Learn everything about your treatment
Learn everything about your treatment
Fertility treatment overview
What is fertility treatment?
Fertility treatment, or assisted conception, are the medical terms for several different procedures which can help a woman to become pregnant. If you are struggling to conceive naturally then having a fertility treatment can increase your chance of becoming pregnant. The exact type of treatment that is most suitable for you depends on several factors, including the reason that you are struggling to conceive. This fertility treatment overview page aims to inform you about both the causes of and treatments for infertility. Some of the most common causes of sub-fertility and infertility are listed below. Each procedure has different risks and success rates and so it is important that you fully understand your options before making a decision.
What causes infertility?
Infertility has a range of different causes, that can be split into a:
- Female cause
- Male cause
- Unknown cause
The root of the cause affects which treatment would be the most suitable for you.
Female causes include:
- Ovulation problems (e.g. polycystic ovary syndrome or premature ovarian failure).
- Internal scarring from previous pelvic surgery or pelvic inflammatory disease.
- Fibroids, which can prevent implantation or block the fallopian tubes.
- Problems with cervical mucus.
- Medical conditions such as endometriosis, thyroid problems or eating disorders.
- A previous sterilisation procedure – if you have had your “tubes tied”.
- Certain medications.
Male causes include:
- A low sperm count
- Unusually shaped or slow moving sperm
- Infections of the testicles
- Previous testicular surgery
- Congenital problems with the testicles
- Undescended testicles
- A previous sterilisation procedure (vasectomy)
- Low testosterone levels
- Ejaculation problems
- Certain medications
If an identifiable cause is present, then steps to cure or improve are the initial steps taken for fertility treatment. In some people struggling to conceive, there is no clear cause. If this is the case for you, your doctor may write that you have infertility of an unknown cause. For these people, in vitro fertilisation (IVF) is generally the best type of fertility treatment.
What types of fertility treatment are available?
Medications to improve fertility are usually a suitable option for women who have problems ovulating, including those with conditions such as Polycystic Ovary Syndrome (PCOS). The common medications are listed below –
- Gonadotrophin-releasing hormone agonists
Usually, it is the woman who takes these medications. Sometimes, men also take medication to help to make them more fertile.
If you have scarred or blocked fallopian tubes, it may be possible to perform surgery to restore their normal function. It is possible to have surgery to remove fibroids which can help with fertility issues. In people with PCOS, a procedure called ovarian drilling can increase the likelihood of pregnancy. Finally, women with endometriosis may be suitable for surgery to remove some of the abnormal tissue or any cysts that have developed. Surgeons frequently perform this treatment with keyhole surgery. If you have other medical problems or suffer from severe endometriosis then the keyhole approach may not be possible.
Some men are born with a blockage in a part of the testicle which affects the passage of sperm. This blockage stops the release of sperm. If this is the case for you, surgery to correct this may be a suitable option. If you have had this surgery in the past and it did not work, or if the problem is instead how the testicle produces sperm, then a procedure such as surgical sperm extraction may be suitable. This involves the direct collection of sperm via the testicle under an anaesthetic.
In Vitro Fertilisation (IVF)
IVF is probably the most famous type of fertility treatment. It requires the woman to take fertility medication to stimulate ovulation, followed by a procedure to collect her eggs. Sperm is collected from the man, and then in the laboratory the eggs are manually fertilised. After successful fertilisation, you must wait 2 to 6 days before the fertilised egg (known as the embryo) is back into the womb. After this, the pregnancy should continue in the same way as in a woman who conceived naturally.
Intracytoplasmic sperm injection (ICSI) is a specific part of IVF in cases of male infertility. It involves surgical sperm extraction from the testes directly (as mentioned above). The sperm then undergoes analysis to identify the best quality sperm for insertion. Then, a single sperm is injected directly into a single egg which was collected from the woman. The resulting embryo is then replaced into the woman’s womb.
