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Fertility treatments

Over eight out of 10 couples will get pregnant (conceive) within one year of having regular, unprotected sex (if the woman is under 40). The majority of other couples will do so within two years. But for one in seven couples in the UK this isn’t the case and they continue to have trouble getting pregnant. This is sometimes called subfertility. For more information about infertility and its possible causes, see our topics on male infertility and female infertility.

There are a number of different treatments available that will increase your chance of getting pregnant. And there are things that you can do for yourself to improve your fertility and the chance of getting pregnant without needing medical intervention.

The fertility treatment that’s best for you will depend on the reasons why you can’t get pregnant. It may also depend on how long you’ve been trying to conceive. It’s important to understand that there are no guarantees that pregnancy will happen with any of the fertility treatments on offer. Your doctor can give you more information about the success rate of each treatment.

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  • Self-help Self-help

    Taking steps to stick to a healthy lifestyle may improve your chance of getting pregnant and having a healthy pregnancy. If either of you smoke, giving up can greatly improve your fertility. Smoking has been linked to numerous problems associated with getting pregnant and with lower success rates of assisted conception techniques.

    Limiting how much alcohol you drink can also improve your fertility and the success of fertility treatments. Women shouldn’t drink more than one or two units of alcohol once or twice per week when trying to get pregnant. Men should aim to not drink any more than three to four units per day.

    For women, having a body mass index (BMI) below 18 or above 30 can affect how often you release an egg from your ovaries (ovulate). If your periods are irregular or have stopped, this is a sign that you might not be ovulating. Getting back to a healthy BMI, between 18 and 25, may regulate your ovulation and periods. Men should also keep their BMI below 29 to maximise their fertility.

    If you eat a balanced and varied diet, it will provide you with all the nutrients you need to conceive and have a healthy pregnancy. Folic acid and vitamin D are particularly important for women who are planning to get pregnant. Talk to your GP about taking supplements of these.

    Vitamins C and E and some minerals, such as zinc and selenium, are important for the health of men’s sperm. These important nutrients can be found in a variety of foods including nuts, oily fish, green vegetables and tomatoes. If you think you may be missing out on some of these, you could take a daily supplement. See our Related information for more about healthy eating.

  • Ovulation induction Ovulation induction

    If you aren't ovulating, you can take medicines that aim to stimulate your ovaries to produce eggs. This is called ovulation induction.

    The main medicine used for this is called clomifene (eg Clomid). An alternative is tamoxifen. You will take these medicines for four or five days each month. You can take clomifene for up to six months, although if it’s going to be effective, this usually happens within the first three months. After this, your doctor will discuss other treatment options. You may be able to take tamoxifen for longer than six months.

    If you have polycystic ovary syndrome, which can affect ovulation, your doctor may also prescribe a medicine called metformin. You may also be advised to take steps to eat more healthily and exercise to lose weight. This can improve your chance of ovulating more regularly.

    If you’ve tried clomifene and it hasn’t worked for you, another option is a type of keyhole surgery called laparoscopic ovarian drilling. In this operation, your surgeon will make tiny holes in the surface of your ovary to stimulate it. It’s been found to be as effective as medicines.

    Another option if clomifene hasn’t worked for you may be injections that aim to trigger ovulation. These are called follicle-stimulating hormone injections.

  • Fertility treatments for men Fertility treatments 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 because of hormone problems, such as male hypogonadism, medicines may help. Male hypogonadism is when your pituitary gland doesn’t produce enough of certain hormones called gonadotrophins (these control the function of your testes).
    • You may be able to have an operation to try to remove any blockage in your epididymis. This is a tightly coiled mass of thin tubes around your testicles where sperm is stored. If there is a blockage, an operation may help to restore fertility.
    • If you have ejaculation problems or erectile dysfunction, medicines and other treatments may help.
  • Prompt access to quality care

    From treatment through to aftercare, with Bupa health insurance we aim to get you the help you need, as quickly as possible. Find out more today.

  • Assisted conception Assisted conception

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

    Intra-uterine insemination (IUI)

    IUI involves taking a sample of sperm and placing it inside the womb close to the time of ovulation. IUI can be done with your own sperm or with donor sperm. This is often one of the first methods offered to couples where no cause can be found for problems with fertility (unexplained infertility). If you have mild endometriosis, your doctor may also recommend you try IUI. IUI is useful for men who have ejaculation problems or mild problems with the quality of their sperm too.

    IUI is usually combined with injections to stimulate the ovaries. Your doctor will monitor you closely during this treatment to reduce the chance of several eggs developing. This could result in a multiple pregnancy (twins, triplets or more).

