Treatments for women
If your ovaries are not producing eggs normally you should be offered treatment to stimulate them to produce eggs. This is known as 'ovulation induction'. The type of treatment you need will depend on what is causing the problem.
Polycystic ovary syndrome (PCOS) is a common condition where your ovaries contain more eggs than normal but you do not ovulate regularly.
Polycystic ovary syndrome and weight loss
If you have polycystic ovary syndrome and you are obese (your BMI is 30 or above), losing weight may restart ovulation and increase your chance of becoming pregnant without needing any further treatment. If you do need to take fertility drugs, losing weight will improve how your ovaries respond to these drugs.
If you have polycystic ovary syndrome you should be offered drugs called clomifene citrate or metformin to help you start ovulating. You may be offered one of these drugs or both together. If you are taking clomifene citrate, you should take it for a maximum of 6 months to see whether it will help you.
If you are offered treatment with metformin, your doctor should explain that it can cause side effects, such as nausea, vomiting or other digestive symptoms.
Clomifene citrate and metformin do not work for everyone. If they do not help, you may be offered treatment with gonadotrophins. However, your doctor should explain the increased risks of multiple pregnancy and ovarian hyperstimulation syndrome before you decide to start this treatment (see risks of fertility drugs).
An alternative treatment for polycystic ovary syndrome is called laparoscopic ovarian drilling, which is a surgical procedure that involves a general anaesthetic and a laparoscopy. This can work just as well as treatment with gonadotrophins but does not need monitoring by ultrasound and does not increase your risk of multiple pregnancy.
Your doctor should tell you more about the risks, benefits and side effects of all of these treatments for polycystic ovary syndrome and methods of ovulation induction before you decide to try them.
Ovulation induction using gonadotrophins or clomifene citrate increases your chance of becoming pregnant with more than one baby (a multiple pregnancy). Multiple pregnancies carry greater health risks for you and your babies. The babies are more likely to be premature and have low birth weight. To reduce the risk of multiple pregnancy, your response to these drugs should be monitored by ultrasound during treatment.
Ovarian hyperstimulation syndrome
There is a risk that your ovaries could 'over‑react' to fertility drugs, known as ovarian hyperstimulation syndrome. Mild symptoms of this, including bloating and nausea, are relatively common, but severe ovarian hyperstimulation syndrome can be a serious condition. You should be monitored by ultrasound for this condition during your ovulation induction.
Long-term safety of ovulation induction
There are not known to be any health risks (including cancer risks) directly associated with the use of fertility drugs for ovulation induction in women or in children born as a result of treatment. However, more research is needed into long‑term safety. Your doctor should give you up‑to‑date safety information before you start treatment. They should also limit the drugs used in ovulation induction to the lowest effective dose and length of use.
If you have an ovulation disorder with low levels of gonadotrophin hormones and you have low levels of oestrogen (the female sex hormone), this is often due to low body weight or excessive amounts of exercise. Increasing your body weight (if your BMI is less than 19) and cutting down your exercise may be enough to restart ovulation. To help you ovulate, you may be offered gonadotrophins, or a treatment called pulsatile gonadotrophin-releasing hormone, in which a drug is given gradually through a pump to mimic the natural delivery of gonadotrophins within the body.
If you have a disorder called hyperprolactinaemia you should be offered treatment with a type of drug known as a dopamine agonist, such as bromocriptine. Your doctor should discuss with you the safety of dopamine agonists for women who are intending to get pregnant.
If you have blocked fallopian tubes you may be offered surgery to correct it if the blockage is not severe.
If your fallopian tubes are blocked and swollen (a condition known as hydrosalpinx), you should be offered the choice of having your tubes removed through laparoscopy before IVF. This increases your chances of a successful pregnancy through IVF, but it means you will never be able to conceive naturally in the future.
Since this document was originally published, NICE has published a guideline on endometriosis – please refer to this for help and advice on this topic.
A rare cause of fertility problems is adhesions (tissues that have joined together) in the womb causing a woman's periods to stop. If this happens you may be offered a minor procedure to clear the adhesions, which may help your periods to start again and so improve your chances of getting pregnant.