Fertility treatments if you can't get pregnant

 

If you’ve been trying to get pregnant for less than a year, find out how to maximise your chances of getting pregnant. Eating a healthy diet, cutting down on alcohol, keeping to a healthy weight and getting exercise can all help.
If you’ve been trying to conceive for a year or more and you're not pregnant, it’s time to see your doctor. If you're a woman over 35, or if you think either of you may have a fertility problem, you might want to see your doctor after six months of trying to conceive. After some initial tests, your doctor may refer you to a fertility clinic.
The fertility treatment that's right for you depends on a range of factors. Staff at your fertility clinic can help you choose the treatment that will give you the best chance of conceiving.
 

Types of fertility treatment

 

No single fertility treatment is best for everyone. The right treatment for you will depend on your circumstances, including the cause of your fertility problems, the age of the female partner and your medical history. Broadly speaking, fertility treatments fall into three categories.
 
 
 
 
 
 
 
 
 

Fertility medicines

 

These are usually prescribed to women. Most of the common fertility medicines are intended to help with ovulation problems.
 

Surgical procedures

 

These include fallopian tube surgery, which can be helpful if the fallopian tubes, which lead from the ovaries to the uterus (womb), become blocked or scarred, preventing pregnancy.
 

Assisted conception

 

This can include intrauterine insemination (IUI), in which sperm is placed into the womb using a fine plastic tube. This can be helpful in cases of mild sperm problems. Assisted conception also includes IVF (in vitro fertilisation), in which sperm and eggs are mixed outside the body and put back into the womb. This can be helpful for a range of fertility problems, including more severe sperm problems and cases of unexplained infertility.
Access to fertility treatment
If you think you may be experiencing fertility problems, see your doctor first. Your doctor may do a range of tests to help identify any fertility problems.
 

 Treatments Explained

 

 

  

 

 

 Intrauterine insemination (IUI)

 

  • What is it? Intrauterine insemination, also known as artificial insemination, involves inserting sperm into the womb at the time of ovulation using a catheter (a very fine needle or probe). The woman may need to take fertility drugs to stimulate egg production. The sperm used may be her partner's or donated.
  • Used to treat: unexplained infertility, premature ejaculation, erection difficulties.
    In vitro fertilisation (IVF)

 

 

  • What is it? Eggs and sperm are collected and fertilised in the laboratory before the resulting embryo is transferred to the womb. The woman takes fertility drugs to stimulate the production of eggs. Once these are mature, they're collected by the doctor, using ultrasound to guide the collecting tube. The man produces a sperm sample, which is prepared before being put with the eggs in a Petri dish and left for a few days to see if fertilisation takes place. If a healthy embryo develops, this is placed in the womb using a catheter (a very fine needle or probe). Usually, no more than one or two are placed. Any remaining embryos suitable for freezing may be stored for future use. The sperm and/or eggs used may be the couple's own or donated.
  • Why it's used: to treat unexplained infertility, blocked fallopian tubes, endometriosis, PCOS.
 

Intracytoplasmic sperm injection (ICSI)

 

  • What is it? A single sperm is injected into the cytoplasm or centre of a single egg. This is then transferred to the womb using the same process as IVF.
  • Why it's used: to treat male factor infertility, such as low sperm count or poor motility (mobility or movement) or abnormally shaped sperm. ICSI may also be used following previous unsuccessful attempts at fertilisation using IVF and when sperm has been retrieved directly from the epididymis or the testicles (see 'Sperm extraction', below).
Gamete intrafallopian transfer (GIFT)
  • What is it? Gametes - eggs and sperm - are collected as for IVF. Instead of mixing sperm and eggs together in the laboratory, they're immediately transferred to one of the woman's fallopian tubes so fertilisation takes place inside the body. Only a few clinics offer this in the UK.
  • Why it's used: unexplained infertility.
 

Sperm extraction

 

  • What is it? A small operation that removes sperm from the epididymis (the tube where sperm mature in the man's body) or the testicles (where sperm cells are made) for use in ICSI or another treatment. There are several different methods of sperm extraction:
  • PESA (percutaneous epididymal sperm aspiration) involves guiding a small needle into the epididymis to draw out fluid containing sperm.
  • TESE (testicular sperm extraction) uses the same method to remove tissue from the testes.
  • MESA (microsurgical sperm aspiration) uses a small needle to extract mature sperm from the epididymis.
  • Why it's used: when a man can't produce sperm - for example, after a vasectomy or failed reversal.
 

Embryo freezing

 

  • What is it? IVF often creates more embryos than can be transferred in a single cycle, most clinics will freeze any remaining healthy embryos for use in future IVF treatments, with the patients' consent.
  • Why it's used: to avoid the need for further fresh IVF cycles involving invasive processes of egg stimulation and collection.
  • Success rate: normally only 60 per cent of embryos survive the freeze/thaw process and those that do survive have a lower rate of implantation and so a lower pregnancy rate than fresh embryos.
 

Other options

 

 
 

Clinics are increasingly using two newer techniques that may enhance the chances of pregnancy in some patients.

 

 
 

Blastocyst transfer

 

 
 

If during previous IVF attempts, the embryos fail to implant in the womb, the doctor may suggest a blastocyst transfer. The embryo is allowed to develop for five or six days before being transferred to the womb. Because the embryo is more developed and transfer occurs closer to the time that implantation would occur naturally, the pregnancy rate is usually higher. However, some embryos will die in the laboratory, so the number of embryos available for transfer and freezing will be fewer. For this reason, it's generally only offered to women who produce a large number of good quality embryos.

 

 
Assisted hatching
 
Before attaching itself to the wall of the womb, an embryo has to break out (hatch) from a gel-like membrane known as the zona pellucida. This membrane can be tough or thickened and some fertility experts think it may impede implantation of the embryo in the womb. To help the embryo break through, the embryologist may make a tiny hole in the membrane before it's transferred to help the hatching process.