Generally, the IVF process results in the production of several embryos. Usually, you should only replace one embryo at a time. Therefore, your doctor may suggest freezing the other embryos so you can use them if you go on to have a second round of IVF, or if you wish to have another baby later on.
Intrauterine Insemination (IUI)
Another name for this type of fertility treatment is artificial insemination. It is most often, but not always, suitable for people who are using donated sperm. The IUI process also requires sperm collection or a sample of donated sperm. The sperm is then introduced into the womb with the help of a small injection type tube. The fertilisation process then occurs in the same way as it would naturally. IUI is a cheaper but less effective treatment in comparison to IVF.
This fertility treatment overview gives a brief introduction to infertility and the possible treatment options. To find out more about the right treatment for you, please speak to a specialist fertility team to arrange a consultation.
Fertility treatment candidates
Why choose to have fertility treatment?
For many people, having a child is an extremely important aspect of their life. Most couples find that they are able to conceive naturally within a year of regular unprotected sex. Unfortunately, a large proportion of people have problems in conceiving a baby naturally. Consequently, these people may need treatment to help increase their chances of becoming pregnant. Furthermore, some people may not have a partner or are in same sex relationships and may need help to have a child. In all of these cases, fertility treatments have the potential to overcome these difficulties. This page on fertility treatment candidates aims to help you decide if fertility treatment is right for you.
Who are the ideal candidates for fertility treatment?
As it is a biological process, infertility can only be diagnosed after a year of trying to conceive naturally. However, as fertility declines with age, it is important to seek help earlier if you are a woman over 36. There are a wide range of reasons that may make it difficult to conceive and these can also affect your treatment options.
Below is a list of general features for the ideal candidate. However, the precise type of treatment which may suit you best also depends on your circumstances and if there is a known cause for your infertility. Therefore, the best approach is to arrange a consultation to see if you are a candidate for fertility treatment.
An ideal candidate include those who:
- Have been trying to conceive naturally for over 1 year, or females over 36 years old.
- Are aware or suspect that they have fertility problems.
- Are in relatively good health.
- Have a healthy BMI.
- Have a positive outlook on their fertility journey.
- Are aware that the treatment may not work.
- Have support available from family and/or friends.
- Appreciate the possible risks and complications of fertility treatment.
- Have considered and decided against surrogacy or adoption.
- Have a referral from a specialist health professional.
Fertility treatment procedure
How is fertility treatment performed?
There are a number of different ways a fertility treatment procedure can be carried out. Therefore, the different steps of your specific procedure will vary. Your medical team will discuss the available options and explain which option they think is the most appropriate for you. This means the procedure time will vary from treatment to treatment. This page broadly explains what to expect from some of the different types of treatments. Your doctor or surgeon will provide more specific information once you decide which fertility treatment you wish to try.
If you choose to take medication, the first step is a consultation with a fertility specialist. They will discuss the problems that you have been experiencing and take a full medical history from you. They may run some blood tests before deciding which medication is the right one for you. Once everyone is happy with the plan to start a particular medication, the doctor will write up a prescription for you.
The course of medical treatment for infertility depends on which medication your doctor prescribes for you. In most cases, the medication will be taken for at least 3 menstrual cycles to ensure the best chance of ovulation.
Additionally, there is some variation in when you take the medication. Some medications such as Metformin are taken every day, whereas others like Clomifene may only be taken for a few days per cycle. Your doctor will ensure that you have clear instructions on when you should take your medication.
As with all fertility treatments, you may not get pregnant immediately. Unfortunately, there is no way of predicting how long it will take for you to conceive on fertility medication. If you have any questions or concerns about the timeframe, your doctor will be happy to answer these for you.
Before you have any type of fertility treatment, you will have to give your consent to treatment in writing. You should read the consent form carefully to make sure you fully understand the procedure you are about to have, and the risks that come with it. These are different depending on the procedure that you are having.
