Alternatives to IVF

Fertility problems are very common, with one in ten couples trying to conceive having difficulty. In couples who have fertility problems, 50% of the time there is a problem with the woman's fertility, while 30% of the time there is an issue with the man's fertility, and in 20% of cases there is a problem on both sides. There are several alternatives to IVF for couples having fertility problems, and IVF may not be the right option for you. The right fertility option for you depends on your age (if you are female), your medical history, and the reason for your fertility problems. If you are having difficulty conceiving, see your GP who will carry out a range of tests and will be able to advise you on the best fertility treatment for you. Here is a guide to the other fertility options available that your doctor may advise, aside from IVF.

The treatments outlined below are all available on the NHS, but people seeking fertility treatment on the NHS have to satisfy certain criteria, and these can vary depending on your Primary Care Trust (PCT). The type of fertility treatment available on the NHS also varies across PCTs, and waiting lists can be long. To find your local PCT, look on www.nhs.uk. Your doctor will be able to advise you on what fertility treatment is available at your PCT. Fertility treatments are available at private clinics, but they can be very expensive. If you decide to go private, use a clinic that is licensed by the Human Fertilisation and Embryology Department (HFEA), as these clinics are subject to regulations and inspections by the HFEA.

Fertility medicine

Some women have fertility issues because they either don't ovulate, or only rarely ovulate. Women can suffer ovulation problems for a variety of reasons, including having a hormonal imbalance, polycystic ovary syndrome, and mental illness such as depression. Fertility drugs are usually the first step in fertility treatment for women who have been diagnosed with ovulation problems. Clomiphene and tamoxifen are the names of medicines doctors can give which help encourage ovulation (the release of an egg) so it can become fertilised by a sperm cell.

If a medical examination discovers you aren't ovulating (or are ovulating very infrequently), you might be offered this treatment. This procedure involves taking a pill every day for 5 days at the start of your monthly cycle.

In some cases, a doctor may prescribe a one-off injection of Human Chorionic Gonadotropin, which is designed to be very similar to your body's natural ovulation hormone. This helps encourage the egg to be released from its sac. After having this injection you will be advised to have sex within a certain time frame. This procedure has a 90% success rate of stimulating a woman's ovaries so that they produce an egg and release it. As with most fertility treatments, fertility medicines increase the chance of having a multiple birth. In the case of fertility medicine, it's increased by 10%.

Male fertility medicines

There are also fertility medicines available to help increase sperm count in men. These are actually the same medicines which are used to encourage ovulation in women, and can help men who have low sperm counts caused by a hormone imbalance. They can also help increase sperm motility (its ability to move). The success rate for men using fertility medicine is 20-25%.

Fallopian tube surgery

Sometimes, depending on the reason for infertility, surgery may be the best option to treat fertility problems. Having blocked or scarred fallopian tubes is a common cause of infertility, and surgery may be able to unblock these and repair the damaged scar tissue, which is stopping eggs being able to pass through them. Fallopian tubes can become blocked as a result of endometriosis, pelvic inflammatory disease, inflammatory bowel disease, and as a result of abdominal infections such as a ruptured appendix or severe gallbladder disease. In this procedure, the scar tissue is broken up, so that eggs can pass through the tubes more easily. The success rate of this treatment varies, with women who have the least damaged fallopian tubes having a higher chance of having a baby after surgery. It is estimated that 20-50% of women who have this treatment for blocked fallopian tubes will go on to have a baby. Having this type of treatment however, does increase the chance of having an ectopic pregnancy by 8-25%.

Endometriosis is also a common cause of infertility in women. If you have been diagnosed with endometriosis (where the lining of the womb grows outside of the womb), laparoscopic surgery can be performed to remove the cysts. For women who have infertility due to polycystic ovary syndrome, laparoscopic ovarian drilling is sometimes recommended, if ovulation medicine has not worked.

Surgery for male infertility

Infertility in men can be caused by a blockage in the testicles, called an epididymal blockage. This blockage can prevent sperm from being ejaculated normally. Surgery can be performed to correct the blockage.

Surgery is also an option to help treat infertility in men who have low sperm counts, or who have had vasectomies, or who have a congenital absence of the vas deferens (the tube which drains the sperm from the testicle), or who cannot release sperm due to an injury or infection. Surgery can be performed to collect the sperm, which can then be frozen and used for assisted conception. This procedure is called Intracytoplasmic Sperm Injection and involves 'washing' the sperm to find the fastest moving and healthiest sperm from the sample.

Assisted conception

Intrauterine insemination

This procedure is normally used for cases of infertility where the man has a low sperm count or decreased sperm motility, or suffers from erectile dysfunction or premature ejaculation, or when a woman has endometriosis. It involves inserting sperm into the womb using a thin plastic tube during ovulation. Women are often given medicine to increase egg production so that the couple's chances of conceiving are higher. This procedure has a 15% success rate in women under 35.

You can get up to 6 cycles of treatment on the NHS, but this can vary depending on your primary care provider, and is less in some areas of the country.

How to find out more

To find out more about fertility treatment and the criteria you need to fulfil to receive it on the NHS, see the booklet called Assessment and treatment for people with fertility problems by The National Institute for Health and Clinical Excellence.