The treatment you are offered will depend on what is causing your fertility problems and what is available from your primary care trust (PCT).
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.
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.
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 are medicines containing gonadotrophins that can help to stimulate ovulation in women, and may also improve fertility in men.
- Gonadotrophin-releasing hormone and dopamine agonists. These 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 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 the surgery will depend on how damaged your fallopian tubes are. One study found 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 8–23% 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 which 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 biopsy of the testicular tissue after making a small incision in the scrotal skin
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 whether 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, usually enough sperm is obtained for several cycles of treatment (if required).
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 in order 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
IUI tends to be used when:
- Infertility cannot be explained.
- The man has a low sperm count, or decreased sperm mobility.
- The man is impotent (erectile dysfunction, an inability to maintain an erection), or premature ejaculation (when you ejaculate too quickly).
- The woman has mild endometriosis (where small pieces of the womb lining grow in other places).
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.
The National Institute for Health and Clinical Excellence (NICE) recommends that couples should be offered up to six cycles of IUI. However, what is available from your PCT, and the criteria that you need to meet, may vary.
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 information about these, and other, fertility procedures on the Human Fertilisation and Embryology Authority website.
Availability and success
NICE recommends that IVF should be offered to women up to 42 years old, depending on their circumstances. For more specific information on the criteria for IVF treatment on the NHS, see in-vitro fertilisation (IVF).
However, the implementation of these guidelines currently depends on your local PCT. 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.