Fertility treatment options

Infertility treatment can be a long, anxious and emotional journey but success rates are improving and procedures are safer than ever. The treatment you have is likely to depend on the reason for your infertility.

There are three main types of fertility treatment:

• Drugs to help with ovulation, such as clomifene (Clomid).
• Surgery to treat abnormalities in the reproductive system, such as endometriosis or tubal blockages.
• Assisted conception – ways to help the sperm and the egg come together and implant in the womb, including using donor sperm or eggs if necessary.

If you have a high BMI weight loss is also likely to be recommended  to bring weight down closer to a healthy weight for conception and pregnancy. Other lifestyle changes that could improve infertility are:

• cutting down on caffeine if you have more than 200mg daily
• stopping smoking if you smoke
• cutting down or quitting alcohol drinking
• quitting recreational/illicit drugs.

The common reasons for infertility are:

• Unexplained infertility: treated with drugs and/or assisted conception
• Ovulation problems: treated with drugs and/or assisted conception
• Endometriosis: treated with surgery, drugs and/or assisted conception
• Poor egg quality: treated with drugs and/or assisted conception
• Polycystic ovarian 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 assisted conception
• Age: treated with donor eggs and/or assisted conception

Diagnosing infertility

Infertility is often diagnosed when a couple fails to get pregnant after trying.

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 (fertility deceases with age)
• you have a known fertility issue, such as endometriosis or polycystic ovary syndrome (PCOS)
• your partner has a known fertility issue, such as low sperm count
• you are concerned you or your partner may have a medical problem that may be stopping you getting pregnant
• you have irregular or no periods.

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

• any previous pregnancies or children you may have
• how long you have been trying to conceive
• how often you have sex
• how long it has been since you stopped using contraception
• if you take any medication
• your lifestyle and habits.

They may also 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) areas in your pelvis and abdomen for abnormalities, such as cysts on your reproductive organs or scars behind your uterus.

HSG - the hysterosalpingogram

Before IVF or any other treatment, you will be checked for blockages, scarring or growths in the fallopian tubes and womb in case this is preventing eggs from moving through to the womb. This is done using a hysterosalpingogram (HSG) test,, which can be done by x-ray or ultrasound.

This is a special kind of x-ray used to evaluate female fertility. It happens in hospital and the test takes no longer than a half hour. Doctors put a dye through the cervix and take x-rays. These x-rays show the shape of the uterus and whether the fallopian tubes are blocked. Some women find this very painful but others only have mild discomfort.

An HSG is normally 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 possibility you may be pregnant as it is dangerous for the baby. If you period is irregular or doesn’t come at all you will be asked to use contraception or avoid sex in the lead up to it instead.

Drugs to help with ovulation

Ovulation (releasing eggs) is the first step of the monthly reproductive cycle and if it doesn’t happen or if it happens very irregularly it is hard or impossible to conceive with regular sex alone. Problems with ovulation are the most common cause of infertility. The following drugs may help to bring on ovulation in women who don’t ovulate regularly or at all.

• Clomifene – tablets that encourage the monthly release of an egg (ovulation). A commonly used brand of this is Clomid.
• Letrozoke is an alternative to clomifene and also provides a good chance of ovulation
• Metformin – this is not a fertility drug but it may help women with polycystic ovary syndrome (PCOS) ovulate as it treats insulin resistance, which in turn may regulate hormones
• Gonadotrophins – these are injected and can help stimulate ovulation in women, and may also improve fertility in men.

Drugs to help with ovulation aren’t recommended for women with unexplained infertility because it hasn't been found to increase their chances of getting pregnant.

Surgery to treat infertility

Surgery is used to treat physical blockages or scarring on any of the organs involved in the reproductive system. This is because they might be blocking the egg from its journey to the womb.

Fallopian tube surgery

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

Possible complications if you conceive with damaged tubes include an ectopic pregnancy, when the fertilised egg implants in the fallopian tubes.

Surgery for endometriosis, fibroids and PCOS

Laparoscopic surgery is often used for women who have endometriosis to destroy or remove endometrial cysts.

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

In women with PCOS, a minor surgical procedure called laparoscopic ovarian drilling can be used if ovulation drugs haven’t worked. This sounds extreme but in reality it means using either heat or a laser on the ovary.

Assisted conception

Assisted conception is the use of medical techniques to help the process of becoming pregnant. In vitro fertilisation (IVF) is the most widely known but there are variations such as Intrauterine insemination (IUI) and Intracytoplasmic sperm injection (ICSI) as well as using donor eggs or sperm.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a type of fertility treatment in which high quality sperm are separated from sperm that’s sluggish or non-moving. This sperm is then placed directly into the womb to meet the egg.

Although it sounds like it is a treatment for a low sperm count or poor‑quality sperm research evidence does not actually show that it increases the likelihood of pregnancies for couples with this issue, so 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're unable to have vaginal sex – for example, because of a physical disability or psychosexual problem
• you have a condition that means you need specific 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 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.

In vitro fertilisation (IVF)

In IVF, the ovaries are stimulated using drugs so that they produce more eggs than normal. Then the eggs are extracted and fertilised with the sperm in a laboratory by mixing them together in a dish.

The resulting fertilised eggs are called embryos, which are then returned to womb to grow and develop.

Read more about IVF.

Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is a treatment for couples where the man has low sperm count of low quality sperm. It is part of an overall IVF treatment but the sperm is injected directly into the egg instead of simply mixing them in a dish.

This improves the chance of conception because the sperm does not need to be able to penetrate the egg as this part is done with the injection. From a treatment point of view, it is identical for the couple to standard IVF, because the only difference is the laboratory process to fertilise the egg.

Egg and sperm donation

If you or your partner has 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 registers to donate eggs or sperm can no longer remain anonymous and 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).