Getting help
Getting started
If you're having problems getting pregnant, see your GP.
Your GP will look at your medical history and give you a physical examination. They may also recommend some lifestyle changes to help fertility.
Unless there are reasons that may put you at high risk of infertility, such as treatment for cancer in the past, you'll only be considered for infertility investigations and treatment after you've been trying for a baby for at least a year without becoming pregnant.
Your GP will be able to refer you to an infertility specialist at an NHS hospital or fertility clinic.
Referral to an infertility specialist
The specialist will ask about your fertility history, and they may carry out a physical examination.
For women, you may have tests to check the levels of hormones in the blood as well how well the ovaries are working. You may also have an ultrasound or X-ray, to see if there are any blockages or structural problems.
Men may be asked for a sperm sample to test sperm quality.
If the specialist thinks that your infertility could be treated by IVF, or if you've been unable to conceive for at least three years, you may qualify for funding for IVF treatment.
The specialist will advise your GP whether IVF is the best treatment for you. If it is, they will refer you to an assisted conception unit (see below).
For more information, see the A-Z topic on Diagnosing infertility.
The assisted conception unit
Once you're accepted for treatment at the assisted conception unit, you and your partner will have a blood test for HIV, hepatitis B, hepatitis C and syphilis, and to check that you're immune to rubella (German measles). Also, your cervical screening tests should be up to date.
The specialist will investigate the amount of eggs in your body and their quality (your ovarian reserve). It will be assessed by measuring your anti-mullerian hormone (AMH) level. This is a blood test that can be done on any day of your cycle. It will show if there's likely to be any difficulty in obtaining eggs.
Additional semen samples may be required.
The specialist will then discuss your treatment plan with you in full detail.
For more information see IVF - How it is performed.
You will need to sign consent forms giving permission for the use or storage of your eggs, sperm or embryos throughout the procedure.
You may find that you need support and guidance while going through this process. Some people find counselling helpful. For more information, go to HFEA: benefits of counselling and how to access it.
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How is it performed?
The IVF technique was developed in the 1970s. It may differ slightly from clinic to clinic but a typical treatment is as follows.
For women
Step one: suppressing the natural monthly cycle
You are given a drug that will suppress your natural menstrual cycle. This is given either as a daily injection (which you'll be taught to give yourself) or as a nasal spray. You continue this for about two weeks.
Step two: boosting the egg supply
Once your natural cycle is suppressed, you take a fertility hormone called FSH (follicle stimulating hormone). These fertility hormones are known as gonadotrophins. This is another daily injection that you give yourself, usually for about 12 days, but it can vary depending on your response.
FSH increases the number of eggs your ovaries produce. This means that more eggs can be collected and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.
Step three: checking on progress
The clinic will keep an eye on you throughout the drug treatment. You will have vaginal ultrasound scans to monitor your ovaries and, in some cases, blood tests. About 34-36 hours before your eggs are due to be collected, you'll have a final hormone injection that helps your eggs to mature.
Step four: collecting the eggs
For the egg collection, you'll be sedated and your eggs will be collected under ultrasound guidance. This involves a needle being inserted through the vagina and into each ovary. The eggs are then collected through the needle.
Some women experience cramps or a small amount of vaginal bleeding after the procedure.
Step five: fertilising the eggs
The eggs that have been collected are mixed with your partner's or the donor's sperm in the laboratory. After 16-20 hours they're checked to see if any have been fertilised.
If the sperm are few or weak, each egg may need to be injected individually with a single sperm. This is called intra-cytoplasmic sperm injection or ICSI (see below). In 2008, over 40% of all IVF procedures used the ICSI technique.
The cells that have been fertilised (embryos) continue to grow in the laboratory for one to five days before being transferred into the womb. The best one or two embryos will be chosen for transfer.
After egg collection, you will be given medicines, either progesterone or hCG (chorionic gonadotrophin), to help prepare the lining of the womb to receive the embryo. This is given either as a pessary (which is placed inside the vagina) or an injection.
