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Infertility treatments
Expert reviewer Dr Muhammad Akhtar, Consultant Gynaecologist
Next review due November 2022
There are different infertility treatments that can increase your chances of pregnancy. 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, your GP may arrange investigations to look for the reason.
For more information about the diagnosis and causes of infertility, see our male infertility and female infertility pages.
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.
- A healthy lifestyle may improve your chances of pregnancy and having a healthy baby. Quit smoking or at least cut down, and check your alcohol intake too. Both men and women shouldn’t regularly drink more than 14 units a week. And if you’re trying for a baby or pregnancy, 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. 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.
- 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. After two years, this increases to more than nine out of 10. If you’ve been trying for a year, it’s worth seeing your GP. Think about seeing your GP sooner than this if you’re a woman aged over 35. Your GP will be able to talk you through the lifestyle changes mentioned in the section above, which you can try to boost your fertility. They should do some initial investigations, such as testing for ovulation in women and a semen analysis in men. See our female infertility and male infertility pages for more information.
Referral to a specialist
For further tests and treatments for infertility, you’ll need to see a specialist fertility doctor. 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 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 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.
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Looking for prompt access to quality care?Fertility drugs
Fertility drugs for women
Your doctor may be able to prescribe 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. 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 abdominal bloating, sickness, and headaches. Clomifene also often causes hot flushes. With clomifene, some people have blurred vision or see spots or flashes. Tell your doctor if you have this side-effect. It’s important to discuss all possible side-effects with your doctor before you start any treatment.
Polycystic ovary syndrome (PCOS) can affect ovulation. If this is causing your fertility problems, your doctor may prescribe metformin tablets. You may have metformin with clomifene or on its own.
All medicines that stimulate your ovaries are associated with a higher risk of multiple pregnancy.
Fertility drugs for men
Low testosterone levels in men (hypogonadism) can affect sperm production and sperm quality. Your doctor may suggest you try gonadotrophin injections. These increase your testosterone levels.
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.
Medicines such as sildenafil (Viagra®), tadalafil (Cialis®) or alprostadil 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.
Surgery for infertility in women
If you have polycystic ovary syndrome and clomifene hasn’t helped, a type of surgery called ovarian drilling may help. Your surgeon will make tiny holes in the surface of your ovary. This can stimulate your ovaries to ovulate (release eggs). This surgery can only be done once.
Some women with a small blockage in one of their fallopian tubes may be able to have surgery to clear it. Your specialist may suggest IVF instead because there can be increased risk of ectopic pregnancy afterwards.
Sometimes, scar tissue in your uterus can stop you having periods and getting pregnant. Surgery to remove this can restore periods and increase the chance of pregnancy.
If you have endometriosis, tissue from the lining of your uterus grows outside your womb. This may affect your fertility. Your doctor may recommend you have surgery to remove or destroy this extra tissue.
Surgery for infertility in men
Men with fertility problems may have a blockage in the tubes that take sperm from the testicles to the penis, or in the tube at the back of each testicle (the epididymis) which stores sperm. 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, your doctor may suggest surgery. This may improve quality of your sperm, but there’s not enough evidence that it will increase your chance of having a baby naturally. There is a small amount of evidence that it may make pregnancy more likely after assisted conception treatments. Your doctor will discuss this further with you.
Assisted conception
If other treatments don’t help, or aren’t right for you, your doctor may recommend assisted conception (assisted reproduction). These procedures control the way your sperm and egg are brought together so that you’re more likely to become pregnant.
The three main types of assisted conception are explained below. 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 womb close to the time of ovulation. It’s useful for men who have ejaculation problems or if there is any other reason why it is difficult for you to have sex.
IUI may be combined with injections to stimulate the woman’s ovaries. This can 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 collecting one or more of the woman’s eggs and mixing them with sperm in a laboratory. Hopefully this results in eggs being fertilised, usually after two or three days. One or more embryos (fertilised eggs) are then placed in the woman’s womb. Before the eggs are collected, the woman may take medicines to stimulate her ovaries to produce several eggs at once. This increases the chances of having one or more embryos to place back.
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 be recommended for men with ejaculation problems or mild problems with the quality of their sperm.
IVF is also recommended for couples with unexplained infertility (if a cause can’t be found).
Intracytoplasmic sperm injection (ICSI)
In ICSI, only a single sperm is needed to fertilise an egg. The sperm is injected directly into an egg in a laboratory. The resulting embryo is placed in the woman’s womb.
ICSI is used if a man has a very low sperm count, abnormal sperm or difficulty with erections or ejaculation. If the man can’t produce a sample, sperm may be collected directly from his testicles or epididymis.
Complications of assisted conception
Some fertility treatments can make you more likely to have a multiple pregnancy (twins or triplets). There are strict restrictions on how many embryos can be transferred into your 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.
Your body can over-react to the medicines used to stimulate your ovaries. This can cause ovarian hyperstimulation syndrome (OHSS). Up to one in three women having IVF will develop mild OHSS. If you have mild OHSS, you may have a bloated tummy and feel sick. Severe OHSS can cause serious health problems. This happens in up to two in every 100 IVF cycles (up to 2%). Contact your fertility clinic straightaway if you:
- feel sick or vomit
- have severe abdominal (tummy) pain
- notice any abdominal swelling
- have difficulty breathing
- have chest pain
- have problems passing urine
- suddenly put on a lot of weight
Your risk of having an ectopic pregnancy (when the fertilised egg 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 suggesting 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 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.
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’ll help you to explore your feelings and find ways to cope if you’re struggling. You can also talk through the different treatments and options available to you.
All UK fertility clinics must offer 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, speak to your doctor.
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What affects the success of assisted conception?
How well assisted conception works varies between couples. It’s important to talk over all the suitable treatment options with your doctor.
Women become less fertile with age. IVF is most successful in women under 35.
IVF is also more successful in women who’ve been pregnant before. The more unsuccessful cycles of IVF you have, the lower your chance of conceiving.
See our section above on boosting your fertility as many lifestyle factors for men and women are also relevant to IVF, such as smoking, alcohol and weight. Women are also advised to cut down on caffeine.
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 a 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.
Your doctor may suggest 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 womb. Before you’re offered IVF on the NHS, you’ll need to have been trying to get pregnant for at least two years. There may also be other criteria, which differ depending on which part of the country you live in. If you’re not able to have IVF on the NHS, you may still choose to pay for IVF through a private clinic.
Ask your doctor about all of the treatment options available to you.
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Related information
Male infertility
If your partner hasn’t got pregnant after a year of regular sex and no contraception, this could be a sign of fertility problems.
Female infertility
Getting pregnant (conceiving) often takes a while.
Planning for pregnancy
By leading a healthy lifestyle and managing any long-term health problems, you and your partner can increase your chances of conceiving and having a healthy 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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Author information
Reviewed by Graham Pembrey, Bupa Health Content Team and Liz Woolf, Freelance Health Editor, November 2019
Expert reviewer Dr Muhammad Akhtar, Consultant Gynaecologist
Next review due November 2022
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