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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.
If IVF is the best treatment for you, the specialist will refer you to an assisted conception unit (see below).
Read more information about 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.
This can be done with a blood test or by counting the number of egg containing follicles, known as your antral follicle count (AFC), using vaginal ultrasound. An AMH test can be done on any day of your cycle. Your AMH and AFC levels help to estimate how your ovaries will respond to IVF treatment.
Additional semen samples may be required.
The specialist will then discuss your treatment plan with you in detail.
Raed more information about 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.
To read more go HFEA: benefits of counselling and how to access it.
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.
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 collected eggs 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).
The fertilised cells (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), an injection or a gel.
Step six: embryo transfer
The number of embryos to be replaced should have been discussed before treatment starts.
Women under 37 in their first IVF cycle should only have a single embryo transfer. In their second IVF cycle they should have a single embryo transfer if one or more top-quality embryos are available. Doctors should only consider using two embryos if no top-quality embryos are available. In the third IVF cycle, no more than two embryos should be transferred.
Women aged 37–39 years in the first and second full IVF cycles should also have single embryo transfer if there are one or more top-quality embryos, and double embryo transfer should only be considered if there are no top-quality embryos. In the third cycle, no more than two embryos should be transferred.
For women aged 40-42 years, double embryo transfer can be considered.
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 on the HFEA website).
The embryo transfer is done either two to three days after egg collection (cleavage stage of embryo development) or five to six days after egg collection (blastocyst stage).
For more information about embryo transfer, read the HFEA factsheets on:
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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The potential problems associated with IVF are outlined below.
Drug side effects
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
- nausea and vomiting
- shortage of breath
- abdominal bloating due to an accumulation of fluid
- ovarian hyperstimulation syndrome (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.
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:
The 2013 NICE fertility guidelines recommend that double embryo transfers should only be considered during treatment in women aged 40-42. Younger women should only be considered for a double embryo transfer if there are no top-quality 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.
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 and that pregnancy is normal.
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.