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Treatments for infertility
Expert reviewer, Raj Mathur, Consultant Gynaecologist
Next review due May 2020
There are many different treatments for infertility available that can increase your chances of getting pregnant (conceiving). So it’s worth seeking help if you’re having trouble conceiving. Some couples take two years or more to get pregnant naturally. But if you and your partner haven’t conceived after a year of regular sex and no contraception, it could be a sign of fertility problems.
For more information about the diagnosis and causes of infertility, see our topics Male infertility and Female infertility.
How can I boost my fertility?
There are some things you can do to help you to conceive naturally. If you see your GP because you’re having trouble getting pregnant, they’ll usually talk you through these first.
Sticking to a healthy lifestyle may improve your chances of getting pregnant and having a healthy baby. So, quit smoking or at least cut down, and check your alcohol intake too. Both men and women shouldn’t drink more than 14 units a week on a regular basis. And if you’re trying for a baby (as well as if you get pregnant), guidelines from the UK Chief Medical Officers are that it’s best for women not to drink alcohol at all. Maintaining a healthy weight may also help, because being either overweight or underweight can affect your fertility.
Eating a balanced and varied diet should help you get all the nutrients your body needs. But women who are planning a pregnancy should take folic acid and vitamin D supplements. Speak to your pharmacist about which supplements you can take safely before and during pregnancy. See our Related information for more about healthy eating when planning a pregnancy.
Having sex every two to three days will help to make sure you’re having sex around the time of ovulation (a woman’s most fertile time of the month). This will maximise your chances of conceiving. If you use lubricants, be aware that some of these can affect the quality of a man’s sperm and make them less likely to fertilise an egg.
When to seek help for fertility problems
Seeing a GP
More than eight out of 10 couples will conceive within one year of having regular, unprotected sex. If you’ve been trying for a year, it might be worth seeing your GP for advice. Think about seeing your GP sooner than this if you’re a woman aged over 35. Your GP will be able to talk through things you can try to boost your fertility. They may also be able to do some initial investigations, such as testing for ovulation in women and a semen analysis in men. See our topics Female infertility and Male infertility for more information.
Referral to a specialist
For further tests and treatments for infertility, you’ll need to be referred to a specialist fertility doctor. The criteria for when you can be referred to specialist fertility services on the NHS may vary between different regions. 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 over the age of 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’ll still need to pay the normal prescription charges for any fertility medicines you’re prescribed.
Getting private treatment
You can choose to have infertility treatments privately, which means you have to pay the costs yourself. The costs vary from one clinic to another. Before accepting any treatments privately, you should be given a personalised treatment plan outlining all of the costs involved.
At a specialist fertility clinic, you’ll be offered 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 and weight (or body mass index) restrictions on patients. Some will only treat you privately. The success rates between clinics vary too.
Fertility drugs
Women
Your doctor may be able to prescribe some medicines to improve your fertility and increase your chances of getting pregnant.
Women who aren’t ovulating regularly or at all, may be able to take medicines that stimulate their ovaries to make eggs. This is called ovulation induction. Clomifene citrate is often the first medicine that doctors recommend. You can use clomifene for up to six months, but if the medicine is going to work, this usually happens within around three months. Clomifene can cause hot flushes, mood swings, depression and headaches. It’s important to discuss all of the possible side-effects with your doctor before you start any treatment.
If clomifene hasn’t worked for you, your doctor may recommend gonadotrophin injections instead. These also trigger ovulation. There are also other medicines (for example, tamoxifen) which stimulate your ovaries. If you have polycystic ovary syndrome, which can affect ovulation, your doctor may prescribe a medicine called metformin. You may take metformin with clomifene or on its own.
Medicines that stimulate your ovaries (such as the ones mentioned above) are associated with a higher risk of multiple pregnancy.
Men
Low testosterone levels in men (called hypogonadism) can affect sperm production and sperm quality. If you have this condition, your doctor may suggest you try gonadotrophin injections. These work by triggering your body to make testosterone.
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 close the opening to your bladder, such as pseudoephedrine, may help.
Medicines such as sildenafil (Viagra®) may be helpful if you have trouble getting an erection.
Surgery for infertility
Depending on what’s causing your infertility, your doctor may recommend surgery. If so, you will be referred to a surgeon to discuss your options.
Women
For women who have polycystic ovary syndrome and have already tried clomifene, a type of surgery called laparoscopic ovarian drilling may help. This keyhole surgery technique can stimulate your ovaries to ovulate (release eggs). During surgery, your surgeon will make tiny holes in the surface of your ovary.
Women who have a small blockage in one of their fallopian tubes may be able to have surgery to clear it. Sometimes, scar tissue in your uterus can stop you having periods and getting pregnant. If this is the case, the tissue needs to be removed.
