Infertility - Treatment 

Treating infertility 

The treatment you are offered will depend on what is causing your fertility problems and what is available from your local clinical commissioning group (CCG).

Eligibility for treatment

Fertility treatment funded by the NHS varies across the UK. In some areas, waiting lists for treatment can be very long.

The criteria that you must meet to be eligible for treatment can also vary. Your GP will be able to advise about your eligibility for treatment.

If your GP refers you to a specialist for further tests, the NHS will pay for this. All patients have the right to be referred to an NHS clinic for the initial investigation.

Going private

If you have an infertility problem, you may wish to consider private treatment. This can be expensive and there is no guarantee of success.

It is important to choose a private clinic carefully.

You should find out:

  • which clinics are available
  • which treatments are offered
  • the success rates of treatments
  • the length of the waiting list
  • the costs

Ask for a personalised, fully costed treatment plan that explains exactly what is included, such as fees, scans and any necessary medication.

If you decide to go private, you can ask your GP for advice, and make sure you choose a clinic licensed by the Human Fertilisation and Embryology Authority (HFEA). The HFEA is a government organisation that regulates and inspects all UK clinics that provide fertility treatment, including the storage of eggs, sperm or embryos.

Treatment options

There are three main types of fertility treatment:

  • medicines to assist fertility
  • surgical procedures
  • assisted conception

Medicines to assist fertility

Medicines often used to assist fertility are listed below. These are usually prescribed for women, although in some cases they may also be prescribed for men.

  • Clomifene helps to encourage ovulation (the monthly release of an egg) in women who do not ovulate regularly or who cannot ovulate at all.
  • Tamoxifen is an alternative to clomifene that may be offered to women with ovulation problems.
  • Metformin is particularly beneficial for women with polycystic ovary syndrome (PCOS).
  • Gonadotrophins can help stimulate ovulation in women, and may also improve fertility in men.
  • Gonadotrophin-releasing hormone and dopamine agonists are other types of medication prescribed to encourage ovulation in women.

However, medication that stimulates the ovaries should not be given to women with unexplained infertility, as it is not thought to be an effective treatment in these circumstances.

Surgical procedures

Surgical procedures that may be used to investigate fertility problems and assist with fertility are listed below.

Fallopian tube surgery

If your fallopian tubes have become blocked or scarred, perhaps as a result of pelvic inflammatory disease (PID), you may need surgery to repair the tubes. Surgery can be used to break up the scar tissue in your fallopian tubes, making it easier for eggs to pass along them.

The success of surgery will depend on how damaged your fallopian tubes are. One study found that 69% of women with the least damaged tubes had a live birth after surgery. Other estimates for live births in women following surgery are 20–50%.

Possible complications from tubal surgery include an ectopic pregnancy (when the fertilised egg implants outside of your womb). Between 8% and 23% of women may experience an ectopic pregnancy after having surgery on their fallopian tubes.

Laparoscopic surgery is often used for women who have endometriosis (when parts of the womb lining start growing outside of the womb), to destroy or remove cysts (fluid-filled sacs). It may also be used to remove submucosal fibroids (small growths in the womb).

In women with PCOS, laparoscopic ovarian drilling can be used if ovulation medication has not worked. This involves using either heat or a laser to destroy part of the ovary.

Read more information about a laparoscopy.

Correction of an epididymal blockage and surgical extraction of sperm

The epididymis is a coil-like structure in the testicles that helps to store and transport sperm. Sometimes the epididymis becomes blocked, preventing sperm from being ejaculated normally. If this is causing infertility, surgery to correct the blockage can be performed.

Surgical extraction of sperm may be an option for men with:

  • an obstruction that prevents the release of sperm, such as an injury or infection
  • a congenital absence of the vas deferens (men born without the tube that drains the sperm from the testicle)
  • a vasectomy or a failed vasectomy reversal

Both procedures only take a few hours and are carried out as outpatient procedures under local anaesthetic. You will be advised on the same day about the quality of the material collected and if there are any sperm present.

