Infertility treatments
- Mr David Ogutu, Consultant Obstetrician and Gynaecologist
Infertility treatments can increase your chances of getting pregnant (conceiving). Around 8 in every 10 couples under the age of 40 conceive within a year. But for around 1 in 7 couples trying for a baby, it can take a while, so try not to worry if it doesn’t happen straightaway. If you haven’t managed to conceive after a year of trying, you should contact your GP to arrange fertility tests for you and your partner.
We also have information about male infertility and female infertility, including the diagnosis and causes of these.
Self-help for fertility
There are lots of things you can do to boost your fertility and help you conceive naturally. If you’re having unprotected vaginal sex to conceive, try to have sex regularly, every two or three days. If you use lubricants, be aware that some of these can harm sperm – ask a pharmacist which lubricants are best to use.
A healthy lifestyle may improve your chances of conceiving and having a healthy baby.
- If you smoke, it’s best to stop. Ask a pharmacist or your GP about the best way to give up smoking.
- If you regularly drink alcohol, try to cut down to no more than one or two units a couple of times a week or don’t drink at all.
- Try to keep to a healthy weight – if you’re overweight or underweight, this can affect your fertility.
Trying to get pregnant can be stressful. This may affect your sex drive or your relationship. And it can make getting pregnant even harder. Try to reduce your stress levels as much as possible. It may help to speak to a counsellor.
Try our BMI calculator and ask your doctor about your score and how it may affect your chances of getting pregnant.
When to seek help for fertility problems
Seeing a GP
If you’ve been trying for a baby for a year or more, it’s a good idea to see your GP. If you’re a woman over 35, speak to your GP earlier than this, after six months of trying. Your GP may do some initial investigations such as:
- a blood test to check your hormone levels to see if you’re ovulating (female infertility)
- a semen analysis test to check you’re producing enough healthy sperm (male infertility)
- where you live
- your age
- your test results
- local guidelines
- you’re a woman over 35
- initial test results have shown up something abnormal
- your infertility is thought to be linked to a specific cause
- the treatments they offer
- your eligibility for their treatment
- their location and opening hours
- waiting times
- any age restrictions on patients
- any weight (or body mass index) restrictions before you can start treatment
- success rates
- counselling services
Referral to a specialist
You’ll need to see a specialist fertility doctor for further tests and treatments for infertility. When you can be referred to specialist fertility services on the NHS may depend on:
You’ll usually be referred after you’ve been trying to conceive for two years with regular sex and no contraception. You may be referred sooner if:
If you’re eligible for NHS-funded treatment, you’ll be referred to a specialist fertility clinic. Most fertility clinics can start your treatment within 18 weeks of your referral. But waiting times vary and it could be months before your treatment starts in some areas of the UK. Even if you’re eligible for treatment on the NHS, you may still need to pay prescription charges for any fertility medicines you’re prescribed.
Getting private infertility treatment
If you choose to have private infertility treatment, you have to pay the costs yourself. The costs vary from one clinic to another. Ask your clinic for a personalised treatment plan that outlines all of the costs involved.
A specialist fertility clinic will offer you an assessment, followed by tests and treatments if these are appropriate for you. It’s important to choose a clinic that’s right for you, so take your time when making your decision. Ask each clinic about:
Fertility medicines
Your doctor may prescribe medicines to improve your fertility and increase your chances of conceiving.
Medicines for female infertility
If you’re not ovulating (producing eggs) regularly or at all, you may be able to take medicines that stimulate your ovaries to make eggs. This is called ovulation induction.
- Your doctor is likely to suggest clomifene first. You can take this tablet for up to six months.
- If clomifene hasn’t worked for you, your doctor may recommend gonadotrophin injections – for example, menotrophin.
Common side-effects for these medicines include:p
It’s important to talk to your doctor about possible side-effects so you know what to look out for before you start treatment.
All medicines that stimulate your ovaries may increase your risk of a multiple pregnancy (having twins or more). Your doctor will keep a close watch on how your body responds to the medicines.