If you opt for surgical treatment, you will be given an anaesthetic before the procedure. For a surgical sperm extraction, the surgeon will usually inject a local anaesthetic to numb the testicle and surrounding area. You will therefore be awake for the procedure, but you will not feel any pain. It will take a few hours after the surgery for the numbness to wear off.
For more extensive surgery, such as that involving the fallopian tubes, a general anaesthetic may be more appropriate. In this case, you will meet with the anaesthetist and they will explain how the anaesthetic agent will work. You will be asleep for the surgery and will wake up slowly when it is over. You may feel groggy for a few hours after waking up, but this will wear off. It may also affect your memory and concentration for 1 to 2 days but this will also resolve.
3. Surgical technique
The actual surgical technique used will vary depending on the cause of infertility and the procedure that you have chosen to have. Your surgeon will discuss this with you before you make your decision about undergoing the surgery.
If you are undergoing keyhole surgery, the surgeon will make several small incisions around the areas they want to access through which they can insert surgical tools. If however, you are having more extensive surgery using an open technique, your surgeon will make a larger incision over the area to be operated on.
Generally, treatments like surgical sperm extraction are quicker to perform than those for blockages in both genders and operations for fibroids and endometriosis. As the time taken is specific to you and your operation, the best person to get an indication of operation time from is your surgeon.
4. Return home
In many cases, you will be able to return home soon after your procedure. Your treatment area may remain numb for a few hours but the effects of the anaesthetic will wear off with time.
If you have more extensive surgery, you may have to stay in hospital overnight. Again, your surgeon will discuss this with you before the operation and together you will come up with a recovery plan. If you have any questions about a surgical fertility treatment procedure, you can always contact your surgeon to ask.
Here, we will discuss the general IVF procedure and what it involves. This differs depending on your needs and preferences and so the following information is a rough guide only. For more specific details, please ask your fertility specialist.
If you are male, your IVF treatment involves you providing a sperm sample. This undergoes analysis to identify the most healthy sperm to use in the fertilisation process.
For women, the procedure has a lot more steps. After deciding to go ahead with the treatment, your doctor or surgeon will prescribe some medications which first override your natural menstrual cycle and then stimulates it to produce eggs. You usually take these medications for around 2 weeks each, one after the other.
During the IVF process, you can expect to have at least one ultrasound scan and also some blood tests for monitoring of your progress. This allows the fertility specialists to be sure that the medication is working and to plan to best time to collect your eggs.
Egg collection is a minor surgical procedure and requires local anaesthetic with sedation to keep you as comfortable as possible. This part of the treatment involves using a fine needle to collect the eggs via the vagina.
After egg collection, the next step is fertilisation. In IVF, this means that the egg and sperm sample mix and after 1 day the fertility specialist returns to assess them and see if there has been any fertilisation. If this is successful, these embryos grow for 2 to 6 days in the lab before embryo transfer, the act of replacing them into the womb. During this time, you can expect to take medication to help your womb to prepare to accept the embryo.
The transfer part of the IVF treatment procedure is less invasive than the egg collection and often does not require sedation. Your specialist will use a thin tube to pass into the vagina and deliver the embryo to the womb. Your specialist may suggest waiting 2 weeks before taking a pregnancy test to see if the treatment has been successful.
Fertility treatment consultation
What should I expect from my fertility treatment consultation?
Your fertility treatment consultation will involve meeting a specialist doctor to discuss your potential treatment options. During your fertility treatment consultation, your fertility specialist will talk you through your treatment options. They can run through the procedures with you and discuss any risks or complications. Additionally, they may ask to see a referral from your GP and a copy of any test results you have, so make sure to take these along with you. During the consultation, your fertility specialist may ask a number of questions including:
- What is your current health like?
- Do you suffer from any other medical conditions?
- Have you or your partner had any previous pregnancies or children?
- Do you take any regular medications? (Including prescription, over-the-counter or herbal medications)
- Do you smoke, drink alcohol or use recreational drugs?
- How long have you been trying to conceive?
