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.
You can also see this guideline in the NICE pathway on fertility.
To find out what NICE has said on topics related to this guideline, see our web page on fertility.
See also the guideline committee's discussion and the evidence reviews (in the addendum and full guideline), and information about how the guideline was developed, including details of the committees.