FACTSHEET: Fertility treatments

Fertility treatments increase the chances of pregnancy in couples who are having difficulty conceiving.

More than 136 million women around the world give birth a year. However, some couples have difficulties. According to the World Health Organization, around 49 million couples globally, have difficulty conceiving. This is sometimes called subfertility.

There are a number of different treatments available that will increase your chances of getting pregnant. The treatment that is best for you will depend on the reasons why you can't get pregnant and the length of time you have been trying to conceive.

It's important to understand that there are no guarantees that pregnancy will happen with any of the fertility treatments available. A doctor can give you more information about the success rate of each treatment.

Some treatments can help to improve your fertility and the chances of a natural conception.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice about your treatment options.

Self-help

Maintaining a healthy lifestyle before you try to conceive will improve your chances of getting pregnant and having a healthy pregnancy.

If either of you smoke, giving up can greatly improve your fertility because smoking has been linked to problems at every stage of conception and with lower success rates of assisted-conception techniques.

If you drink alcohol, limiting how much both of you regularly drink can also improve your fertility, and if you do become pregnant, it’s advisable for women to cut out alcohol altogether, especially in the first trimester.

For women, having a body mass index (BMI) below 18 or above 30 can affect how often they ovulate. If your periods are irregular or have stopped, this is a sign that you might not be ovulating.

Getting back to a healthy BMI, between 18 and 25, may regulate your ovulation and periods. Men are also advised to keep their BMI below 29 to maximise their fertility.

Having a balanced and varied diet will provide you with all the nutrients you need to conceive and maintain a pregnancy. Folic acid and vitamin D are particularly important for women who are planning a pregnancy and a doctor may advise you to take a supplement of these.

Vitamins C, E, some minerals, such as zinc and selenium and omega-3 fats are important for the health of a man’s sperm. These important nutrients can be found in a variety of foods including nuts, oily fish, green vegetables and tomatoes, but if you think you may be missing out on some of these, you could add a daily supplement.

Ovulation induction

If you aren't ovulating (eg if you have polycystic ovary syndrome), you can take medicines that can stimulate your ovaries to produce eggs. This is called ovulation induction.

There are two main medicines used for this; they are called clomifene and tamoxifen. You take these medicines for five days each month. You can continue to take clomifene for a maximum of six months, although for most women a response to the medicine will be seen within three months.

After this, your doctor may discuss other treatment options. You may be able to take tamoxifen for longer than six months.

If you have polycystic ovary syndrome and are overweight, your doctor may also prescribe a medicine called metformin. He or she will also advise you to take steps to eat more healthily and exercise because this has been shown to encourage weight loss, which can improve your chances of ovulating more regularly.

You may be able to have keyhole surgery to make tiny holes in the surface of your ovary to stimulate it. This is known as laparoscopic ovarian drilling. It's as effective as hormone injections and it might be an option for you if clomifene or tamoxifen don't make you ovulate.

You may be offered hormone injections with human gonadotrophin hormone (follicle-stimulating hormone) if clomifene or tamoxifen haven’t worked for you.

Fertility treatments for men

There are a number of treatments that can help to improve the quality of your sperm, or help it to reach your partner's womb.

• If your sperm quality is affected by hormone problems such as male hypogonadism (where your pituitary gland doesn't produce enough of certain hormones called gonadotrophins), medicines may help.

• An operation may be able to remove any blockage in the epididymis (this is where the sperm are stored in each testicle).

• If you have ejaculation problems, medicines and other treatments may help.

Assisted conception

Other treatments give you more help to conceive by controlling the way that the sperm and the egg are brought together. This is called assisted conception. There are three main types of assisted conception.

Intra-uterine insemination (IUI)

IUI involves taking fast-moving sperm and placing them inside the womb close to the time of ovulation. This method may be offered to couples who have unexplained infertility. It can be used if you’re a woman who has mild endometriosis.

Endometriosis is a condition in which the lining of the womb grows somewhere else inside your abdomen, such as on your ovaries, behind your womb or on your bowel or bladder.

IUI is also useful for men who have ejaculation problems or mild problems with the quality of their sperm. IUI may be combined with injections to stimulate the ovaries.

It’s important that this treatment is monitored carefully to reduce the chance of several eggs developing, which may result in multiple pregnancy (twins, triplets or higher).

