Fertility treatment and drug options UK

You should also keep in mind that what you’re offered, when you’re offered it, and how much you’re offered on the NHS will vary greatly depending on your location, as each region’s Clinical Commissioning Group (CCG) does things a bit differently.

We've all heard of the IVF postcode lottery, right?

But here's a rundown of the basics, the most common treatments, the not-so-common, plus where to find further information…

Clomid

What is it: Clomid (Clomifene Citrate) is a fertility drug.

What it does: Clomid kick-starts ovulation in women who do not ovulate regularly (or at all). It’s taken daily for 5 days at a time, for 3 to 6 months.

Who's it suitable for? Women with irregular ovulation cycles who need a ‘boost’ – but not those with other fertility issues.

It’s also used for women who have Polycystic Ovary Syndrome (PCOS). It’s thought to be a good 'first step’ on the TTC journey. It’s not recommended for women over 40.

Is it available on the NHS? Clomid is available only on prescription – and costs around £12 for a month’s supply.

What’s the success rate? Clomid is successful in around 10% of cases, though this number varies.

Where can I get more information? We have a full guide to the ins-and-outs of Clomid, which also explains exactly how the drug works. You can also get more information on the Human Embryo & Fertility Authority (HFEA) website.

One mum's experience: "I will shortly be TTC my 3rd Clomid baby! My first is 3 in October and my second is 1 in about 3 weeks!!!! This was after being told it probably wouldn't happen without IVF!" says Natalie, who is a member of our MadeForMums community.

Metformin

What it is: Metformin is a fertility drug that stimulates the ovaries.

What it does: Metformin is used to treat Type 2 Diabetes and PCOS – but in the context of fertility, it works to stimulate the ovaries, encourage regular periods and reduce the risk of miscarriage. It can also lower high cholesterol, according to the NHS.

Who is Metformin suitable for? This may be offered to women for whom Clomid isn’t having the desired effect. It may be offered to take with Clomid, too.

Is it available on the NHS? You can be prescribed Metformin on the NHS. It costs around £19.99 for 56 tablets.

Where can I get more information? There's information on Metformin on the NHS website.

One mum's experience: "I have been TTC for 14 months and had a [miscarriage] back in April last year. Since coming off the pill, I have only had 4 cycles, got diagnosed with PCOS in Oct, wasn't offered a referral, just Metformin for 12 months at a 1000mg/day dose.

"I honestly thought that this wouldn't happen for us for a really long time, especially as I felt like most people were being referred and or offered other treatment straight away." - Diana.

IUI

What it is: Intrauterine Insemination (IUI), also known as Artificial Insemination.

What it does: This method of conception places sperm inside a woman’s uterus, ideally just after ovulation takes place.

The procedure also requires some lab work, where the man’s quickest sperm are separated from the ‘sluggish’ (so a healthy sample is available to use).

Who is IUI suitable for? The HFEA say that IUI is suitable for women using donated sperm in their treatment, women unable to (or would find it difficult to) have vaginal intercourse with her partner, or those with a condition that requires specific help with conception (such as HIV).

It can also be offered to same-sex couples who have a diagnosed fertility issue. Women must have confirmed healthy, open fallopian tubes for the procedure.

It was previously offered to couples with unexplained infertility or a fertility condition like mild endometriosis, but the National Institute for Health and Clinical Excellence (NICE) advises that it should only be offered in exceptional circumstances. In this case, you’re more likely to be offered IVF. Speak to your GP if you have any questions.

Is it available on the NHS? If you meet the criteria, and dependent on the area you live in, you may be offered up to 6 cycles of IUI for free. A further 6 cycles can be offered before considering IVF treatment.

What does it cost privately? It varies, but the NHS estimates £500 - £1,000 per session at a private clinic.

What’s the success rate? Figures from HFEA show that with donated sperm, IUI has a success rate of 15.8% for women under 35. The success rate lowers to 11% for ages 35 – 39, and 4% for 40 years.

Where can I get more information? There's more info on the NHS and HFEA websites.

One mum's experience: "We had TTC for 28 months, unexplained infertility. Our results were always kinda borderline but they gave us the IUI option first and given that it is much less invasive we tried it... and it worked first time!" - Joan

IVF

What it is: In Vitro Fertilisation (IVF)

What it does: This procedure involves taking numerous drugs to stimulate egg production. Once the woman's body is ready, her eggs are taken and fertilised in a lab. Then, the fertilised eggs are placed inside the womb.

Who is IVF suitable for? Women using donor sperm, women with fertility disorders – such as PCOS or fallopian tube blockage – and women who’ve tried and been unsuccessful with other fertility treatments.

