Fertility

Trying for a baby

The decision to start a family is an important step that many couples make together. When couples start trying to conceive but are finding it hard, it can be both disheartening and stressful, but you are not alone. As many as 1 in 7 heterosexual couples will struggle to conceive naturally; that’s as many as 3.5 million people in the UK.

Conceiving naturally can take time. You and your partner should aim to have regular sex every two to three days without any form of contraception. It can sometimes take a while for some types of contraception to stop working which may affect your ability to get pregnant initially.

Conceiving is a very natural but also very complicated part of life. Sometimes it can feel like you are in the dark about what is going on which can be very frustrating, but if you have been trying less than a year and are aged under 36, then there may be no need to seek help. If you have been trying for over a year without success, then you can speak to your GP about what may be going on and also find out ways that might help boost your chances of getting pregnant.

Same-sex Couples

For same-sex female couples where one of you is trying to become pregnant, the first treatment option is self-funded intrauterine insemination (IUI). This is a process where a sperm is directly inserted into the womb. You can speak to your GP to find out more about this treatment. Other treatments are discussed in the further treatment options section.

Seeing your GP

Your GP should be the first health professional you see to discuss why you are finding it difficult to conceive. Both you and your partner should book an appointment so that your GP can start investigations to find out why you may be struggling to get pregnant.

During the appointment, your GP will ask you a series of questions about your medical and sexual history and also your lifestyle. They may also conduct a physical examination of your pelvic area if you’re a woman or your testicles and penis if a man. Some of the questions and the physical examination may make you feel uncomfortable, but remember your GP is trying to help and needs to ask questions and conduct examinations so that they can narrow down potential causes.

After asking questions about your fertility, you will then be asked to provide a number of samples which can then be tested.

Female investigations include:

Blood test to check hormone levels which can reveal details about your egg production;
Cervical screening to check for abnormal cells which can have an effect on pregnancy and birth;
Ultrasound scan to check the womb for conditions that can prevent pregnancy;
Chlamydia test to test for chlamydia which can affect fertility.

Male investigations include:

Semen Analysis so that the health of your sperm can be determined;
Chlamydia test due to its effect on fertility.

A visual infographic detailing the steps involved in a medical process. Step 1: Represented by a purple circle with the text 'Your GP is the first port of call and can carry out a number of tests and examinations'. Step 2: Illustrated with a turquoise circle stating 'You may be referred to a consultant within secondary care for further investigations'. Step 3: Showcased by a green circle with the inscription 'You will then have a further appointment with the consultant who will discuss treatment options'. Step 4: Highlighted by a blue circle which reads 'Couples who require IVF treatment, who meet the criteria in place will be referred to an ACU of their choice'.

IVF pathway diagram

1. Your GP is the first port of call and can carry out a number of tests and examinations.
2. You may be referred to a consultant within secondary care for further investigations.
3. You will then have a further appointment with the consultant who will discuss treatment options.
4. Couples who require IVF treatment, who meet the criteria in place will be referred to a ACU of their choice.

What happens after your GP visit?

After your appointment, you can continue to try and conceive naturally. Your GP will give you some recommendations based on your lifestyle answers which could help boost your chance on conceiving. These may include dietary changes or quitting smoking. You can find out more about lifestyle changes that can boost pregnancy on the NHS website:

NHS pregnancy questions NHS men’s health questions

Your GP may refer you to a consultant within secondary care for further investigations. At your consultant appointment, a number of tests will be completed to further investigate what may be preventing you and your partner from becoming pregnant. Some of these will be similar to the ones carried out by your GP, some others may be new to you. The tests include:

Physical examination / medical history: you and your partner will both be asked about your medical history. Your height and weight will be recorded and the doctor may ask to examine you.
Blood tests: You or your partner may be asked to provide a blood sample to run some checks such on your hormone levels.
Chlamydia test or chlamydia swab
Repeat semen analysis if necessary
An ultrasound will be requested
A hysterosalpingogram: this is an x-ray procedure used to check the uterus and fallopian tubes (the passage between ovaries and uterus).

A follow up appointment will be arranged, after the first appointment. Your consultant will discuss the findings of your tests and what is the best way forward. This could include a number of procedures which can help boost you chances of getting pregnant. This includes Ovulation Induction which is a fertility treatment for women that encourages the production and release of eggs.

Depending on the results of your tests, some further investigations may be needed to see why you are struggling to conceive, or you may be referred to one of eight commissioned Assisted Conception Units (ACU) where other treatment options are available.

Further treatment options

If you are still not able to conceive after the fertility investigations and treatment within secondary care, you may be eligible to be referred to an Assisted Conception Units (ACU) for In Vitro Fertilisation (IVF) or Intacytoplasmic Sperm Injection (ICSI) You can read more about both of these treatments in the next section. There are certain eligibility criteria that every couple must meet before they can be referred to these treatments. To be eligible for treatment within the MSE:

