Eligibility for treatment
Fertility treatment that is funded by the NHS varies across the UK. In some areas, the 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 you about your eligibility for treatment. If they refer 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 having private treatment. Private treatment can be very expensive and there is no guarantee that it will be successful.
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 medication that is needed.
If you decide to go private, you can ask your GP for advice, and you should make sure that you choose a clinic that is 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
The treatment that you are offered will depend on what is causing your fertility problems and what is available from your Health Board
Medicines to assist fertility
The medicines that are 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. You may have to take this if you have not responded to clomifene. It is particularly beneficial for women with polycystic ovary syndrome (PCOS) and a body mass index (BMI) of over 25.
- Gonadotrophins. Medicines containing gonadotrophins 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 that may be prescribed to encourage ovulation in women.
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 to have 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.
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 your internal organs, take samples, and perform small operations.
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.
Correction of an epididymal blockage
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.
Intrauterine insemination (IUI)
Intrauterine insemination (IUI) involves sperm being placed into the womb through a fine plastic tube. Sperm is collected from the man 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 in order to increase the likelihood of conception.
Some women may experience temporary cramps, that are similar to period cramps, after or during IUI, but other than that the procedure should be painless. For more information, see the Health A-Z topic about artificial insemination.
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 who are 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. The fertilised embryos are then put back inside the woman's body.
There are several different methods that can be used during IVF. For example, blastocyst transfer is sometimes used for women who are able to make good quality embryos that fail to implant in the womb. Assisted hatching, when the shell of the embryo is made thinner or a small hole is made in the shell, can be used to help the embryo hatch.
For more information about these and other fertility procedures, see the Health A-Z topic about IVF or the Human Fertilisation and Embryology Authority website.
Availability and success
NICE recommends that up to three cycles of IVF should be offered to couples if:
- the woman is between 23–39 years of age at the time of treatment, and
- the cause of the couple’s fertility problems has been identified, or
- the couple has had infertility problems for at least three years.
The NHS aims to provide at least one funded cycle of IVF treatment for couples who meet these criteria. It is hoped that in future more cycles will be available on the NHS, although this currently depends on your local primary care trust. Priority is given to couples who do not already have a child living with them.
The success rate for a cycle of IVF is 29% for women who are 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.
Ovulation is when an egg is released from a woman's ovaries.
The ovaries are two small, round organs in the female reproductive system that release an egg every month.
The tubes connecting the ovaries to the womb.
The womb (or uterus) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.
The neck of the womb in a woman.
An embryo is an unborn baby, from when the female egg is fertilised by the sperm, until the eighth week of pregnancy.
The testicles are part of the male reproductive system. They produce sperm and are located within the scrotum (a loose bag of skin) hanging down behind the penis.
Semen is the fluid released when a man ejaculates. It is made up of sperm produced in the testicles plus fluid from the prostate and seminal vesicle glands.
Ejaculation is the squirting out of semen from the penis during an orgasm (sexual climax).
IVF stands for in vitro fertilisation. An egg is surgically removed from a woman and fertilised by a sperm outside of the body.
A donor is a person (living or dead) who donates blood, an organ or other body parts to another person in need.