Fertility treatments

Infertility is a condition where you cannot get pregnant after trying for a year or more to conceive. There are various causes of infertility in men and women, and a number of fertility treatments that may be considered following preliminary investigative tests. In this article, we will set out to explain the main causes and types of infertility, and the types of fertility treatments that may be recommended.

What is infertility?

A couple is considered infertile if they have been actively trying without success to get pregnant for 12 months.

‘Actively trying’ means having unprotected sex every two to three days throughout the month. Infertility does not include miscarrying, or being unable to carry a baby to childbirth.

There are two main types of infertility. Primary infertility is where someone who has never conceived a pregnancy previously has difficulty conceiving. Secondary infertility is where someone has had one or more pregnancies in the past, but is having difficulty conceiving again.

What causes infertility?

Fertility issues affect one in seven couples in the UK. They can occur in either women or men. In approximately 40% of infertile couples, there is a problem with both the man and the woman.

There are many causes of infertility. In women, some of the most common reasons for not being able to get pregnant include lack of regular ovulation, scarring from surgery, fibroids, endometriosis, pelvic inflammatory disease, sterilisation, and the use of certain medications and drugs.

Infertility in men is often down to poor quality semen. This may be due to a lack of sperm, sperm that have limited mobility, or abnormal sperm. However, a lot of the time, many cases of poor quality semen go unexplained. Infertility in men may also be down to problems with the testicles, sterilisation, ejaculation disorders, hypogonadism (low testosterone), or the use of certain medications and drugs.

In the UK, around one in four cases of infertility are unexplained. If a cause for infertility cannot be found in the man or the woman, then it is advisable to talk to your GP in the first instance about the types of fertility treatments that may be available to you.

The National Institute for Health and Care Excellence (NICE) suggests that women with unexplained infertility who have been unsuccessful in conceiving after two years of actively trying should be offered IVF treatment.

How is infertility diagnosed?

The first step if you have been actively trying to get pregnant for at least 12 months without success is to see your GP. All couples are entitled to NHS funded preliminary investigations for infertility.

You should, however, make that visit earlier if you are female and aged over the age of 36, as fertility declines into the mid-thirties. It is also recommended to see your GP earlier if you have other reasons for being concerned about your fertility, for example if you have undergone cancer treatment, or if you believe you’ve had a sexually transmitted infection (STI), or have very irregular periods.

Visiting the GP

It is important that both partners visit the GP. They will do an initial assessment to check for anything that may be causing your fertility issues, and will guide you on the next steps to take.

The GP will ask a series of questions around your medical and sexual histories. They will ask about previous pregnancies, whether either of you have children from previous relationships, and how long you have been trying to conceive. Women will be asked about their periods and any issues they may have had with their monthly cycles.

Other areas they will discuss with you will be how often you have sex, the type of contraception you used in the past and when you stopped using it, and your respective medical histories and lifestyles.

Because there are so many factors that can lead to infertility, from stress and medication to certain types of contraception taking time to stop working, it is important that you are fully open and honest with your GP when answering their questions.

Physical infertility examinations

Your GP may also carry out a physical examination. If you are female, your GP may examine your pelvic area. They will be looking for signs of fibroids, endometriosis, ovarian tumours or pelvic inflammatory disease (PID), all of which can be causes of infertility. If you are male, the doctor may examine your testicles to check for any deformities or lumps, and your penis for any obvious abnormalities.

Following the physical examination, you may be referred to a fertility clinic for further tests.

For women, these may include blood tests to check for various reproductive hormones; a chlamydia test; an ultrasound scan to check your womb, ovaries and fallopian tubes; an X-ray of your womb and fallopian tubes to check for any blockages, and, only if it is likely there is a problem, a laparoscopy (keyhole surgery) to examine your womb, fallopian tubes and ovaries.

Fertility tests for men may include semen analysis, and a chlamydia test.

What types of fertility treatments are available?

Once your infertility tests are complete, a personalised fertility treatment plan will be put together for you.

There are three main types of fertility treatments:

  1. Medicinal fertility treatments
  2. Surgical fertility treatments
  3. Assisted conception

Medicinal fertility treatments

Some of the most commonly used medicinal fertility treatments include clomifene, letrozole or tamoxifen (to encourage ovulation in women who do not produce eggs); gonadotrophins (to help stimulate ovulation in women and boost fertility in men), and gonadotrophin-releasing hormone and dopamine agonists, again to stimulate ovulation in women.

There can be side effects associated with some of these medications, including headaches, hot flushes, and nausea and vomiting. Women with unexplained infertility will not usually be prescribed ovulation-stimulating fertility treatments, as there is no evidence to suggest they increase the chances of getting pregnant in such cases.

Surgical fertility treatments

There are various surgical fertility treatments that may be suggested depending on the results of the investigative tests.

In women, these may include fallopian tube surgery to correct blocked or scarred tubes; laparoscopic surgery to treat endometriosis, and laparoscopic ovarian drilling to help with ovulation for women with polycystic ovary syndrome (PCOS) who have not responded to medicinal fertility treatments. Fibroid surgery may sometimes be undertaken depending on the size and position of the fibroids.

For men, surgical fertility treatments may be used to correct a blockage in the epididymis, or to retrieve sperm. The epididymis is the tube that transports sperm from the testes. When blocked, it can prevent sperm from being ejaculated properly.

Surgical extraction of sperm may be used where there is an obstruction preventing the release of sperm, where a man was born without the tube that drains the sperm from the testicle (vas deferens), or where there has been a vasectomy or failed vasectomy reversal.

Assisted conception

There are two main types of infertility treatments that can be considered ‘assisted conception’.

Intrauterine insemination (IUI), also referred to as artificial insemination, involves inserting sperm into the womb via a thin plastic tube passed through the cervix. Sperm is first collected and washed in a fluid, with the best quality, fastest moving specimens selected.

Learn more about IUI…

In vitro fertilisation (IVF) involves an egg being fertilised outside the body. Fertility medicine is first taken to stimulate the ovaries to produce a larger number of eggs than normal. Eggs are removed from the ovaries and fertilised with sperm in a laboratory. A fertilised egg (embryo) is then returned to the womb to grow and develop.

Read more about IVF…

There are various other fertility treatments that may be recommended to you following your fertility consultation and investigative tests.

Getting referred for fertility treatments

All patients are entitled to NHS funded infertility investigations. The availability of NHS funded fertility treatments varies across the UK, as do waiting lists and eligibility criteria.

If you have an infertility problem, you may wish to consider private treatment. Always make sure you choose a clinic that is licensed by the HFEA.

Hull & East Riding Fertility is a private fertility clinic founded in 1986. We are East Yorkshire’s only registered clinic providing specialist infertility investigations and personalised treatment, both self-funded and NHS. We also offer a range of investigatory and fertility treatment planning services at our two satellite fertility clinics in York.

There is no need to arrange a GP referral, although all patients are entitled to NHS funded investigations.

We would be delighted to welcome you at any of our clinics to discuss your fertility journey. Please get in touch to let us know how we can help you.