haven’t worked

You will need to take medicines to control the timing of your monthly cycle accurately so that the eggs can be removed and fertilised on a specific day. A normal monthly cycle produces only one egg, but with this method, which uses three hormones given at different times, you will produce several mature eggs at once. This is called superovulation and it increases your chances of a pregnancy.

Usually, the eggs are collected while you have an ultrasound scan. A thin needle is passed through your vagina and into your ovary. This is done as an outpatient procedure, so you won't need to stay overnight in hospital and you won't usually need a general anaesthetic.

At around the same time, your partner will need to give a sperm sample. The sperm are washed and spun at a high speed so that the healthiest sperm can be selected. If you’re using donated sperm, it’s removed from storage and prepared in the same way.

The sperm and eggs are then mixed together in the laboratory.

Successful fertilisation can be seen with a microscope after about 16 to 20 hours. If you’re a woman under 40, one or two of the resulting embryos are transferred into your womb using a soft plastic tube passed through your vagina. As many as three embryos may be transferred if you’re 40 or over.

H4 Intracytoplasmic sperm injection (ICSI)

ICSI is very similar to IVF, but in ICSI a single sperm is injected into an egg in the laboratory and the resulting embryo is transferred to the womb. This means that as long as just a small number of sperm can be obtained, it’s possible to fertilise the egg. This type of fertility treatment is used when there are more serious problems with the sperm, when the man has had a vasectomy or when problems between the egg and sperm are preventing fertilisation.

What are the risks?

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

The medicines women take during IVF and ICSI may cause side-effects, such as hot flushes, changes in mood, night sweats, feeling sick, headaches and restlessness. Symptoms usually disappear after a short time but if they don’t, you should see your doctor as soon as possible.

Complications

Complications are when problems occur during or after the treatment.

Having fertility treatment increases the chances of having a multiple pregnancy (such as twins or triplets). This is why there are restrictions on the number of embryos that can be transferred into the womb. A multiple pregnancy increases the risk of health problems for both you and your baby. Miscarriage, early labour and health problems in pregnancy such as high blood pressure are all more likely if you are having more than one baby.

Ovulation induction can cause a condition called ovarian hyperstimulation syndrome (OHSS). This is an over-reaction to the medicines used to stimulate the ovaries. When having IVF and ICSI, around one in twenty women will develop OHSS. For most women, the symptoms are mild. However, for a few it can cause more serious health problems. If you have any of the following symptoms you should contact your fertility clinic or GP straightaway:

• feeling sick and being sick
• severe pains and swelling in your abdomen (tummy)
• feeling short of breath
• feeling faint
• passing a small amount of urine compared to normal

The chances of having an ectopic pregnancy may be higher in women who have IVF or other fertility treatments. An ectopic pregnancy is when the embryo starts to develop outside the womb, usually in a fallopian tube. The main symptoms include:

• one-sided low abdominal pain
• vaginal bleeding
• dark brown or red vaginal discharge 

The pain will get worse as the pregnancy goes on. If you have these symptoms you should see your doctor straight away.

Removing the eggs for IVF or ICSI involves passing a tube through the vagina and into the ovary. This means that there is a risk of infection. If this happens, it can usually be treated with antibiotics.