Is it available on the NHS? NICE recommends women who are under 43 and have been trying to get pregnant through unprotected sex for 2 years, or have had 12 failed IUI attempts, for IVF.

You can get up to 3 free cycles, depending on your situation. In England, if or how much you’ll be offered depends on your location, as the decisions are made by local commissioning groups.

What does it cost privately? The NHS website states that one cycle of IVF can cost £5,000 or more in a private clinic.

What’s the success rate? For women under 35, the success rate is around 32%.

One mum's experience: “People said the 2-week wait [to see if IVF was successful] would crawl by, and it did. I went back to work after a week of pottering and slowly losing my mind at home. But our little embryo stuck it out and made its home in me" - Yvette

ICSI

What it is: Intra-Cytoplasmic Sperm Injection (ICSI)

What it does: ICSI is similar to IVF – but a single sperm, selected for its high quality, is directly injected into the egg, rather than simply placing several sperm near it.

Who is ICSI suitable for? Couples for whom the male has low sperm count, sperm problems or cases where the sperm needs to be removed surgically from the testicle. Also when embryo testing or frozen sperm is being used.

Is it available on the NHS? Yes. Your GP should be able to advise.

Where can I get more information? Visit the HFEA website for more info.

One mum's experience: "Went through IVF with ICSI in 2008 and was lucky to conceive first time, I highly recommend the treatment.

"The thought of all those drugs and needles is really daunting but once you get started it's not so bad, the thought of it is worse than it actually is." - Lottie

IVM

What it is: In Vitro Maturation

What it does: The procedure takes the woman’s eggs while they are still ‘immature’, and matures them in a lab. Then, they are fertilised via IVF and are placed inside the womb.

Who is IVM suitable for? HFEA says you may be recommended for IVM if you have identified the fertility issue is with the male sperm, or if the female is at risk of developing an illness (Ovarian Hyper-Stimulation Syndrome) as a reaction to fertility drugs.

Is it available on the NHS? Not that we know of, no. But it really depends on your situation and your current location within England. If your GP thinks this is right for you, they’ll refer you to a fertility specialist or clinic.

What does it cost privately? Costs will be specific to your own situation - so private clinics will offer quotes.

What’s the success rate? IVM is quite rare, so there isn’t enough data to provide success rate statistics yet.

Where can I get more information? Visit HFEA for more information.

GIFT

What it is: Gamete Intra Fallopian Transfer (GIFT)

What it does: The eggs are prepped as per IVF, but the fertilisation doesn’t take place in a lab, it takes place in the fallopian tubes, where the healthiest eggs and sperm are placed.

Who is GIFT suitable for? NICE doesn’t recommend GIFT for unexplained fertility, but it has been done before. It’s also suitable when the male has a low sperm count, when for religious reasons IVF is not suitable, or when several IVF attempts have failed. For GIFT to be an option, the woman’s fallopian tubes can’t be blocked or damaged.

Is it available on the NHS? Again, not that we know of. It's best to speak to your GP or specialist to see if this might be a plausible option for you.

Where can I get more information? The HFEA website has more information and resource.

Donor Insemination (DI)

What it is: Using a sperm donor or egg donor to achieve a pregnancy.

What it does: Donated sperm is inserted using IUI, but can also be used in IVF treatments. ICSI and IVF are options for using a donated egg.

Who is DI suitable for? Same sex couples, couples for whom one partner has eggs or sperm that is not viable.

Where can I get more information? There’s a lot to consider when using a donor egg or sperm, including legal info around rights to the child, and the donor’s right to withdraw their donation. Read the full guide on the HFEA website for more information.

Surrogacy

What it is: Surrogacy is when another woman carries and gives birth to your baby.

What it does: There are numerous ways surrogacy can take place: either using the egg and sperm of a couple, which is then ‘hosted’ inside the surrogate – or using donor eggs/sperm (or both).

On some occasions, an egg from the surrogate can be used, at which point IUI will be used to insert the man’s sperm.

Who is surrogacy suitable for? Women who are unable to carry a child for medical reasons (such as a hysterectomy, an absent uterus or premature menopause), same-sex couples, and couples who’ve had repeat miscarriages/unsuccessful IVF treatments.

Is it available on the NHS? No.

What’s the success rate? HFEA notes that it’s too difficult to determine a success rate for surrogacy, as it depends on many differing factors.

Where can I get more information? In the UK, the woman giving birth to the child is considered the legal mother, so there’s a lot to think about before considering surrogacy as an option.

It's widely recommended that you obtain legal advice before going down this road. Visit Surrogacy UK and the British Surrogacy Centre for more detailed info.

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Elizabeth Atkin