Fertility treatment options

Infertility treatment can be a long and anxious journey, but success rates are getting better and procedures are safer than ever.  

There are three main types of fertility treatment:

• Medication that can help you ovulate, such as clomifene. 
• Surgery on the reproductive system, to treat issues such as endometriosis, or tube blockages. 
• Assisted conception to help the sperm and the egg combine and implant in the womb, including using donor sperm or eggs if needed.  

The treatment you have will depend on the reason for your infertility. Common reasons for infertility and the likely treatments are:

• Ovulation problems: treated with drugs and/or assisted conception
• Endometriosis: treated with surgery, drugs and/or assisted conception
• Polycystic ovary syndrome (PCOS): treated with drugs and/or assisted conception
• Fallopian tube problems: treated with surgery and/or assisted conception
• Unexplained fertility problems: treated with drugs and/or assisted conception
• Poor sperm quality: treated with donor sperm and/or assisted conception
• Damage to the testicles (where the sperm is stored): treated with surgery and/or assisted conception
• Ejaculation problems: treated with surgery and/or assisted conception
• Age: treated with donor sperm and/or assisted conception.

If you have a high BMI, it's likely you'll also be advised to lose weight, so you're closer to a healthy weight for conception and pregnancy. Other lifestyle changes that improve infertility are:

• stopping smoking
• cutting out alcohol and recreational drugs.

Diagnosing infertility

Make an appointment with your GP if you haven’t conceived after a year of regular sex (every 2 to 3 days).

 You should see your GP sooner if:

• You are over 36, as fertility decreases with age.
• You have a known fertility issue, such as endometriosis or PCOS.
• Your partner has a known fertility issue, such as low sperm count.
• You are concerned you might have a medical problem that may be stopping you getting pregnant.
• You have irregular periods, or no periods.

Your GP will ask you about your lifestyle, general health and medical history. They may ask you questions about:

• previous pregnancies, or children you have
• previous miscarriages
• how long you have been trying to conceive
• how often you have sex
• your medical history and any symptoms
• any medication you take
• your lifestyle and habits.

They may advise you about the things you can do to improve your chances of getting pregnant, and how your partner can improve their fertility. 

The doctor may also feel (palpate) your pelvis and abdomen for abnormalities, such as cysts on your reproductive organs, or scars behind your uterus. 

Looking for blockages

Before you are offered in vitro fertilisation (IVF) or any other treatment, you will be checked for blockages, scarring or growths in the fallopian tubes and womb. 

This is in case anything is stopping eggs moving through to the womb. The check is done using a hysterosalpingogram (HSG) test which is a special type of x-ray.

The test happens in hospital and takes around half an hour. Doctors put a dye through the cervix (neck of your womb) and take x-rays. 

These show the shape of the uterus and whether the fallopian tubes are blocked. 

An HSG is done between days 7 and 10 of your cycle (after your period and before ovulation). This is because the HSG can’t be done if there is any chance you may be pregnant, as it could harm your baby.

If your periods are irregular, or don't tend to come at all, you will be asked to use contraception or avoid sex in the lead-up to the x-ray to be safe.

Drugs to help with ovulation

Ovulation (releasing eggs) is the first step of the monthly reproductive cycle. If it doesn’t happen, or if it happens very irregularly, it is very hard to conceive with regular sex alone. 

Problems with ovulation are the most common cause of infertility.  Certain drugs help to bring on ovulation in women and birthing people who don’t ovulate often, or at all.

• Clomifene tablets encourage the monthly release of an egg (ovulation). A commonly used brand of this is Clomid.
• Tamoxifen is a drug that’s similar to clomifene.
• Metformin is not a fertility drug, but it may help people with PCOS ovulate because it treats insulin resistance, which in turn may regulate hormones.
• Gonadotrophins are injected and can help stimulate ovulation. They may also improve fertility in men.
• Gonadotrophin-releasing hormone and dopamine agonists are other types of medication sometimes prescribed to encourage ovulation.

Drugs to help with ovulation are not prescribed if you have unexplained infertility. This is because they have not been found to increase your chances of getting pregnant.

Surgery to treat infertility 

Surgery is used to treat blockages or scarring on any of the organs in the reproductive system so that your eggs can make their way to your womb more easily. 

Fallopian tube surgery

If your fallopian tubes have been shown to be blocked or scarred, you may need surgery to remove the blockage, to allow eggs to go through.

Surgery for endometriosis, fibroids and PCOS

Laparoscopic (keyhole) surgery can be used for people who have endometriosis, to destroy or remove endometrial cysts.

It may also be used to remove fibroids, which are benign growths in the womb.

If you have PCOS, a minor surgical procedure called laparoscopic ovarian drilling can be used if ovulation drugs haven’t worked for you.

This sounds extreme but in reality it means using either heat or a laser to remove tissue on your ovaries that produce too much testosterone. This extra testosterone can stop you getting pregnant.

Assisted conception 

Assisted conception is the use of medical techniques to help with the process of becoming pregnant.

IVF is the most widely known, but there are others such as intrauterine insemination (IUI). 

In vitro fertilisation (IVF)

For IVF, you take medicine to encourage your ovaries to produce more eggs than normal. The eggs are taken out and fertilised with the sperm in a lab. 

This is usually done by mixing them in a dish. If low sperm count or low-quality sperm may be the reason for infertility, a single sperm might be injected directly into the egg instead.

This is a process called intracytoplasmic sperm injection (ICSI) . It improves the chance of conception because the sperm does not need to be able to penetrate the egg by itself. 

Fertilised eggs are placed in the womb in the hope that they will grow and develop.

Find out more about IVF, including whether you might be offered it on the NHS.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is where high-quality sperm are separated from sperm that’s sluggish. The high-quality sperm is then placed directly into the womb to meet the egg.

Although it sounds like a treatment for a low sperm count or poor quality sperm, research does not actually show that it increases the likelihood of pregnancy for people with this issue. 

It’s unlikely it will be offered on the NHS for this reason alone. 

You may however be offered IUI free of charge on the NHS if:

• You cannot have vaginal sex – perhaps because of a physical disability or a psychosexual problem.
• You have a condition that means you need help to conceive, for example, if one of you has HIV and it's not safe to have unprotected sex.
• You're in a same-sex relationship and haven't got pregnant after up to six cycles of IUI using donor sperm from a licensed fertility unit.

The waiting list for IUI treatment can be very long in some places. The criteria you have to meet to be eligible for IUI can also vary. 

Check with your GP or local CCG to find out what the rules are where you live.

Egg and sperm donation

If you have an infertility problem with eggs or sperm, you may be able to receive eggs or sperm from a donor to help you conceive. Treatment with donor eggs is usually carried out using IVF.

Anyone who registered to donate eggs or sperm after April 1 2005 has to provide information about their identity.

This is because a child born as a result of donated eggs or sperm is legally entitled to find out the identity of the donor when they become an adult at age 18. 

More support

Get more information about fertility treatment options on the Human Fertilisation and Embryology Authority (HFEA) website.

Fertility Network UK has support and forums for anyone affected by infertility.

The IVF Network offers support throughout your IVF journey.