Getting started Your guide to fertility treatment www.hfea.gov.uk This guide is for general information only; the HFEA does not provide medical or legal advice to individuals. If you are considering fertility treatment, you should first get professional advice based on your specific circumstances. While we have made every effort to ensure that the guide is accurate as at September 2017, we make no representations or warranty of any kind, express or implied, as to its accuracy, completeness, suitability or reliability. We accept no liability for any consequences that may arise from your acting or not acting in reliance on the information in this guide. 1 We’re here to help When you’re As chair of the HFEA, I am exploring fertility proud that we have used our treatment, it’s expertise and years of experience difficult to know to produce this guide, which is where to start. an excellent resource, and one There’s so much which I would have very much information appreciated when I was a out there and fertility patient. It brings together it’s hard to know which sources authoritative, independent you can trust. I know this from information on a wide range personal experience. of topics to help you through your journey, providing a holistic We are the Human Fertilisation view of the advice, treatment and Embryology Authority (HFEA), and support available. the UK regulator of fertility treatment and research. We work You can find more information hard to make sure that the on our website www.hfea.gov.uk treatment you have is high quality, Sally Cheshire CBE whatever the outcome. HFEA Chair 2 Contents We’re here to help 1 How to choose a clinic 24 Services offered 25 How and when to seek fertility treatment 4 Eligibility for treatment 25 If you are having problems Cost 25 conceiving 5 Location and opening times 25 If you are in a same sex Waiting times 25 female couple 10 First appearances 26 If you are a single woman 12 Cycles of treatment If you have a attempted 26 genetic condition 13 Embryo transfer policy 26 If you want to preserve your fertility 15 Support groups and counselling 27 If you are trans or non-binary 16 Faith and language issues 27 Get started 18 What does our inspection NHS treatment 19 report say about this clinic? 27 Private treatment 19 Birth rates 27 Treatment abroad 20 How can I see birth rates relevant to me? 29 Boosting your chances 22 Get support and advice 23 3 What to expect at a clinic 31 Storing eggs, sperm and embryos 66 Tests 32 Freezing and storing embryos 67 Forms 32 Freezing and storing sperm 70 Questions to ask at the clinic 34 Freezing and storing eggs 71 Treatment options 36 Ovarian tissue freezing 72 Fertility drugs 37 Testicular tissue freezing 73 In vitro fertilisation (IVF) 40 What to think about Intra-cytoplasmic before starting treatment 75 sperm injection (ICSI) 46 Cost 76 Intrauterine insemination (IUI) 50 Risks 77 Using donated sperm, eggs or embryos in your treatment 53 Consent to treatment 81 Genetic testing 61 Get support and advice 87 Treatment add ons 65 If fertility treatment fails, what next? 88 Contacts 90 4 How and when to seek fertility treatment If you are thinking about having fertility treatment, it can be difficult to know where to start. This section gives you an overview of the initial steps you may take, depending on your situation, and how this guide might be useful to you in each case. Getting started: your guide to fertility treatment 5 While every person is different Your GP may also arrange for and it’s impossible to map you to have some initial tests. out every scenario, we have For women, this may include: identified the most common • a cervical smear test if you reasons for seeking fertility haven’t had one recently treatment. In every case there • a urine test for chlamydia, will be sections of this guide which can block your fallopian which are relevant to you. tubes, preventing you from becoming pregnant If you are having • a blood test to see if you problems conceiving are ovulating (this is done by If you are having trouble becoming measuring progesterone in pregnant, you’re not alone. About a blood sample taken seven one in seven couples have days before your period is due) difficulty conceiving naturally. • a blood test during your If you have been trying for a period to check for hormone baby for over a year you should imbalances – measuring follicle see your GP. You should see your stimulating hormone (FSH), GP sooner if you are aged 36 or luteinising hormone (LH) over, have been diagnosed with and oestradiol. a cause of infertility or have a For men initial history of problems which may tests may include: affect your fertility. • a urine test for chlamydia, (S)he will listen to your concerns, which, as well as being a make a note of your medical known cause of infertility in history, ask you questions about women, can also affect sperm your diet and lifestyle and perhaps function and male fertility give you a physical examination. 