If you have a health condition that’s causing your fertility problems, your doctor may treat this to improve your fertility.
If you have polycystic ovary syndrome(PCOS), your doctor may prescribe a medicine called metformin. Metformin may help you ovulate. You may have metformin with clomifene or on its own.
Medicines for male infertility
If you have low levels of the hormone testosterone, this is called hypogonadism. It can affect your sperm production and sperm quality. Your doctor may suggest you try gonadotrophin injections. These trigger your body to make testosterone and produce sperm.
If you have retrograde ejaculation, your sperm are ejaculated backwards into your bladder instead of forwards through your urethra to the outside of your body. Medicines such as pseudoephedrine may help to stop this happening.
If you have trouble getting an erection, some medicines may help. These include:
- sildenafil (Viagra®)
- tadalafil (Cialis®)
- alprostadil
Always read the patient information leaflet that comes with your medicine and ask your pharmacist or GP for advice if you have any questions.
Surgery for infertility
Depending on what’s causing your infertility, you may need an operation to improve your fertility. If your doctor thinks this is an option for you, they’ll refer you to see a surgeon to discuss your options.
Surgery for female infertility
If you have polycystic ovary syndrome and clomifene hasn’t helped, ovarian drilling may improve your fertility. Your surgeon will make tiny holes in the surface of your ovary. This can stimulate your ovaries to release eggs.
If you have a small blockage or damage in one of your fallopian tubes, you may be able to have surgery to clear or treat it. But this operation can increase your risk of an ectopic pregnancy (when the embryo grows outside your uterus).You may also be recommended to have surgery to remove:
- a fibroid or a polyp in your womb or one of your fallopian tubes
- scar tissue in your womb, which may have been caused by an infection
- extra tissue from the lining of your womb that’s growing outside your womb – caused by endometriosis
Surgery for male infertility
If you have a blockage in the tubes that take sperm from your testicles to your penis, this can affect your fertility. You may be able to have an operation to remove the blockage and restore your fertility.
If you have varicoceles (swollen veins in your scrotum) and there’s no other reason for your infertility, your doctor may suggest surgery. But the National Institute for Health and Care Excellence (NICE) doesn’t recommend this as a treatment. Some research suggests that surgery may improve your chances of pregnancy, but there’s not enough evidence to show it increases the chance of having a baby naturally. Your doctor will discuss this with you.
Freezing eggs and sperm
You may decide that you’d like to preserve your fertility to give you the possible option of having a baby in the future. People do this for lots of reasons. Some treatments – for example, cancer treatments – can affect fertility. Or you may be getting older but aren’t yet at a point in your life where you’re ready to have a baby.
One option is to freeze your eggs or sperm. Your eggs or a sample of semen is collected, then frozen. These can then be thawed later on to be used in fertility treatment. But there’s no guarantee that they’ll survive this. Ask your doctor for more information and the risks involved.
Assisted conception
If other treatments haven’t worked or aren’t right for you, your doctor may recommend assisted conception. This means help to get pregnant using ways other than having sex. The main types of assisted conception are explained below. The right type for you will depend on why you’re finding it hard to get pregnant.
Intra-uterine insemination
Intra-uterine insemination (IUI) involves taking a sample of sperm (yours or a donor’s). The sperm is placed inside the womb close to the time of ovulation (when an ovary releases an egg).
IUI is useful if:
- sex is difficult
- you’re in a same-sex relationship
IUI may be combined with injections to stimulate the ovaries. This can cause several eggs to develop at the same time, which can lead to a multiple pregnancy.
In-vitro fertilisation
In-vitro fertilisation (IVF) involves taking medicines to stimulate your ovaries to produce several eggs at once. One or more of these eggs is collected and mixed with sperm in a laboratory. Hopefully this results in eggs being fertilised, usually after two or six days. One or more embryos (fertilised eggs) are then placed in the womb.
