Fertility problems: assessment and treatment

  • NICE guideline
  • NG257
  • Published: 
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Defining infertility and initial assessment

1.16 How infertility is defined and assessed

1.16.1

Offer an initial assessment for people who are concerned about delays in conception. Ask about lifestyle and sexual history to identify people who are less likely to conceive. [2004]

1.16.2

Offer an initial consultation to discuss the options for attempting conception to people who are unable to, or would find it very difficult to, have vaginal intercourse. [2013]

1.16.3

The environment in which investigation of fertility problems takes place should enable people to discuss sensitive issues such as sexual abuse. [2004]

1.16.4

Define infertility in practice as the period of time people have been trying to conceive without success after which formal investigation is justified and possible treatment implemented. [2013]

1.16.5

If a woman, or a trans man or non-binary person with female reproductive organs of reproductive age has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any suspected or known clinical cause of infertility, offer both partners further clinical assessment and investigation. [2013, amended 2026]

1.16.6

If a woman, or trans man or non-binary person with female reproductive organs is using artificial insemination to conceive, offer further clinical assessment and investigation if they have not conceived after 6 cycles of insemination, in the absence of any suspected or known clinical cause of infertility. When this is using partner sperm, the referral for clinical assessment and investigation should include their partner. [2013, amended 2026]

1.16.7

If a woman, or a trans man or non-binary person with female reproductive organs experiences a miscarriage or ectopic pregnancy during any of the following timeframes:

  • the 1 year of unprotected vaginal sexual intercourse before people become eligible to have investigations for infertility

  • the period of expectant management for people with unexplained infertility

  • the 12 cycles of artificial insemination

    continue to follow the timeframe and do not restart it after the miscarriage or ectopic pregnancy. [2026]

For a short explanation of why the committee made the 2026 recommendation and how it might affect practice, see the rationale and impact section on miscarriage or ectopic pregnancy when trying to conceive.

1.16.8

Offer referral at presentation for a specialist consultation to discuss the options for attempting conception, further assessment and appropriate treatment if:

  • the woman, trans man or non-binary person with female reproductive organs trying to become pregnant is aged 36 years or over, or

  • either partner has a suspected or known clinical cause of infertility or a history of predisposing factors for infertility. [2013, amended 2026]

1.16.10

Ensure that appropriate advice is provided to people who have chronic viral infections such as hepatitis B, hepatitis C or HIV, and have concerns about their fertility. See the section on viral transmission. [2004, amended 2026]