Any material with sperm will be frozen and placed in storage for use at a later stage. If surgical retrieval of sperm is successful, enough sperm is usually obtained for several cycles of treatment (if required).

Assisted conception

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) involves sperm being placed into the womb through a fine plastic tube. Sperm is collected and washed in a fluid. The best quality specimens (the fastest moving) are selected.

The sperm are passed through a tube that enters the cervix and extends into the womb. This procedure is performed to coincide with ovulation, to increase the chance of conception. The woman may also be given a low dose of ovary stimulating hormones to increase the likelihood of conception.

Some women may experience temporary cramps, similar to period cramps, after or during IUI, but other than that, the procedure should be painless.

Availability and success

The National Institute for Health and Care Excellence (NICE) recommends that you should be offered up to six cycles of IUI if:

  • you are unable (or would find it very difficult) to have vaginal intercourse – for example, due to a physical disability
  • you have a condition (such as a viral infection that can be sexually transmitted) that means you need specific help to conceive
  • you are in a same-sex relationship 

The availability of this fertility treatment on the NHS varies throughout the UK. In some areas, the waiting list for treatment can be very long. The criteria that must be met to be eligible for treatment can also vary.

Provided that the man's sperm and the woman's tubes are healthy, the success rate for IUI in women under 35 is around 15% for each cycle of treatment.

In-vitro fertilisation (IVF)

During in-vitro fertilisation (IVF), the fertilisation of the egg occurs outside the body. The woman takes fertility medication to encourage her ovaries to produce more eggs than normal. Eggs are then removed from her ovaries and fertilised with sperm in a laboratory dish. A fertilised embryo is then put back inside the woman's body.

There are several different methods that can be used during IVF and intracytoplasmic sperm injection (ICSI). You can read more about these and other fertility procedures on the HFEA website.

Availability and success

NICE recommends that IVF should be offered to women up to 42 years of age, depending on their circumstances. Read more about the criteria for IVF treatment on the NHS.

However, the implementation of these guidelines currently depends on your local CCG. Priority is often given to couples who do not already have a child living with them.

The success rate for a cycle of IVF is about 32% for women under 35 years of age. The success rate decreases as the woman’s age increases.

Egg and sperm donation

If you or your partner has an infertility problem, 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 either eggs or sperm after 1 April 2005 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 upon reaching the age of 18.

 

Page last reviewed: 15/07/2014

Next review due: 15/07/2016

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Comments

The 13 comments posted are personal views. Any information they give has not been checked and may not be accurate.

charlene2014 said on 15 July 2014

I am a 25 year old single woman i have wanted a baby for years now but have never been in the position to have one
i have been thinking a lot over the past few years about sperm donation can single women have this treatment on the nhs? many thanks

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Dee81 said on 07 April 2014

I'm currently waiting for IVF treatment on the NHS due to blocked tubes. I was wondering if anyone has been through it and how long they waited?
I'm 32 years old and been trying to conceive for 3 years. We were referred by the GP on 16.10.13 then we had our first hospital appointment on 18.12.13, I then had a baseline scan completed on the 06.01.14 which showed I have a retroverted uterus which might be caused by endometriosis. I had a laparoscopy and a hysteroscopy operation on 22.01.14 which showed some adhesions to my tubes and no dye would pass through. My tubes are blocked and the only way to get pregnant is via IVF. I then had to wait till 12.03.14 for my next consultation, where we had a choice of 3 hospitals for IVF and had to number them 1-3. We made our decision and received a letter on 27.03.14 from my consultant at the NHS to our number 1 choice for IVF (Nuffield. Woking) asking for them to accept us for IVF treatment.
I was wondering if anyone knows how long it takes to get an answer and date from this point?
I hope all these timings are useful to people as I really stressed about the wait and not knowing :-)