Both individuals in the couple must be ordinarily resident in the UK and have been registered with a GP within Mid and South Essex ICB for a minimum of 12 months
Couples must have experienced unexplained infertility for two (2) years or more of regular unprotected sexual intercourse or they are using artificial insemination to conceive and have not become pregnant after 6 cycles. For couples with a diagnosed cause of infertility there is no time criterion
The woman or person assigned female at birth must be between their 23rd and 42nd birthday, with a BMI of more than 19kg/m2 and less than 30kg/m2
The man or person assigned male at birth must have a BMI of less than 35kg/m2.
You will need to have a follicle stimulating hormone (FSH) level of 9IU/I or below as women with higher levels of this hormone are less likely to respond to fertility drugs. Speak to your consultant to find out more about FSH and its importance to fertility treatment;
There should be no surviving children from this relationship including adopted children but excluding fostered children. There should be no children from previous relationships. There is an explicit and recorded assessment that the social circumstances of the family unit have been considered within the context of the assessment of the welfare of the child.
The welfare of any resulting children is paramount. In order to take into account, the welfare of the child, the clinician should consider factors which are likely to cause serious physical, psychological or medical harm, either to the child to be born or to any existing children of the family. This is a requirement of the licensing body, Human Fertilisation and Embryology Authority (HFEA).
If any fertility treatment results in a surviving child, then the couple will no longer be considered childless and will not be eligible for further NHS funded fertility treatments, including the implantation of any stored embryos. Any costs relating to the continued storage of the embryos beyond the first calendar year of the retrieval date is the responsibility of the couple.
Both partners must be confirmed non-smokers
Written consent to treatment is required from both partners
Neither partner has been sterilised

Same-sex couples

NHS funded IVF treatment is available for same-sex female couples. After an initial GP visit you will attend secondary care for further fertility investigations. You will become eligible for NHS funded IVF treatment or ICSI after you have completed 6 cycles of self-funded intrauterine insemination (IUI), unless there is a diagnosed cause of infertility. In addition you will also need to meet the same eligibility criteria outlined above.

What is IVF and ICSI?

IVF (In Vitro Fertilisation) and ICSI (Intracytoplasmic Sperm Injection) are both a form of treatment that involves collecting some eggs from a female partner and fertilising them with sperm in the lab. Once the eggs have been fertilised, one or two embryos will be placed back in to the womb. The two treatments differ in the number of sperm used. with IVF, the egg is added to a solution containing a large number of sperm. With ICSI, one sperm is injected directly into the egg. ICSI is used if sperm is unlikely to fertilise an egg naturally.

To collect the eggs that are to be used in either IVF or ICSI treatment, medication will be given to the partner who is trying to become pregnant. This medication will stop the natural cycle of egg production. You will also receive daily injections that will boost the number of eggs that mature. A short procedure will then take place to collect a number of eggs which will be fertilised using a sperm sample from either your partner or a donor. One or two eggs are then placed back into the uterus.

An illustrated diagram showcasing parts of the female reproductive system. At the top is a depiction of the uterus and ovaries (labelled as 1), below it is a magnified view of an ovary containing follicles (labelled as 2). Further down, there's a representation of the fallopian tube (labelled as 3) with a close-up of two sections: one depicting a mature egg (labelled as 'a') and another showing the cilia lining the tube (labelled as 'b'). Next, a zoomed-in image (labelled as 4) displays an ovum surrounded by smaller cells. At the bottom, there's another view of the uterus (labelled as 5) with a highlighted section showcasing the endometrial lining

IVF cycle diagram

The picture displays a uterus with eggs in the right ovary.
1. Boosting egg supply: Medication is used to boost the number of mature eggs.
2. Collecting eggs: The mature eggs are collected during a short medical procedure. (A graphic displays eggs within a test tube.)
3. Fertilising the eggs: The eggs are introduced to sperm in one of two ways.
a. IVF: The eggs are added to a solution containing a large number of sperm. (A graphic shows four eggs each surrounded by numerous sperm.)
b. ICSI: A single sperm is injected straight into an egg. (A graphic shows a single sperm being injected into the egg.)
4. Embryo develops: The fertilised egg begins to develop into an embryo. (A graphic displays an embryo.)
5. Embryo transfer: Once the embryo is ready, it will be transferred to the uterus.
Picture displays a uterus with

IVF with or without ICSI

Women between the age of 23-40 will be funded for a maximum of 4 embryo transfers (fresh and frozen), obtained from a maximum of 2 cycles of IVF, with or without ICSI, which includes any abandoned/cancelled cycles, as defined in the criteria.

Women between the age of 40-42 will be funded a maximum of two (2) embryo transfers
(fresh and frozen) obtained from a maximum of one (1) cycle of IVF, with or without ICSI,
which includes any abandoned/cancelled cycles , as defined in the criteria.

Either your consultant or fertility nurse within secondary care will complete a prior approval form which will be sent to the Funding Team who process applications on behalf of MSE ICB. A decision will be made based on the clinical information provided which evidences that the couple meet the criteria for NHS funded treatment within the MSE.

Your consultant or fertility nurse will notify you of the decision made. If funding is declined, an explanation will be provided to the Trust to enable them to feedback to the couple. Please note that either your GP or another clinical professional can appeal the decision to decline funding, however this will only be considered on receipt of additional clinical evidence. Patients who do not meet the full criteria will not be offered NHS funding.

If your funding is approved, you will then be able to attend an ACU to discuss fertility treatment. There are five clinics* that provide IVF and ICSI which couples can choose from. These are:

Please note IVF treatment can takes several weeks and will differ slightly from clinic to clinic, but the full process will be explained to you at your initial appointment with the ACU you choose. You can find out a little more about IVF and ICSI treatment following some of the links in the below section.

*The clinics that provide IVF and ICSI are subject to change.