It is important that you answer these questions as honestly as possible so that your doctor can help to direct you towards the best choice of fertility treatment. Therefore, the more details you can provide, the better your doctor’s understanding of you and your struggle with infertility will be.
Questions to ask during your fertility treatment consultation
This consultation is also an excellent time for you to ask any questions that you may have about your treatment options. These may include more specific details on a procedure, or the chances of a successful pregnancy after each sort of treatment. It is important that you have a good understanding of what your chosen treatment involves, the risks and complications that may arise, and what your recovery will be like. Therefore, some questions that you may like to ask include:
- Which treatment do you think will work best for me?
- Will the procedure be painful?
- How long does it usually take for the type of treatment I have chosen to be successful?
- Is there anything else I can do to increase my chances of conceiving?
Fertility treatment risks and complications
What are the main fertility treatment risks and complications?
As with any treatment, there are some fertility treatment risks and complications that you should be aware of. These vary depending on the type of treatment that you opt for. It is vital that you are aware of all the risks and complications that could occur during and after your treatment. You must educate yourself on these before you make a decision about having treatment. The one risk that is true of every type of fertility treatment is the chance that you may not become pregnant. How likely this is depends on your individual circumstances and your fertility specialist will be able to give you a better indication. Overall, fertility treatments are considered safe and effective. Having said this, it is still important to understand what could happen if things do not go to plan.
If you opt for fertility medications, the possible risks and complications include:
Medication side effects
All medications have the potential to cause side effects. Not everyone that takes fertility medications will suffer from side effects and even if they do, they are usually mild. Some of the common side effects include:
- Breast tenderness
- Hot flushes
- Mood swings.
Ovarian hyper-stimulation syndrome
- Fast weight gain
- Severe abdominal pain
- Severe nausea
- Problems passing urine
- Shortness of breath
- Rapid heartbeat
Because of the stimulatory effect of fertility medications, you are much more likely to conceive more than one baby whilst undergoing treatment than you would by conceiving naturally. Although some people may welcome this, others may not. Occasionally, more than 3 eggs are fertilised which as the pregnancy progresses, is detrimental to both the mother’s health and that of the developing babies. Your doctor will explain this risk and what your options would be if you found yourself with a multiple pregnancy.
Fertility medications can lead to a small increase in the risk of an ectopic pregnancy. This is when the embryo implants in the fallopian tubes rather than in the womb. This is dangerous as it can cause the fallopian tube to rupture and can require emergency treatment. The symptoms of an ectopic pregnancy are commonly:
- Severe abdominal pain
- Vaginal bleeding and/or dark discharge
If you have any of these symptoms after you have a positive pregnancy test following fertility treatment, it is very important that you seek immediate medical attention.
If your fertility treatment involves any sort of surgery, the potential surgical risks include the following:
Every type of surgery carries a risk of infection. Your surgeon will do their best to prevent any infections from occurring. If you develop an infection, your team will usually treat it with a course of antibiotics. Infections should not be left without treatment as they can spread and become more severe. Therefore, it is important that you are aware of the signs of infection so that you know when to seek medical help. These include:
- Redness around the wound that gets worse over time
- Redness that is beginning to spread away from the incision
- Foul smelling discharge or pus from the wound
- A temperature of over 38° C
- Pain that is not relieved by painkillers
Bleeding & bruising
There may be some minor bleeding from your wounds and bruising of the skin around it. This is common and can be expected in most cases. However, more rarely a collection of blood can gather beneath the skin – the medical name for this is a haematoma. These can occur in the first few days after surgery and require further treatment by your surgeon.
General surgical complications
There are general risks that come with all surgeries. These include nausea and vomiting, risks of aneasthesia, post-operative pain and blood clots. To reduce the risks of their occurrence, we advise that you take your time choosing a qualified, experienced surgeon that you can trust.