A doctor may suggest IVF if:
- you have blocked fallopian tubes
- other treatments such as fertility drugs haven’t worked
- you have a low sperm count or problems with the quality of your sperm
- you have unexplained infertility (a cause can’t be found)
Intracytoplasmic sperm injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is the injection of a single sperm directly into an egg in a laboratory. The resulting embryo is placed in the womb.
ICSI may be an option if you have:
- a very low sperm count
- abnormal sperm
- difficulty with erections or ejaculation
If you can’t produce a sample, sperm may be collected directly from your testicles or epididymis.
You can find out more about all types of assisted conception, including their success rates and risks, from the Human Fertilisation & Embryology Authority (HFEA) .
Complications of assisted conception
Some fertility treatments can increase your chances of a multiple pregnancy. There are strict restrictions on how many embryos can be transferred into the womb at one time. This is because multiple pregnancy increases the risk of health problems such as miscarriage, premature birth or high blood pressure.
Your body can over-react to the medicines used to stimulate your ovaries. This can cause ovarian hyperstimulation syndrome (OHSS). Around a third of women who have IVF will develop mild OHSS. If you get mild OHSS, you may have a bloated tummy and feel sick. Severe OHSS is far less common but can cause serious health problems.
Contact your fertility clinic straightaway if you:
- feel sick or vomit
- have severe tummy pain
- notice any swelling in your tummy
- have difficulty breathing
- have problems peeing
- suddenly put on a lot of weight
Your risk of having an ectopic pregnancy (when the embryo grows outside your uterus) may be higher if you have IVF or other assisted conception treatments.
During in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), your doctor will pass a needle through your vagina and into your ovary to collect eggs. A possible complication is an infection. You will be prescribed antibiotics during the egg collection procedure to reduce your chance of getting an infection. You may also get a small amount of bleeding after your eggs are collected.
Babies born by IVF may be born early. Some research suggests that fertility treatment may increase the risk of birth defects, but this research is still ongoing. It’s important to know that the risk of this happening is very low, and most babies conceived with IVF aren’t affected. It may be that any increased risk is related to the infertility problems in the parents, rather than the treatment itself.
Living with infertility
Having trouble getting pregnant can be stressful and may affect your relationship. There’s also some evidence that stress can affect how successful certain treatments are.
Your GP may suggest counselling (talking therapy) to discuss how you’re feeling. Counselling can also help you to discuss how you feel about using donated sperm, eggs or embryos. All UK fertility clinics must offer the chance to have counselling before, during and after infertility treatment.
It may help to speak to other people who understand what you’re going through. You can join a support group to meet with other couples in a similar situation or access online support through the charity Fertility Network UK.
This depends on what’s causing your fertility problems. Medicines may help if you’re struggling to produce eggs or sperm. Surgery may help a physical problem such as a blockage that’s stopping you releasing eggs or sperm.
For more information, see our sections on fertility medicines and surgery for infertility.
Infertility treatments include medicines, surgery and assisted conception. Assisted conception helps you to get pregnant without having sex. This can help you to conceive if you haven’t been successful or can’t conceive through having sex.
For more information, see our sections on fertility medicines, surgery for infertility, and assisted conception.
It depends on what’s causing your infertility. Medicines or surgery may help to treat some causes of female infertility. But these may not necessarily cure the infertility. Even so, assisted conception may help you to have a baby.
For more information, see our sections on fertility medicines, surgery for infertility, and assisted conception.
There are lots of different causes of female infertility. These range from problems producing eggs, to conditions that affect the ovaries, fallopian tubes or womb. But sometimes doctors can’t find any cause. This is called unexplained infertility.
It depends on why you’re infertile. You may be able to have treatment to improve your fertility. And assisted conception procedures may help your chances of getting pregnant. Ask your doctor to talk through your options with you.
For more information, see our sections on fertility medicines, surgery for infertility, and assisted conception.
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- Victoria Goldman, Freelance Health Editor