    In vitro fertilisation (IVF)

    IVF is a procedure where eggs are removed and mixed with sperm in a laboratory. Once the eggs are 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. Sperm, eggs and embryos can also be frozen for future use, although there are strict legal rules to regulate these procedures. These are supervised by the Human Fertilisation and Embryology Authority.

    You may need IVF treatment if:

    • a cause can’t be found for your infertility
    • your fallopian tubes are blocked
    • you have ejaculation problems or mild problems with the quality of your sperm
    • other techniques, such as fertility drugs or IUI, haven’t worked

    You may need to take medicines to suppress your own body’s hormones. Your doctor will then prescribe you some hormone medicines to stimulate your ovaries to produce several eggs. A normal monthly cycle produces only one egg, but this method, which uses different hormones at specific times, means you produce several eggs at once. This is called superovulation and it increases your chance of a pregnancy.

    Usually, you’ll need to have an ultrasound scan when your doctor takes the eggs from your ovaries. An ultrasound uses sound waves to produce an image of the inside of your body so they can be seen clearly. Your doctor will pass a thin needle through your vagina and into your ovaries. You may be offered a sedative before the procedure because it could feel uncomfortable and it’s important that you can remain still. A sedative relieves anxiety and helps you to relax.

    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 a laboratory to create one or more embryos. This will be checked under a microscope after about 16 to 20 hours to see if fertilisation has been successful.

    Your fertility clinic will advise you on how many embryos will be transferred into your womb. This will be based on your age and the quality of the embryos. In most women under the age of 38, a single embryo will be transferred. In older women, two embryos may be transferred. Very rarely, the fertility clinic may advise you to have three embryos transferred. The idea is to give you a good chance of conceiving, while minimising the possibility of a multiple pregnancy. A multiple pregnancy carries higher risks to both you and your babies than a single pregnancy.

    Intracytoplasmic sperm injection (ICSI)

    ICSI is very similar to IVF and may be an option if this hasn't worked for you. However, in ICSI, a single sperm is directly injected into an egg in a laboratory and the resulting embryo is transferred to the womb. This means that even if only a small number of sperm can be obtained, it may be possible to fertilise the egg.

    This type of fertility treatment is used if there are more serious problems with the sperm, such as a low sperm count or abnormal sperm. It may also be an option if you have had a vasectomy – sperm are collected from your testicles or epididymis.

  • Risks What are the risks?

    Side-effects

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

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

    Complications

    Complications are when problems occur during or after the treatment.

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

    The medicines used to stimulate your ovaries during assisted conception can cause a condition called ovarian hyperstimulation syndrome (OHSS). This is when your body over-reacts to the medicines. When having IVF and ICSI, around five in 100 women develop OHSS. For most women, the symptoms are mild. However, for a few, it can cause more serious health problems. Contact your fertility clinic or GP straight away if you:

    • feel sick or vomit
    • have severe pain in your abdomen (tummy)
    • have swelling in your abdomen
    • feel short of breath or faint
    • go to the toilet less than usual

    The risk of having an ectopic pregnancy may be higher if you have IVF or other fertility treatments, especially if your fallopian tubes are damaged.

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

  • FAQs FAQs

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

    Answer

    Unexplained infertility is when doctors have carried out tests on both you and your partner but can't find any reason why you haven’t become pregnant. There are several assisted-conception techniques that you can try to help you get pregnant.

    Explanation

    Unexplained infertility isn't a condition in itself. It’s when you and your partner can’t get pregnant but test results don’t show any specific problem. Around a quarter of couples who are having difficulty getting pregnant have unexplained infertility. 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 medicines, which aim to stimulate your ovaries to produce eggs, are unlikely to increase your chance of getting pregnant. Intra-uterine insemination (IUI) is often the first treatment used. Another option is in vitro fertilisation (IVF). However, you must have been trying to get pregnant for at least two years to be offered this treatment.

    Talk to your doctor about what assisted conception procedure is the best option for you.

    What affects the success of assisted-conception treatments?

    Answer

    There are several factors that affect how successful assisted conception treatments are. The single most important factor is the woman’s age. Other factors include how many cycles of treatment you have tried previously and if you have had a previous successful pregnancy. Lifestyle factors, such as if you drink alcohol and smoke, can affect the success of assisted conception treatments too.

    Explanation

    The success of assisted conception treatments depends on many things. Some of these are listed below.

    • Women’s fertility decreases with age, which means that the success of assisted conception treatments also reduces as you get older. IVF is most successful in women under 35.
    • The chance of conceiving falls as the number of unsuccessful cycles of assisted conception treatments, such as IVF, increases.
    • If you have previously been pregnant, either naturally or through assisted conception techniques, your chance of getting pregnant from assisted conception is higher.
    • If you or your partner smokes, or drinks more than one unit of alcohol per day, you lower your chance of successful assisted conception. Women who drink caffeine have a lower chance of getting pregnant from assisted conception techniques too.
    • If you’re very overweight (with a BMI greater than 30) or underweight (BMI under 19), you may also reduce your chance of successful treatment.
    • If you have endometriosis, it may reduce your chance of success with IVF. You may need to have treatment with a type of medicine called a gonadotrophin-releasing hormone (GnRH) for three months before you start IVF.

