Guidance

Context

Context

It is estimated that infertility affects 1 in 7 heterosexual couples in the UK. Since the original NICE guideline on fertility published in 2004, there has been a small increase in the prevalence of fertility problems, and a greater proportion of people now seeking help for such problems.

The main causes of infertility in the UK are (per cent figures indicate approximate prevalence):

  • unexplained infertility (no identified male or female cause; 25%)

  • ovulatory disorders (25%)

  • tubal damage (20%)

  • factors in the male causing infertility (30%)

  • uterine or peritoneal disorders (10%).

In about 40% of cases, disorders are found in both the man and the woman. Uterine or endometrial factors, gamete or embryo defects, and pelvic conditions such as endometriosis may also play a role.

Given the range of causes of fertility problems, the provision of appropriate investigations is critical. These investigations include semen analysis; assessment of ovulation, tubal damage and uterine abnormalities; and screening for infections such as Chlamydia trachomatis and susceptibility to rubella.

Once a diagnosis has been established, treatment falls into 3 main types:

  • medical treatment to restore fertility (for example, the use of drugs for ovulation induction)

  • surgical treatment to restore fertility (for example, laparoscopy for ablation of endometriosis)

  • assisted reproduction techniques (ART) – any treatment that deals with means of conception other than vaginal intercourse. It frequently involves the handling of gametes or embryos.