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shareme93 said on 13 December 2013

hiya i am 20 years of age and myself and partner have been together for 6 years i have pcos and endometriosis and i have irregular periods and we would like to start a family of our own i am not sure what to do i am metformin for pcos and folic acid and pregnacare conception and also trying to lose weight but the probhlem not just trying to conceive this may sound silly but i dont fell likea woman and that is also one of a reason why i want to have a period what can i do to help the situaction please help
yours faithfully
shareme reese

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Preciouslove said on 15 August 2013

Fertility treatment is like postcode lottery at the moment, all depends if your lucky enough to live in an area that has the funding...where i am i can have 2 chances of IVF some places have 1 and some areas can have 3...Also treatmet has changed on NHS as you can only get NHS help if you havnt had kids before....Also they only allow you to have 1 child as they dont like multible birth anymore...Being woman we all would love to have kids and its very hard when we are the unlucky ones that cant have them naturally when others take it for granted :-( ....good luck to everyone, im going through the treatment at the moment myself.

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flopy said on 04 May 2012

iam 29 years lady ttc i have been to the doctors and they did al the blood test on me and i am fine so is my hubby's sperm count.the problem is the said i have PCOS i hv also done hsg test wr they put a dye in and they said my tubes are blocked. and they will refere me for IVF. my QSN is ,is that the only option, and how long is the nhs waiting list roughly. can falopian tube be unblocked.

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wellies said on 27 September 2011

I am 34 and my husband is 28, we have been trying for a baby for 2 years.
I have 2 children from a previous marriage, but he doesnt have any.
We have just been told he has abnormal sperm, does this mean we will never be able to have children?
Is there some kind of medication he can take or is the only way from a sperm donor?

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lillyloo said on 21 August 2011

i am 25 and my husband is 26 and we have been trying for a baby for 8 years and we have had a round of ivf with we paid for then we had one round of ivf on the nhs after that i had etopic pregnacy and had to get my right overy removed now we have been refered to the ferility clinic again but all they can do now is blood test but what we wait to no is that if we are entitled to iui on the nhs thanks x

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babecakes said on 01 August 2011

i am 35 i was told wen i was 25 that i had under active overies. i had ivf twice and it didnt work.. i would like to no if i could have doner embrios on the nhs as i would like to have a baby and its all i can think about. i am single and make a great mum ..

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Leanne1990 said on 23 June 2011

Im 21 & my partner is 24, we have just moved in together starting our own lives & wanting to have a family, but in the same boat as naive_jennie my partner has klinefleters syndrome, we have a friend who is willing to be a sperm donor, what price does this come to? or are there any forms of fertlilty treatment we are entitled to on the NHS??

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Leanne1990 said on 23 June 2011

Im 21 & my partner is 24, we have just moved in together starting our own lives & wanting to have a family, but in the same boat as naive_jennie my partner has klinefleters syndrome, we have a friend who is willing to be a sperm donor, what price does this come to? or are there any forms of fertlilty treatment we are entitled to on the NHS??

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hazy35 said on 10 June 2011

I am a 35 year old single woman i have wanted a baby for almost ten years now but have never been in the position to have one
scared i am leaving it to late i have been thinking a lot over the past few years about sperm donation can single women have this treatment on the nhs?

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amberlea1997 said on 26 May 2011

i have a 14 daughter from a previous relationship and i have been with my husband for 12 years now and never have we used birth control , we decided to start trying for a family when we got married 10 years ago and we have had no luck, we have been to see our doctor a few times about it and he has sent my husband for sperm tests a few times, they come back normal and because i already have a daughter and my monthly cycle has always been regular we have been told to just keep trying, its getting us both down now as its been 10 years with nothing and we are 34 now and there is no way we could afford thousands of pounds to have treatment privetly, we dont drink, have given up smoking and are both taking vitamins, we have even tried ovolation kits.....what else can we do?

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naive_jennie said on 14 March 2011

My partner is 43 and i am 21 on monday my partner has klinefelters syndrome and we desperately wish to start a family how many rounds of IUI are we entitled to on the NHS?

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