If you have endometriosis, tissue from the lining of your uterus grows in other places in your body. This may affect your fertility. Your doctor may recommend you have surgery to remove or destroy this extra tissue.
Men
Surgery can also help some men with fertility problems. You may have a blockage in the tubes that take sperm from your testicles to your penis or in your epididymis, which stores sperm. If this is what’s causing your problems, 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 no other reason for your infertility has been found, your doctor may suggest surgery. Surgery for varicoceles is thought to improve quality of your sperm, but there’s no evidence that it will increase your chance of having a baby. If this treatment is an option, your doctor will discuss this further with you.
Assisted conception
If other treatments don’t work, or aren’t appropriate for you, your doctor may recommend that you try assisted conception (assisted reproduction). These procedures control the way your sperm and egg are brought together so that you’re more likely to conceive.
The three main types of assisted conception are intra-uterine insemination (IUI), in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). You may be able to use your own sperm or eggs or donor sperm or eggs, depending on what’s causing your infertility.
Intra-uterine insemination (IUI)
IUI involves taking a sample of sperm and placing it inside the woman’s uterus close to the time of ovulation. It’s useful for men who have ejaculation problems or mild problems with the quality of their sperm.
IUI is usually combined with injections to stimulate the woman’s ovaries. This may cause several eggs to develop at the same time, which can lead to a multiple pregnancy (twins, triplets or more).
In vitro fertilisation (IVF)
IVF involves removing one or more of the woman’s eggs and mixing them with sperm in a laboratory. Once the eggs are fertilised (usually after two or three days), the embryos (fertilised eggs) are placed in the woman’s uterus. The woman may need to take medicines to stimulate her ovaries to produce several eggs at once. This is called superovulation and increases your chances of a pregnancy.
A doctor may suggest IVF for women who have blocked fallopian tubes or if other treatments, such as fertility drugs, haven’t worked. It may also be suggested if you have endometriosis. IVF may also be recommended if men have ejaculation problems or mild problems with the quality of their sperm. It’s also the recommended procedure if a cause can’t be found for your infertility (called unexplained infertility).
Intracytoplasmic sperm injection (ICSI)
In ICSI, a single sperm is injected directly into an egg in a laboratory. This means that only a very small number of sperm are needed to be sure of fertilising the egg. The resulting embryo is transferred to the woman’s uterus.
ICSI is used if a man has a very low sperm count or abnormal sperm. Sperm may be collected directly from his testicles or epididymis.
Complications of assisted conception
Having fertility treatment makes you more likely to have a multiple pregnancy (such as twins or triplets). This is why there are strict restrictions on how many embryos can be transferred into your uterus at one time. A multiple pregnancy increases the risk of health problems for you and your babies. You may be more likely to have a miscarriage, premature birth and high blood pressure.
Your body can over-react to the medicines used to stimulate your ovaries. This can cause ovarian hyperstimulation syndrome (OHSS). Around one in four women develop mild OHSS. If you have mild OHSS, you may have a bloated tummy and feel sick. In fewer than eight in every 100 IVF cycles, women develop severe OHSS, which can cause serious health problems. Contact your fertility clinic straightaway if you:
- feel sick or vomit
- have severe pain in your tummy
- notice any swelling in your tummy
- feel short of breath or faint
- suddenly put on a lot of weight
Your risk of having an ectopic pregnancy (when your baby grows outside your uterus) may be higher if you have IVF or other assisted conception treatments.
Removing the eggs for IVF or ICSI involves passing a needle through your vagina and into your ovary. This can cause an infection. If this happens, you’ll usually be given antibiotics.
Babies conceived by IVF may have a low birth weight or be born early in pregnancy. There has been some research to suggest that fertility treatment may be associated with a higher risk of birth defects. However, the risk of this happening is very low – 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 conceiving can be stressful and may affect your relationship. Your GP may suggest you have some counselling (talking therapy) to discuss your thoughts and feelings. Counselling can also help you to discuss the implications of treatment if you’re using donated sperm, eggs or embryos.
It may help if you 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 can reassure you that you’re not alone.
Sometimes it helps to talk to someone who doesn’t know you or your partner and isn’t involved in your treatment. Your clinic can give you details of a specialist fertility counsellor. They may be able to help you explore your feelings and find ways to cope if you’re struggling. You can also talk through the different treatments and which options are available to you.
All UK fertility clinics must offer you counselling (talking therapies). You’ll be offered the chance to have counselling before, during and after infertility treatment. If you have any questions or concerns about infertility treatment and counselling, speak to your doctor.
Frequently asked questions
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What affects the success of assisted conception?
Assisted conception procedures can be very successful. But how well they work varies between couples. So it’s important to discuss each procedure with your doctor to check whether it’s right for you.
A woman’s fertility reduces naturally as she gets older. So if you’re using your own eggs, your chance of success is higher the younger you are. IVF is most successful in women under 35.
