Fertility treatment, funded by the NHS, currently varies across the UK. In some areas, waiting lists for treatment can be long. The criteria you must meet in order to receive treatment can also vary. Your GP will be able to advise you about your eligibility for treatment.Treatment options
There are three main types of fertility treatment:
- medicines to assist fertility,
- surgical procedures, and
- assisted conception.
Medicines to assist fertility
- Clomifene - this medicine helps to encourage ovulation (the monthly release of an egg) in women who do not ovulate regularly, or who cannot ovulate at all.
- Metformin - you may have to take this medicine if you have not responded to clomifene. It is particularly beneficial to women with polycystic ovary syndrome (PCOS) - see causes section.
- Gonadotrophins - medicines containing gonadotrophins can help to stimulate ovulation.
- Fallopian tube surgery - if your fallopian tubes have become blocked, or scarred, you may require surgery to help repair the tubes and make it easier for eggs to pass along them.
- Laparoscopic surgery - a laparoscopy involves having a small cut (incision) made in your abdomen. A thin, flexible microscope with a light on the end, called a laparoscope, is then passed through the incision. This type of procedure can be used to look at internal organs, take samples and perform small operations. It is often used for women who have endometriosis - see 'causes' section.
- Epididymal blockage - this type of surgery is used to repair the epididymis (a coil like structure in the testicles which helps to store and transport sperm). Sometimes, the epididymis becomes blocked which can stop sperm from being ejaculated normally.
Intrauterine insemination (IUI)
This procedure involves sperm being placed into the womb through a fine plastic tube. The tube is passed through the cervix and into the womb. Sperm is collected from the man and then washed in a fluid, after which the best quality specimens are selected. The sperm are then passed through the tube. This procedure is performed to coincide with ovulation and increase the chance of conception. You may also be given a low dose of ovary stimulating hormones to again increase to chance of conception.
IUI tends to be used when infertility cannot be explained, or when a man has a low sperm count, or decreased sperm mobility. It is also helpful for men who experience severe impotence. Provided that the man's sperm and the woman's tubes are healthy, the success rate for IUI is around 15% per cycle of treatment.
In vitro fertilisation (IVF)
In IVF, fertilisation happens outside the body. The female partner takes fertility medication to encourage the ovaries to produce more eggs than normal. Eggs are then removed from her ovaries and fertilised with sperm in a laboratory dish. The fertilised embryos are then put back inside the woman's body. The chance of multiple births is higher with IVF because more than one embryo is often put back into the woman's womb. In the UK, approximately 1% of all births are the result of IVF and donor insemination.
The NHS aims to provide at least one funded cycle of IVF treatment for couples who meet certain criteria. Couples are eligible for IVF treatment if:
- the woman is between 23-39 years of age at the time of treatment, and
- a cause for their fertility problems have been identified, or
- they have had infertility problems for at least a period of three years.
Your GP, or specialist, must have identified the cause of infertility. Priority is also given to couples who do not already have children.
Egg and sperm donation
If a couple have an infertility problem, they may be able to receive eggs, or sperm, from a donor to help them get pregnant. Fertility treatment with donor eggs is normally carried out using IVF.
Anyone who registered to donate either eggs, or sperm, after 1st April 2005, can no longer remain anonymous and has to provide information about their identity. This is because a child who is born as a result of eggs or sperm being donated is legally entitled to find out the identity of the donor, upon reaching the age of 18.
Blastocyst transfer treatment is sometimes used for women who are able to make good number of good quality embryos which fail to implant in the womb. In this procedure, embryos are allowed to develop for five to six days after fertilisation before they are put back in the womb.
In order to attach to the wall of the womb, an embryo first has to break out ('hatch') from the gel-like shell that it is contained in. This shell is called the zona pellucida and is harder in some embryos than others. Assisted hatching is when the embryologist helps the embryo to hatch by making the shell of the embryo thinner, or by making a small hole in its shell. This is however an unproven technique that is less commonly practised in recent years as it can also damage an otherwise healthy embryo.