Damage to surrounding structures
There is the risk that the surgery may cause damage to structures surrounding your treatment area. For example, nerve damage, or damage to other structures such as the womb or testicles. Rarely, the operation becomes difficult and the surgeon must perform a more extensive surgery than initially planned. To reduce the risk of this occurring, it is important you choose an experienced surgeon.
Surgical techniques will leave scarring on your treatment area. In the first few months after your surgery, your scars will be pink and quite obvious. However, with time and a good scar care regimen, your scars will fade. In order to minimise your scars, ask your surgeon for any scar care recommendations that they may have. Frequently, fertility operations can be done with a keyhole technique, meaning that you will have much smaller scars than those from traditional surgical incisions.
Unfortunately, there is always a risk that the surgery may not be successful. You must be aware of this and understand that having the operation does not guarantee that you will conceive. Ask your surgeon about the likelihood of this and what the next steps would be if you did not fall pregnant after the surgery. It is also important that you attend any follow-up appointments you have been given.
Finally, there are also possible risks and complications with IVF treatment. These include those listed under the medication and surgery sections and so are not outlined specifically here. If you would like more information, please ask your fertility doctor for advice.
Fertility treatment preparation
How can I prepare for my fertility treatment?
Fertility treatment preparation is key in order to give yourself the best chance of successfully becoming pregnant after undergoing fertility treatment. Below are some suggestions of things you can do to improve your health and lifestyle before you begin your journey.
Maintain a healthy weight
People who are underweight or overweight can both struggle to conceive. Therefore, in the lead up to starting fertility treatment it is important that you are assessed by the fertility specialist. They will be able to see if your weight may be affecting your fertility. Then, the best thing that you can do is to lose or gain weight so that your body mass index (BMI) lies in the healthy range of 18.5 – 24.9. If you think that your weight may be contributing to the problem, please discuss this during your consultation.
Regardless of your weight, a healthy diet is vital to ensuring that your body is in its best condition. In order to nourish a baby, your body needs to be well nourished in itself. A healthy diet consists of plenty of fruits and vegetables alongside some meat, fish, dairy or vegetarian sources of protein. Try to eat less sugar and saturated fats and avoid processed foods when you can.
Cut out alcohol and caffeine
It is true that alcohol consumption has a negative impact on fertility for both men and women. Therefore, your surgeon may recommend that you completely cut out alcohol if you are struggling to conceive or want to undergo fertility treatment. Also, your surgeon may suggest cutting out caffeinated drinks such as tea, coffee and energy drinks. The best way of staying hydrated is to drink lots of water. You can put mint, lemon or cucumber in your water to change the flavour if you struggle to drink plain water.
Stress has a huge impact on fertility and won’t help your chances of becoming pregnant. Although easier said than done, you should try to reduce your stress levels as much as possible. Think about the things that cause you the most stress and how you can change this. For example, if you have a stressful job, consider talking to a colleague or boss about how it affects you. You could come up with some suggestions that would make work less stressful. Try to stay organised, but allow yourself some time to relax. Getting a good night’s sleep will be beneficial in many ways, not just in helping to lower stress and prime your body for fertility treatment.
Your fertility specialist will tell you if you need to take any medication or supplements before beginning the fertility treatment process. There are a huge range of supplements which claim to help with fertility but these often have little effect. Therefore, we recommend that you discuss any supplements you wish to take with your doctor to ensure they are right for you. Folic acid is recommended for all women trying to become pregnant, so this would be a sensible choice. Your fertility specialist will give you more information about this and answer any questions that you may have.
Fertility treatment aftercare
What can I expect after fertility treatment?
Knowing what to expect after your treatment is an important part of understanding the process of your fertility procedure. Your specialist doctor will be able to give you specific fertility treatment aftercare advice.
After you have your treatment, they will organise a follow-up appointment to check up on you and to see if the treatment has been successful. They will ensure that you feel well and understand what is happening . They will also talk you through the next steps.
How will I feel after treatment?
