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.

What is unexplained infertility? What can be done to treat it?
What affects the success of assisted conception treatments?
For which conditions and under what circumstances is IVF used?
Why have my partner and I been offered counselling while having assisted conception treatments?

What is unexplained infertility? What can be done to treat it?

Unexplained infertility is when doctors have carried out tests on both you and your partner but have been unable to find any reason why you have not become pregnant. There are several different types of assisted-conception technique that can be used to treat unexplained infertility.

Explanation

Unexplained infertility is not a condition in itself. It’s when tests show no specific problem that explains why you and your partner can’t get pregnant. Around one in four couples have unexplained infertility. Without treatment, the chances of getting pregnant will depend on how long you have unexplained fertility. In general, the longer you have it, the smaller your chances are of becoming pregnant naturally. It’s possible for couples to become pregnant even if they have had unexplained infertility for years but some people will need assisted-conception techniques to conceive.
Ovulation induction (OI) and intra-uterine insemination (IUI) are often the first treatments used. If these don’t work, then your doctor may suggest IVF. Some doctors believe that unexplained infertility shouldn't be given as a diagnosis, because nothing has been diagnosed. The type of fertility test carried out and how well the results of the tests are interpreted can vary from doctor to doctor and may mean specific causes of fertility problems are missed. However, the value of some fertility tests remains uncertain, as reaching an actual diagnosis may not alter the treatment options available to you. Talk to your doctor about what tests are suitable for you.

Further information

Sources

  • Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Clinical Excellence (NICE), February 2004. www.gserve.nice.org.uk
  • Quick facts about fertility. The Human Fertilisation and Embryology Authority www.hfea.gov.uk, accessed 12 November 2009
  • Gleicher N, Barad D. Unexplained infertility: Does it really exist? Hum Reprod, 2006; 21(8):1951–55

What affects the success of assisted-conception treatments?

There are several factors that affect how successful assisted-conception treatments will be. The single most important factor is the age of the female partner. Other factors include the number of eggs in the ovaries, how long you have had fertility problems for, how many cycles of treatment you have tried previously and if you have had a successful pregnancy before.

Explanation

Assisted-conception techniques are treatments that can help you to conceive. These procedures aim to bring the sperm and egg, or eggs, close together to increase the chances of fertilisation. The success of these treatments is dependent on many factors. Some of these are listed below.

  • Your fertility decreases with age which means that the success of assisted-conception treatments also reduce as you get older. IVF is most successful when a woman is aged between 25 and 39.
  • The best chances of conceiving are within the first three cycles of assisted-conception treatments.
  • If you have had a previously successful pregnancy, either naturally or through assisted-conception techniques, you will have a higher chance becoming pregnant from assisted conception.
  • If you or your partner smoke, drink more than one unit of alcohol per day or drink excessive amounts of caffeine, you will lower your chances of successful assisted conception.
  • If you’re very overweight (with a Body Mass Index greater than 30) you will also reduce your chances of successful treatment.

If you have any questions or concerns about assisted conception techniques, talk to your doctor.

Further information

Source

  • Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Clinical Excellence (NICE), February 2004. www.nice.org.uk

 
 

For which conditions and under what circumstances is IVF used?

In vitro fertilisation (IVF) is a fertility treatment used to help couples become pregnant. It can be used to overcome a number of health problems.

Explanation

IVF is when an egg and sperm are mixed together in a laboratory to create a fertilised egg. IVF is considered for people with certain health conditions. Some of these are listed below.

  • IVF may be helpful if you have fallopian tubes that are blocked, damaged or diseased. The fallopian tubes carry eggs from your ovaries to your womb. In some women, surgery may be able to restore the tubes to normal. IVF is generally the first choice for women with severe tubal damage.
  • IVF can be used if you have endometriosis. This is where cells like the ones found in the womb lining (endometrium) grow outside your womb. This commonly affects the ovaries. IVF is often used when severe endometriosis is causing fertility problems.
  • IVF can be used if a man has low or poor-quality sperm.
  • IVF can be considered for women with ovulation disorders who don’t respond to more straightforward treatments. For example, when your ovaries are not producing eggs.

If you have any questions or concerns about IVF, talk to your doctor.

Further information

 

Source

  • Collins S, Arulkumaran S, Hayes K, et al. Oxford handbook of obstetrics and gynaecology. 2nd ed. Oxford: Oxford University Press. 2008:574

 

Why have my partner and I been offered counselling while having assisted-conception treatments?

All UK clinics offering assisted-conception techniques are required to offer couples counselling. This is to help you cope with any issues surrounding your fertility and the possible outcomes of treatment.

Explanation

Undergoing assisted-conception treatments can be very stressful for many couples. Coming to terms with fertility problems, going through treatment and dealing with an unsuccessful fertility treatment can all place strain on you and your relationship. Some couples experience a deep sense of bereavement if they are eventually unsuccessful in their treatment.

By offering an independent counselling service, fertility clinics in the UK are able to help couples come to terms with difficult feelings and emotions. Counselling can also help you to discuss the implications of treatment if you’re using donated sperm, eggs or embryos. A qualified counsellor will be able to offer you information, discuss the implications of having treatment and give you support throughout your treatment. Counselling can give you the opportunity to talk openly and to find ways of coping that work for you. All of this takes place in a confidential, safe environment.

If you have any questions or concerns about fertility treatment and counselling, talk to your doctor.

Further information

Source

  • Benefits of counselling and how to access it. The Human Fertilisation and Embryology Authority www.hfea.gov.uk, accessed 12 November 2009

Related topics

 

Related topics

Further information

  • Human Fertilisation and Embryology Authority (HFEA)
    www.hfea.gov.uk

  • Infertility Network UK (INUK)

0800 008 7464
www.infertilitynetworkuk.com

Sources

  • Fertility basics. The Human Fertilisation and Embryology Authority. www.hfea.gov.uk, accessed 1 February 2010.
  • Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Clinical Excellence (NICE), February 2004. www.nice.org.uk
  • What to expect at the clinic. The Human Fertilisation and Embryology Authority. www.hfea.gov.uk, accessed 12 November 2009
  • Clomifene citrate. Joint Formulary Committee, British National Formulary. 58th ed. www.bnf.org, accessed 12 November 2009
  • Ovulation defects. Infertility Network UK. www.infertilitynetworkuk.com, accessed 12 November 2009
  • What is in vitro fertilisation (IVF) and how does it work? The Human Fertilisation and Embryology Authority. www.hfea.gov.uk, accessed 12 November 2009
  • Commonly used fertility drugs. The Human Fertilisation and Embryology Authority. www.hfea.gov.uk, accessed 12 November 2009
  • Risks and complications of assisted conception. British Fertility Society. www.britishfertilitysociety.org.uk, accessed 12 November 2008
  • Risks of fertility treatment. The Human Fertilisation and Embryology Authority. www.hfea.gov.uk, accessed 12 November 2009

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