Infertility treatments
Your health expert: Mr Luciano Nardo, Consultant in Obstetrics and Gynaecology, RCOG accredited subspecialist in Reproductive Medicine
Content editor review by Rachael Mayfield-Blake, March 2022
Next review due March 2025
Infertility treatments can increase your chances of getting pregnant (conceiving). While for some people who try for a baby it happens quickly, for others it can take a while so try not to worry if it doesn’t happen straightaway. But if you haven’t managed to conceive after a year or two of trying, it could be a sign of fertility problems and you may need some extra help.
We also have information about male infertility and female infertility, including the diagnosis and causes of these.
Self-help for fertility
There are some things you can do to boost your fertility to help you to conceive naturally.
- A healthy lifestyle may improve your chances of conceiving and having a healthy baby. If you smoke, it’s best to stop – your GP can help you with this.
- If you regularly drink alcohol, try to cut down, or don’t drink at all.
- Try to keep to a healthy weight because if you’re overweight or underweight, it can affect your fertility.
- Eat a balanced and varied diet to help you get all the nutrients your body needs. Women planning a pregnancy should take folic acid and vitamin D supplements, for example.
- If you’re having unprotected vaginal sex to conceive, have sex regularly, every two or three days to help make sure you’re having sex around the time of ovulation. This will maximise your chances of getting pregnant. If you use lubricants, be aware that some of these can harm sperm – ask a pharmacist which is best.
- Manage stress. Having trouble getting pregnant can be stressful. This may affect your sex drive or your relationship, meaning you have sex less often. Your GP may refer you for counselling (talking therapy) to discuss your thoughts and feelings.
When to seek help for fertility problems
Seeing a GP
If you’ve been trying for a baby for a year, it’s a good idea to see your GP. Or sooner than this if you’re a woman aged over 35.
Your GP will talk to you about making some changes to your lifestyle (see above), which you can try to boost your fertility. They may do some initial investigations, such as test for ovulation to check female infertility and do a semen analysis to check male infertility, for example.
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 vary between different regions of the UK. It’s usually only after you’ve been trying to conceive for at least a year with regular sex and no contraception, but this depends on your age, your tests results and local guidelines.
You may be referred sooner if you’re a woman older than 35, if initial test results have shown up something abnormal, or if your infertility is thought to be linked to a specific cause. Once you’ve got a referral, you may have to wait for treatment, and NHS waiting lists vary from area to area. 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
You can choose to have private infertility treatment, which means 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 that will be 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 over your decision. Check which services clinics offer, your eligibility for their treatment, and their location, opening hours and waiting times. Some clinics have age restrictions on patients and there may be a weight (or body mass index) restriction before you can start treatment. The success rates between clinics vary too.
Fertility medicines
Your doctor may prescribe medicines to improve your fertility and increase your chances of conceiving.
Medications for female infertility
If you aren’t 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, but if it’s going to work, it usually does within three months. If clomifene hasn’t worked for you, your specialist doctor may recommend gonadotrophin injections instead.
Common side-effects for these treatments include tummy bloating, sickness, and headaches. Clomifene can also cause hot flushes and some people have blurred vision or see spots or flashes. 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 more than one baby in one pregnancy, such as twins).
If you have a health condition that’s causing your fertility problems, your doctor may treat this to improve your fertility. For example, polycystic ovary syndrome (PCOS) can affect ovulation, and your doctor may prescribe a medicine called metformin. You may have metformin with clomifene, or on its own.
Medications for male infertility
If you have low levels of the hormone, testosterone, which is called hypogonadism, it can affect your sperm production and sperm quality. Your doctor may suggest you try gonadotrophin injections, which trigger your body to make testosterone and produce sperm.
If you have retrograde ejaculation, your sperm are ejaculated backwards into your bladder instead of through your urethra to the outside of your body. Medicines that help to close the opening to your bladder, such as pseudoephedrine, may help.
If you have trouble getting an erection, medicines such as sildenafil (Viagra®), tadalafil (Cialis®) or alprostadil may help.
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, a type of surgery called ovarian drilling may improve your fertility. Your surgeon will make tiny holes in the surface of your ovary. This can stimulate your ovaries to ovulate (release eggs). You can only have this surgery once.
- 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 it’s possible that your specialist may suggest IVF instead because this operation can increase your risk of an ectopic pregnancy.