IVF is more successful in women who have previously been pregnant, either naturally or with assisted conception. The more unsuccessful cycles of IVF you go through, the lower your chances of conceiving.
If you or your partner smokes, or drinks more than one unit of alcohol each day, you lower your chance of successful assisted conception. Women who drink caffeine can reduce their chances of getting pregnant from assisted conception procedures too.
Being very overweight (your BMI is higher than 30) or underweight (your BMI is under 19) may also reduce your chance of successful treatment.
The success rate of each procedure varies between fertility clinics too. So it’s important to take this into account when you’re choosing a clinic.
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Can unexplained infertility be treated?
Unexplained infertility is when you and your partner can’t conceive but doctors can’t find any specific cause. Around one in four couples who are having difficulty getting pregnant have unexplained infertility.
Assisted conception may help you get pregnant. These procedures control how your sperm and egg are brought together so that you’re more likely to conceive.
If you have unexplained infertility, your doctor may suggest that you try in vitro fertilisation (IVF). IVF involves removing one or more eggs and mixing them with sperm in a laboratory. Once the eggs are fertilised, the embryos (fertilised eggs) are placed in the woman’s uterus. Before you’re offered IVF, you’ll need to have been trying to get pregnant for at least two years.
Ask your doctor about all of the treatment options available to you.
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When is in vitro fertilisation (IVF) used?
IVF is a common assisted conception procedure that can help couples get pregnant. It involves mixing an egg and sperm together in a laboratory to create a fertilised egg. The egg is then transplanted into the woman’s uterus. IVF is offered to couples who have fertility problems for many different reasons.
IVF may be helpful for women with blocked, damaged or diseased fallopian tubes. Sometimes you can have surgery to remove a small blockage. But if your fallopian tubes are very damaged, you’ll generally be offered IVF instead.
You may be offered IVF if severe endometriosis is causing your infertility. If you have endometriosis, tissue from your uterine lining (endometrium) grows in other parts of your body, such as around your ovaries. Surgery may help to treat mild endometriosis by removing the extra tissue.
IVF may be offered if a man has ejaculation problems or mild problems with the quality of his sperm. IVF may be offered to couples with unexplained infertility (when your doctor can’t find a cause). But it probably won’t be offered to you until you’ve been trying to conceive for two years with regular sex and no contraception.
If you have any questions or concerns about IVF, talk to your doctor.
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Related information
Planning for pregnancy
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Other helpful websites
- Human Fertilisation and Embryology Authority (HFEA)
020 7291 8200
www.hfea.gov.uk - British Infertility Counselling Association
www.bica.net
- Human Fertilisation and Embryology Authority (HFEA)
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Sources
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- Fertility Problems. National Institute for Health and Care Excellence (NICE) Quality Standard QS73, October 2014. www.nice.org.uk
- Infertility treatments. PatientPlus. patient.info/patientplus, last checked April 2016
- Fertility problems: assessment and treatment. National Institute for Health and Care Excellence (NICE) Guidance CG 156, August 2016. www.nice.org.uk
- Reproductive endocrinology. Oxford Handbook of Endocrinology and Diabetes (online). 3rd ed. Oxford Medicine Online. oxfordmedicine.com, published March 2014
- Male infertility. Medscape. emedicine.medscape.com, updated June 2016
- UK Chief Medical Officers’ Low Risk Drinking Guidelines. Department of Health. August 2016. www.gov.uk
- NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed February 2017
- Polycystic ovary syndrome. PatientPlus. patient.info/patientplus, last checked June 2016
- Sexual health and contraception. Oxford Handbook of General Practice (online). 4th ed. Oxford Medicine Online. oxfordmedicine.com, published April 2014
- Mitra S, Nayak PK, Agrawal S. Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome. J Nat Sci, Biol Med 2015; 6(1):40–48.
- Infertility in women. BMJ Best Practice. bestpractice.bmj.com, last updated August 2016
- Multiple pregnancy. PatientPlus. patient.info/patientplus, last checked January 2016
- Funding and payment issues. NHS fertility treatment. Human Fertilisation & Embryology Authority. www.hfea.gov.uk, last updated January 2015
- Human Fertilisation & Embryology Authority Code of Practice. 8th edition. www.hfea.gov.uk, revised July 2016
- Funding and payment issues. Private fertility treatment. Human Fertilisation & Embryology Authority. www.hfea.gov.uk, last updated May 2012
- Choosing a fertility clinic. Human Fertilisation & Embryology Authority. www.hfea.gov.uk, last updated January 2015
- Unexplained infertility. The MSD Manuals. www.msdmanuals.com, last full review/revision August 2015
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Author information
Reviewed by Pippa Coulter, Bupa Health Content Team, May 2017
Expert reviewer, Raj Mathur, Consultant Gynaecologist
Next review due May 2020
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