National Institute for Health and Clinical Excellence. Fertility: assessment and treatment for people with fertility problems (update). (Clinical guideline 156.) 2013. www.nice.org.uk/CG156.
This guideline offers best practice advice on assisting people of reproductive age who have problems conceiving. It is estimated that infertility affects about one in seven heterosexual couples in the UK. Since the original NICE guideline on fertility was published in 2004 there has been a small increase in the prevalence of fertility problems and a greater proportion of people now seeking help for such problems. The main causes of infertility in the UK are (percentage figures indicate approximate prevalence): ovulatory disorders (25%); tubal damage (20%); factors in the male causing infertility (30%); uterine or peritoneal disorders (10%). In about 25% of cases infertility is unexplained, with no identified male or female cause. In about 40% of cases disorders are found in both the man and the woman. Uterine or endometrial factors, gamete or embryo defects, and pelvic conditions such as endometriosis may also play a role. Given the range of causes of fertility problems, the provision of appropriate investigations is critical. These investigations include semen analysis; assessment of ovulation, tubal damage and uterine abnormalities; and screening for infections such as Chlamydia trachomatis and susceptibility to rubella. Once a diagnosis has been established, treatment falls into three main types: medical treatment to restore fertility (for example the use of drugs for ovulation induction); surgical treatment to restore fertility (for example laparoscopy for ablation of endometriosis); assisted reproduction technology (ART) – any treatment that deals with means of conception other than vaginal coitus; frequently involving the handling of gametes or embryos.