Step six: embryo transfer
The number of embryos to be replaced should have been discussed before treatment starts. Couples should think carefully about the replacement of a single embryo, especially when the female is under 35 and when five or more embryos have been produced. If you're 40 or over, a maximum of three embryos may be transferred.
All multiple embryo replacements carry the risk of a multiple pregnancy and birth.
Multiple pregnancies are associated with a significantly increased risk of premature labour, resulting in a three- to five-fold increased risk of blindness, deafness and cerebral palsy.
Read more about the risks associated with multiple births.
If any embryos are left over, and they're suitable, they may be frozen for future IVF attempts (see HFEA: freezing and storing embryos).
Some clinics may also offer a process called blastocyst transfer. This is where the fertilised eggs are left to mature for five to six days before being transferred. For more information about embryo transfer, read the HFEA factsheets on:
For men
Around the time your partner's eggs are collected, you'll be asked to produce a fresh sample of sperm. The sperm are washed and spun at a high speed, so the healthiest and most active sperm can be selected.
If you're using donated sperm, it is removed from frozen storage, thawed and prepared in the same way.
Information on other techniques
There are many alternative methods to help a couple conceive. For more information, see the HFEA factsheets on:
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Risks
The potential problems associated with IVF are outlined below.
Drug reaction
Most women will have some reaction to the drugs. Most of the time the side effects are mild and include:
- hot flushes
- feeling down or irritable
- headaches
- restlessness
- nausea and vomiting
- shortage of breath
- abdominal bloating due to an accumulation of fluid
- ovarian hyperstimulation (excessive ovarian response to the gonadotrophins, with abdominal pain and swelling, shortage of breath and enlargement of the ovaries). It may be necessary to cancel the cycle and restart with a lower dose of gonadotrophin.
If you have these symptoms, see your doctor immediately, especially if you have abdominal pain and swelling.
Multiple births
If more than one embryo is replaced in the womb as part of IVF treatment, there's an increased chance of producing twins or triplets.
Having more than one baby may not seem like a bad thing, but it significantly increases the risk of complications for you and your babies:
- Multiple pregnancy can raise your blood pressure significantly.
- You're two to three times more likely to develop diabetes during pregnancy if you're carrying more than one baby.
- Around half of all twins and 90% of triplets are born prematurely or with a low birth weight. The risk of your baby dying in the first week of life is five times higher for twins than for a single baby. For triplets, the risk is nine times higher.
The Human Fertilisation and Embryology Authority (HFEA) recommends that a maximum of two embryos may be replaced in the womb, and that consideration be given to the transfer of a single embryo during treatment in women under the age of 40.
The HFEA encourages a single embryo transfer in women who are at most risk of having twins (for example, younger women who have produced a lot of embryos).
Ovarian hyper-stimulation syndrome
The ovarian hyper-stimulation syndrome (OHSS) is a rare complication of IVF. It occurs in women who are very sensitive to the fertility drugs that are taken to increase egg production. Too many eggs develop in the ovaries, which become very large and painful.
OHSS is more common in women under 30 and in women who have polycystic ovary syndrome. OHSS generally develops in the week after egg collection.
The symptoms of OHSS are pain and bloating low down in your abdomen, nausea or vomiting. Severe cases can be dangerous. Contact your clinic if you have any of these symptoms.
Ectopic pregnancy
If you have IVF, you have a slightly higher risk of an ectopic pregnancy, where the fertilised egg implants in the fallopian tubes rather than in the womb. This can cause vaginal bleeding or bleeding into your abdomen.
If you have a positive pregnancy test, you'll have a series of hormone tests and a scan at six weeks to make sure that the embryo is growing properly.
Tell your doctor if you experience vaginal bleeding or stomach pain after having IVF and a positive pregnancy test.
Risks for older women
IVF treatment becomes less successful with age. In addition, the risk of miscarriage and birth defects increases with the age of the woman having IVF treatment. Your doctor will discuss the increased risks that come with age, and can answer any questions you may have.
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