Fertility problems: assessment and treatment

  • NICE guideline
  • NG257
  • Published: 
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Management of female factor fertility problems

1.30 Hypogonadotropic hypogonadism

1.30.1

Advise women, and trans men and non-binary people with female reproductive organs who have hypogonadotropic hypogonadism and anovulatory infertility that they may improve their chance of regular ovulation, conception and an uncomplicated pregnancy by:

  • increasing their body weight to reach a healthy weight if they have a body mass index (BMI) of less than 18.5 kg/m2 and/or

  • moderating their exercise levels if they undertake high levels of exercise.

    Also see NHS advice on healthy ways to gain weight. [2026]

1.30.2

Offer gonadotrophins with luteinising hormone activity or gonadotrophin releasing hormone to induce ovulation in women, and trans men and non-binary people with female reproductive organs who have hypogonadotropic hypogonadism. [2026]

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on hypogonadotropic hypogonadism.

Full details of the evidence and the committee's discussion are in evidence review E: ovulation induction strategies for hypogonadotropic hypogonadism.

1.31 Hypothalamic-pituitary-ovarian dysfunction (predominantly PCOS)

The recommendations in this section have been removed because NICE is developing a guideline on polycystic ovary syndrome (PCOS). For more information see the NICE website.

1.32 Ovulatory disorders due to hyperprolactinaemia

1.32.1

Offer cabergoline to treat ovulatory disorders due to hyperprolactinaemia. [2026]

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on ovulatory disorders due to hyperprolactinaemia.

Full details of the evidence and the committee's discussion are in evidence review F: cabergoline for hyperprolactinaemia.

1.33 Monitoring ovulation induction during gonadotrophin therapy

1.33.1

Inform women, and trans men and non-binary people with female reproductive organs who are offered ovulation induction with gonadotrophins about the risk of multiple pregnancy and ovarian hyperstimulation before starting treatment. [2004]

1.33.2

Use ovarian ultrasound monitoring to measure follicular size and number as an integral part of gonadotrophin therapy, to reduce the risk of multiple pregnancy and ovarian hyperstimulation. [2004]

1.34 Tubal surgery

Tubal surgery for mild tubal disease

1.34.1

Consider tubal surgery as a treatment option for mild tubal disease, in centres where appropriate expertise is available. [2026]

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on tubal surgery for mild tubal disease.

Full details of the evidence and the committee's discussion are in evidence review G: tubal surgery.

Tubal catheterisation

1.34.2

Consider fallopian tube catheterisation by hysteroscopic or radiological guidance to treat subfertility due to proximal tube obstruction, after discussing the risks and benefits of other options, including in vitro fertilisation (IVF). [2026]

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on tubal catheterisation.

Full details of the evidence and the committee's discussion are in evidence review I: tubal catheterisation.

Surgery for hydrosalpinges before IVF

1.34.3

Offer laparoscopic salpingectomy or tubal occlusion to treat hydrosalpinges before IVF. [2026]

1.34.4

Consider aspiration to treat hydrosalpinges, close to the time of oocyte retrieval, if there is a high risk of complications from laparoscopic surgery. [2026]

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on surgery for hydrosalpinges before IVF.

Full details of the evidence and the committee's discussion are in evidence review H: surgery for hydrosalpinges before IVF.

1.35 Uterine surgery

1.35.1

Offer hysteroscopic adhesiolysis for women, and trans men and non-binary people with female reproductive organs with amenorrhoea who are found to have intrauterine adhesions, because this is likely to restore menstruation and improve the chance of pregnancy. [2004]

1.36 Endometriosis

The recommendations in this section should be read in conjunction with NICE's guideline on endometriosis.

1.36.2

If the woman, trans man or non-binary person with endometriosis has not conceived during 2 years of expectant management or after surgical treatment, or if expectant management or surgical treatment (or both) is not appropriate, discuss the fertility treatment options and:

  • consider up to 4 cycles of intrauterine insemination (IUI) with ovarian stimulation using gonadotrophins before offering IVF treatment, if appropriate, or

  • offer IVF treatment (see the section on access criteria for IVF).

    Explain the potential risks and benefits of each option and take into account the person's individual preferences and circumstances during discussions. [2026]

1.36.3

When discussing fertility with women, and trans men, and non-binary people with female reproductive organs who have endometriosis, take into account:

  • the length of time they have been trying to conceive

  • the symptoms and severity of the endometriosis

  • their age

  • their ovarian reserve

  • any male factor fertility issues. [2026]

For a short explanation of why the committee made the 2026 recommendations and how they might affect practice, see the rationale and impact section on endometriosis.

Full details of the evidence and the committee's discussion are in evidence review K: assisted reproduction techniques for people with unexplained fertility problems, mild endometriosis, and mild male factor fertility problems.