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

    When is in vitro fertilisation (IVF) used?

    Answer

    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 offered to people with certain health conditions, some of which we’ve listed here.

    • IVF may be helpful if you have fallopian tubes that are blocked, damaged or diseased. The fallopian tubes carry eggs from a woman’s ovaries to her womb. Sometimes surgery can be done to help the tubes function better. IVF is generally the first choice for women with severe damage to their fallopian tubes.
    • IVF can be used if you have endometriosis. This is a condition in which 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 is a treatment option if a man has ejaculation problems or mild problems with the quality of their sperm.
    • IVF can be considered for women with ovulation disorders who don’t respond to more straightforward treatments. For example, if you have polycystic ovary syndrome and you have tried ovulation induction medicines but they haven't been successful.
    • IVF is a potential treatment for couples with unexplained infertility (this is when no cause can be found).

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

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

    Answer

    All UK clinics that offer assisted conception techniques must offer couples counselling. This is because fertility problems, the tests involved with looking for a cause and treatment and its possible outcomes can be upsetting.

    Explanation

    Accepting fertility problems, going through treatment and dealing with fertility treatment, successful or not, can be very stressful. These things can all place strain on you and your relationship, and some couples find it hard to come to terms with things if, ultimately, their treatment is unsuccessful.

    By offering an independent counselling service, fertility clinics in the UK can 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 consequences of having treatment and give you support throughout. 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.

  • Resources Resources

    Further information

    • Human Fertilisation and Embryology Authority (HFEA)
    • 020 7291 8200
      www.hfea.gov.uk
    • British Infertility Counselling Association
      www.bica.net

    Sources

    • Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Care Excellence (NICE), February 2013. www.nice.org.uk
    • Infertility treatments. PatientPlus. www.patient.co.uk/patientplus.asp, published 9 April 2013
    • Initial advice to people concerned about delays in conception. National Institute for Health and Care Excellence (NICE), February 2013. www.nice.org.uk
    • Fertility basics. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 1 June 2012
    • Female infertility. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 11 November 2010
    • Infertility. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2013
    • Gurunath S, Pandian Z, Anderson RA. Defining infertility – a systematic review of prevalence studies. Hum Reprod 2011; 17(5):575–88. doi:10.1093/humupd/dmr015
    • Understand fertility clinic success rates. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 8 March 2010
    • Lerchbaum E, Obermayer-Pietsch BM. Vitamin D and fertility – a systematic review. Eur J Endocrinol 2012; 166(5):765–78. doi:10.1530/EJE-11-0984
    • Showell MG, Brown J, Yazdani A, et al. Antioxidants for male subfertility. Cochrane Database of Systematic Reviews 2011, Issue 1. doi:10.1002/14651858.CD007411.pub2
    • Infertility. Medscape. www.emedicine.medscape.com, published 10 June 2013
    • What are nutrients? British Nutrition Foundation. www.nutrition.org.uk, published 4 January 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 7 July 2014
    • Polycystic ovarian syndrome. Medscape. www.emedicine.medscape.com, published 11 November 2013
    • Male reproductive organ anatomy. Medscape. www.emedicine.medscape.com, published 11 November 2013
    • Erectile dysfunction. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published January 2013
    • Assisted reproduction for people with fertility problems. National Institute for Health and Care Excellence (NICE), February 2013. www.nice.org.uk
    • IVF – what is in vitro fertilisation (IVF) and how does it work? Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 2 November 2011
    • Freezing and storing embryos. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 9 January 2013
    • Risks of fertility treatment. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 24 February 2014
    • What is intra-cytoplasmic sperm injection (ICSI) and how does it work? Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 7 January 2013
    • Multiple pregnancy: the management of twin and triplet pregnancies in the antenatal period. National Institute for Health and Care Excellence (NICE), September 2011. www.nice.org.uk
    • IVF – chance of success. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 28 August 2009
    • Sallam HN, Garcia-Velasco JA, Dias S, et al. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database of Systematic Reviews 2006, Issue 1. doi:10.1002/14651858.CD004635.pub2
    • Female reproductive organ anatomy. Medscape. www.emedicine.medscape.com, published 3 October 2013
    • Endometriosis. Medscape. www.emedicine.medscape.com, published 21 April 2014
    • Benefits of counselling and how to access it. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 9 May 2012
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