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. It’s important to understand that there are no guarantees that pregnancy will happen with any of the fertility treatments available. Your 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.
If you aren’t ovulating (eg if you have polycystic ovary syndrome), you may be given 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 will take these medicines for five days each month. You can continue to take them for a maximum of 12 months. After this, your doctor will discuss other treatment options.
If you have polycystic ovary syndrome and are overweight, your doctor may also prescribe a medicine called metformin if the clomifene or tamoxifen hasn’t been effective on its own.
You may 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 doesn't make you ovulate.
Hormone injections with human gonadotrophin hormone (a mixture of luteinising hormone and follicle-stimulating hormone) may be offered if clomifene or tamoxifen hasn’t worked for you.
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), then 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, then medicines and other treatments may help.
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 may be the first method offered to couples who have unexplained infertility. It can be used for women who have mild endometriosis. Endometriosis is a condition in which the lining of the womb grows somewhere else inside the abdomen, such as on the ovaries, behind the womb or on the bowels or bladder.
IUI is also useful for men who have ejaculation problems or mild problems with the quality of their sperm. IUI can be combined with ovulation induction.
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. You will need to discuss these methods with your specialist.
You may need IVF treatment if:
- your infertility is unexplained
- your fallopian tubes are blocked
- 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 three hormones given at different times, you will produce several mature eggs at once. This is called superovulation and it increases your chances of a pregnancy.
The eggs may be collected while you have an ultrasound scan. A thin needle is passed through your vagina and into your ovary. This is done as an outpatient procedure, so you won't need to stay overnight in hospital and you won't usually need a general anaesthetic.
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. One or more of the resulting embryos will be transferred into your womb using a soft plastic tube passed through your vagina.
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 is 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.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.