In vitro fertilisation (IVF)

IVF is a procedure where eggs are removed and mixed with sperm in a laboratory. Once the eggs have been fertilised, they are placed in the womb. IVF can be carried out with your own sperm and eggs or with donor sperm or donor eggs.

Sperm, eggs and embryos can also be frozen for future use, although countries often have strict legal rules to regulate these procedures. You will need to discuss these methods with a specialist.

You may need IVF treatment if:

• your infertility is unexplained

• your fallopian tubes are blocked

• you have severe endometriosis

• other techniques, such as fertility drugs or intrauterine insemination (IUI), haven't worked

You will need to take medicines to control the timing of your monthly cycle accurately so that the eggs can be removed and fertilised on a specific day.

A normal monthly cycle produces only one egg, but with this method, which uses different hormones given at specific times, you will produce several mature eggs at once. This is called superovulation and it increases your chances of a pregnancy, but the medicines can cause side-effects, such as feeling sick, vomiting and headaches.

The eggs may be collected while you have an ultrasound scan. A thin needle is passed through your vagina and into your ovary. This may be done as a day case, so you won't need to stay overnight in hospital and you may not need a general anaesthetic.

However, you may be offered a sedative before the procedure because it could feel uncomfortable and it’s important that you can remain still. A sedative relieves anxiety and helps you to relax.

At around the same time, your partner will need to give a sperm sample. The sperm are washed and spun at a high speed so that the healthiest sperm can be selected. If you're using donated sperm, it's removed from storage and prepared in the same way.

The sperm and eggs are then mixed together in the laboratory.

Successful fertilisation can be seen with a microscope after about 16 to 20 hours. If you're a woman under 40, one or two of the resulting embryos are transferred into your womb using a soft plastic tube passed through your vagina.

As many as three embryos may be transferred if you're 40 or over and have previously failed to conceive with IVF.

Intracytoplasmic sperm injection (ICSI)

ICSI is very similar to IVF, but in ICSI a single sperm is injected into an egg in the laboratory and the resulting embryo is transferred to the womb. This means that as long as just a small number of sperm can be obtained, it's possible to fertilise the egg.

This type of fertility treatment may be used when there are more serious problems with the sperm, when the man has had a vasectomy, or when problems between the egg and sperm are preventing fertilisation.

What are the risks?

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

The medicines women take during IVF and ICSI may cause side-effects, such as hot flushes, changes in mood, night sweats, feeling sick, headaches and restlessness.

Symptoms usually disappear after a short time but if they don't, you should see your doctor as soon as possible.

Complications

Complications are when problems occur during or after the treatment.

Having fertility treatment increases the chances of having a multiple pregnancy (such as twins or triplets). This is why there are restrictions on the number of embryos that can be transferred into your womb. A multiple pregnancy increases the risk of health problems for both you and your baby.

Miscarriage, early labour and health problems in pregnancy, such as high blood pressure, are all more likely if you are having more than one baby.

Ovarian stimulation can cause a condition called ovarian hyperstimulation syndrome (OHSS). This is an over-reaction to the medicines used to stimulate the ovaries. For most women, the symptoms are mild.

However, for a few, it can cause more serious health problems. You should contact a fertility clinic (if available) or a doctor straightaway if you have any symptoms including:

• feeling sick and vomiting

• severe pains and swelling in your abdomen (tummy)

• feeling short of breath

• feeling faint

• passing a smaller amount of urine compared to normal

The chances of having an ectopic pregnancy may be higher in women who have IVF or other fertility treatments, especially if there is damage to their fallopian tubes. An ectopic pregnancy is when the embryo starts to develop outside the womb, usually in a fallopian tube. The main symptoms include:

• one-sided low abdominal pain

• vaginal bleeding

• dark brown or red vaginal discharge

The pain will get worse as the pregnancy goes on. If you have these symptoms, you should see your doctor straight away.

Removing the eggs for IVF or ICSI involves passing a needle through the vagina and into the ovary. This means that there is a risk of infection. Symptoms of having an infection in your pelvis include having a high temperature, pain in your abdomen and unusual vaginal discharge.

Usually symptoms begin within a few days or weeks of having the egg removal procedure. If this happens, it may be treated with antibiotics.