6 Getting started: your guide to fertility treatment • a referral to your local hospital • blood tests to find out whether or fertility clinic for a sperm test you are ovulating to check for poor morphology • an ultrasound scan to look (abnormal shape), poor motility at your womb and ovaries (not moving normally), or both. • follicle tracking – a series of If your test results are normal and ultrasound scans to follow the you have been trying for a baby for development of a follicle to less than 18 months, your GP may see if an egg is developing suggest you make a few lifestyle changes and continue trying to • hysterosalpingogram – an x-ray conceive naturally. to check your fallopian tubes If the tests reveal a possible fertility • laparoscopy – an operation issue, especially if you are in your to check for any blockages 30s or older, they may make an in the fallopian tubes appointment for you to see a • hysteroscopy – a procedure specialist for further tests. This which involves using a could be at your local hospital or telescope with a camera at a fertility clinic, where you would attached to view your uterus also go on to have treatment if to check for conditions such necessary (see p24 for advice as fibroids or polyps on choosing a fertility clinic). • hysterosalpingo-contrast For women, the tests you sonography (HyCoSy) – a scan may have at your local hospital which uses a vaginal ultrasound or clinic include: probe to check the fallopian • a full hormone profile to tubes for blockages measure any hormone • occasionally, a tissue imbalance sample may be taken from the endometrium lining of your uterus to be analysed. Getting started: your guide to fertility treatment 7 For men, depending on the results of a semen analysis, Diagnosis the tests you could have at your When there is a fertility problem local hospital or clinic include: in men, this is usually linked to low • blood tests to find out numbers or poor quality of sperm. the reason for any sperm This might be due to past medical abnormalities treatments, genetic abnormalities or lifestyle factors, but more often • karyotyping – a test to than not there is no obvious cause. examine chromosomes In women the causes of fertility • a testicular biopsy to find problems are more varied. They out the reason for a low include the failure to release an sperm count. egg every month (to ovulate), If you are unable to produce endometriosis, damage to the sperm, you may have surgical fallopian tubes, and polycystic sperm retrieval – a procedure to ovary syndrome (PCOS). remove sperm from the epididymis or the testicles – so that diagnostic tests can be performed. 8 Getting started: your guide to fertility treatment Your lifestyle can affect your Key facts chances of conceiving, particularly • Endometriosis is a condition if you are a heavy smoker or are in which endometrial cells, significantly overweight or which normally line the underweight. womb, implant themselves In a quarter of cases, despite around the outside of the investigations, a clear cause of womb or ovaries (or both), infertility is never established. causing internal bleeding This is often called unexplained and pain and reducing infertility. fertility. Whatever your diagnosis, your • Polycystic ovary syndrome clinician will explain the treatment is a condition in which options that are available to you. many small cysts form on the ovary resulting in How this guide can help you hormonal imbalances, This booklet gives you a variety which can cause infertility. of useful information to guide you through your journey – from Women also become less fertile information about NHS funding as they get older. Of women aged and private treatment to how to 35 and under who have regular choose a fertility clinic, what unprotected sexual intercourse, to expect at the clinic and the 95% will get pregnant within three treatment options and support years of trying, while by the age of available. A typical route through 38 only 75% of women will do so. this guide might be as follows: Getting started: your guide to fertility treatment 9 How and when to seek fertility treatment Get started (p18) How to choose a clinic You are considering (p24) using donated sperm, eggs or embryos in your treatment What to expect at a clinic (p31) Treatment options: Using donated sperm, • IVF (p40) eggs or embryos in • ICSI (p46) your treatment • IUI (p50) (p53) You plan to freeze What to think about your unused embryos before starting (IVF and ICSI only) treatment (p75) Storing eggs, sperm Get support and and embryos advice (p66) (p87) 10 Getting started: your guide to fertility treatment IVF would also be used where If you are in a same you carry the baby but use your sex female couple partner’s eggs in your treatment.