The three main types of medical intervention for fertility and conception are medications, surgery, and assisted conception. Surgical options include microsurgery on the fallopian tubes or to clear epididymal blockages, or to remove endometrial tissue in endometriosis.⁵

Assisted conception includes:⁵

• intrauterine insemination (placing sperm into the uterus);
• in vitro fertilisation (incubating ova removed from the ovary with sperm for up to 72 hours and then placing a resulting embryo into the uterus);
• intracytoplasmic sperm injection (ICSI – an individual sperm is injected directly into an ovum in vitro and the embryo is then placed in the uterus);
• oocyte donation (a donor’s ova are harvested and mixed with sperm in vitro before placing in the recipient woman’s uterus);
• embryo donation (in vitro embryos left over from a successful IVF or ICSI process are donated);
• gamete intrafallopian transfer (retrieving ova and mixing them with sperm in vitro before putting the ova and sperm into the uterus).

NICE recommendations for medicines to induce ovulation are:⁵

• clomifene for anovulation;
• gonadotrophins – used if clomifene is ineffective in women, or to improve male fertility where there is hypogonadotropic hypogonadism;
• pulsatile gonadotrophin-releasing hormone (to mimic natural cyclic secretion levels) and dopamine agonists – particularly for women with ovulatory problems due to hyperprolactinaemia.