This will depend on what kind of treatment you have had. If you have a local anaesthetic, you will be awake for the procedure but unable to feel anything. After surgery using a general anaesthetic, you will wake up gradually when the operation is complete and feel slightly groggy as the anaesthetic wears off. You may feel some numbness in your pelvis and groin. This should wear off within a few hours. Your treatment area may begin to feel painful as the numbness wears off. You may notice that your memory and concentration are affected for a day or two after surgery. Again, these side-effects will wear off with time.
For other types of fertility treatment, you may not feel any different. If you are prescribed a medication, you may notice some side-effects. If you opt for an IVF type procedure, you may have some crampy stomach pains and possibly a small amount of bleeding after egg retrieval.
When will I be able to return home after my treatment?
This again depends on the type of treatment you have had. For simple procedures, it is likely that you will be able to go home the same day. However, if your surgeon has to do a more complex operation, such as for fibroids, you may have to stay in hospital overnight. You can ask your surgeon about this during your consultation. For procedures with several steps like IVF, you will come into hospital fairly regularly but usually will not need to stay overnight.
How will I get home after my surgery?
It is advisable that you arrange for a family member or friend to pick you up if your treatment involves surgery. This is to ensure that you are safe if you have an anaesthetic and to make sure you have someone there to look after you.
If you have been given a general anaesthetic, you will not be able to drive yourself home straight after the treatment and may not be able to drive for a short period afterwards depending on your surgeon’s instructions.
When can I return to work?
The majority of people undergoing fertility treatments do not need to take any time off of work. However, if you have a surgical procedure then it is likely that you will need some time to recover. Most people are able to return to office work within 1 to 2 days of their surgical fertility treatment. However, this may vary if you have a more physically demanding job. Your fertility specialist will be able to give you more specific advice on this. Of course, it is up to you to decide how much time to take off, particularly as these treatments can be emotionally draining.
When can I exercise again?
You will be able to return to return to light activities from 5 to 7 days after surgical fertility treatment. Your doctor will give you a more exact timeframe as this depends on the type of treatment that you have. You should avoid strenuous physical activity throughout treatment but we encourage you to keep fit with regular exercise.
When should I take a pregnancy test?
Once again, this depends on the type of treatment. After IVF, you should wait for a minimum of 2 weeks before taking the test to avoid false positives. For medications to be effective they need to be taken for several cycles, so you may wish to test as you were doing before the fertility treatment. There is no set time to test after surgical procedures. We recommend that you ask your fertility specialist to go through this during your consultation.
Fertility treatment FAQs
What are some common fertility treatment FAQs?
Below is a list of some common fertility treatment FAQs. This treatment process can be long and involve a lot of emotions. We hope that the below list can help to answer some of the questions that you may have and put your mind at ease.
Do I need a referral from my GP?
If you are having private fertility treatment, your fertility specialist may require a referral letter from your GP. Your referral letter will help your doctor to understand you and the problems you have with conceiving, so that they can treat you in the most appropriate way.
What are the success rates?
Success rates will vary depending on the type of fertility treatment that you have, as well as your age and health. The technique with the highest success rate at the moment is IVF, with between 7% and 30% success rates. For IUI or artificial insemination, the rate of success ranges from 6% to 12% depending on your age. It is harder to measure the success rates of other methods such as medications. Nevertheless, they are shown to improve fertility in many scientific studies so you should not be put off. Your fertility specialist will take all of these factors into account and give you a realistic estimate of your chance of a successful pregnancy.
Which fertility treatment is best for me?
Firstly, this will depend on the information that your fertility specialist receives in the referral letter from your GP. If you do require surgical treatment, a surgeon will examine you to decide which technique is best to use. They will consider what the problem is and how they can best try to overcome it. Furthermore, your current and past medical and surgical history will also be factors in their decision. The doctor will discuss with you which procedure they think is best and you can ask them any questions you may have. Otherwise, your fertility specialist will run through the options with you and explain which they think is most suitable.