- If you have a fibroid or a polyp in one of your fallopian tubes, it may block it, or fibroids and polyps may affect the inner layer of the womb. You may need surgery to remove them.
- If you have scar tissue in your womb, it can sometimes stop you having periods and getting pregnant. Surgery to remove this can restore your periods and increase your chance of getting pregnant.
- If you have endometriosis, tissue from the lining of your womb grows outside your womb, and this may affect your fertility. Your doctor may recommend you have an operation to remove or destroy this extra tissue.
Surgery for male infertility
- If you have a blockage in the tubes that take sperm from your testicles to your penis, it can affect your fertility. This can also happen if the tube at the back of each testicle (the epididymis) which stores sperm gets blocked. 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. Although the National Institute for Health and Care Excellence doesn’t recommend this as a treatment. But some research suggests that surgery may possibly improve your chances of pregnancy, although there’s not enough evidence to show it increases the chance of having a baby naturally. Your doctor will discuss this further 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 many reasons. For example, some treatments, such as cancer treatments, can affect fertility so you may be able to store eggs or sperm prior to having these. Or you may not be at a point in your life where you are ready to have a baby but are getting older.
One option is to freeze your eggs or sperm. Your eggs or a sample of semen is collected, then frozen. They can then be thawed later on to be used in fertility treatment, although 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 (assisted reproduction). Assisted conception means help to get pregnant using ways other than having sex. What type of assisted conception is an option for you will depend on the reasons why you’re finding it hard to get pregnant.
The main types of assisted conception are explained below.
Intra-uterine insemination (IUI)
IUI involves taking a sample of sperm (yours or a donor’s) and placing it inside the womb close to the time of ovulation (releases an egg). It’s useful if you have problems with ejaculation, or if there’s any other reason why it is difficult for you to have sex. It can also be used if 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 (IVF)
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 or if other treatments, such as fertility drugs, haven’t worked.
IVF may be an option if you have a low sperm count, or problems with the quality of your sperm. And it can also help if you’re using surrogacy to have a baby.
IVF is also recommended for couples with unexplained infertility (if a cause can’t be found).
Intracytoplasmic sperm injection (ICSI)
In ICSI, a single sperm is injected 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 or difficulty with erections or ejaculation. If you can’t produce a sample, sperm may be collected directly from your testicles or epididymis.
Gamete intrafallopian transfer (GIFT)
GIFT involves an egg and sperm being transferred into the fallopian tubes before the egg fertilises.
You can find out more about all types of assisted conception, including their success rates and risks, from the Human Fertilisation and Embryology Authority (HFEA).
Complications of assisted conception
Some fertility treatments can make a multiple pregnancy more likely 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 for you and your babies. You may be more likely to have a miscarriage, premature birth or high blood pressure, for example.
Your body can over-react to the medicines used to stimulate your ovaries, which 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 chest pain
- 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 IVF or ICSI, your doctor will pass a needle through your vagina and into your ovary to collect eggs. A possible complication is an infection. If this happens, your doctor may give you antibiotics. 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 be associated with a higher 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 the majority of babies conceived this way are not 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 your thoughts and feelings. 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 (talking therapies) 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.
This depends on what’s causing your fertility problems. There are medicines that may help if you’re struggling to produce eggs or sperm. And if there’s a physical problem, for example there’s a blockage that’s preventing you releasing eggs or sperm, you may be able to have an operation to clear it.
See our sections: Fertility medicines for infertility and Surgery for infertility above for more information.
There are a range of treatments from medicines and surgery to help improve your fertility, to assisted conception. Assisted conception means help to conceive (get pregnant) using ways other than having sex. This can help you conceive if you haven’t been successful, or can’t conceive through having sex.
See our sections: Fertility medicines for infertility, Surgery for infertility and Assisted conception above for more information.
It really depends on what the cause of your infertility is. Some causes of male infertility are curable, for example. But for most conditions, treatment may help but not necessarily cure infertility. Even so, assisted conception may help you to have a baby.
See our sections: Fertility medicines for infertility, Surgery for infertility and Assisted conception above for more information.
There are many 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 might 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.
See our sections: Fertility medicines for infertility, Surgery for infertility and Assisted conception above for more information.
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, March 2022
Expert reviewer Mr Luciano Nardo, Consultant in Obstetrics and Gynaecology, RCOG accredited subspecialist in Reproductive Medicine
Next review due March 2025
