IVF is only offered on the NHS if certain criteria are met. If you don't meet these criteria, you may need to pay for private treatment.

NICE recommendations

The National Institute for Health and Care Excellence (NICE) fertility guidelines makes recommendations about who should have access to IVF treatment on the NHS in England and Wales.

But individual NHS clinical commissioning groups (CCGs) make the final decision about who can have NHS-funded IVF in their local area, and their criteria may be stricter than those recommended by NICE.

Women under 40

According to NICE, women aged under 40 should be offered 3 cycles of IVF treatment on the NHS if:

• they've been trying to get pregnant through regular unprotected sex for 2 years
• they've not been able to get pregnant after 12 cycles of artificial insemination

If you turn 40 during treatment, the current cycle will be completed, but further cycles shouldn't be offered.

If tests show IVF is the only treatment likely to help you get pregnant, you should be referred straight away.

Women aged 40 to 42

The NICE guidelines also say women aged 40 to 42 should be offered 1 cycle of IVF on the NHS if all of the following criteria are met:

• they've been trying to get pregnant through regular unprotected sex for 2 years, or haven't been able to get pregnant after 12 cycles of artificial insemination
• they've never had IVF treatment before
• they show no evidence of low ovarian reserve (where eggs in your ovaries are low in number or quality)
• they've been informed of the additional implications of IVF and pregnancy at this age

Again, if tests show IVF is the only treatment likely to help you get pregnant, you should be referred straight away.

IVF on the NHS

NHS trusts across England and Wales are working to provide the same levels of service. But the provision of IVF treatment varies across the country, and often depends on local CCG policies.

CCGs may have additional criteria you need to meet before you can have IVF on the NHS, such as:

• not having any children already, from both your current and any previous relationships
• being a healthy weight
• not smoking
• falling into a certain age range (for example, some CCGs only fund treatment for women under 35)

Although NICE recommend that 3 cycles of IVF should be offered on the NHS, some CCGs only offer 1 cycle, or only offer NHS-funded IVF in exceptional circumstances.

Ask your GP or contact your local CCG to find out whether NHS-funded IVF treatment is available in your area.

Private treatment

If you're not eligible for NHS treatment or you decide to pay for IVF, you can have treatment at a private clinic.

Some clinics can be contacted directly without seeing your GP first, but others may ask for a referral from your GP.

The cost of private treatment can vary, but 1 cycle of IVF can cost up to £5,000 or more. There may be additional costs for medicines, consultations and tests.

Make sure you find out exactly what's included in the price during your discussions with the clinic.

Some people consider having IVF abroad, but there are a number of issues you need to think about, including your safety and the standard of care you'll receive. Clinics in other countries may not be as regulated as they are in the UK.

You can read about private fertility treatment and the issues and risks associated with fertility treatment abroad on the Human Fertilisation and Embryology Authority (HFEA) website.

You can also search for HFEA-regulated fertility clinics in the UK.

If you're having problems getting pregnant, see your GP. They will look at your medical history and give you a physical examination.

They may also recommend some lifestyle changes to help fertility.

Unless there are reasons that may put you at high risk of infertility, such as cancer treatment, you'll usually only be considered for infertility investigations and treatment if you've been trying for a baby for at least a year without becoming pregnant.

If appropriate, your GP can refer you to a fertility specialist at an NHS hospital or fertility clinic.

Seeing a fertility specialist

The specialist will ask about your fertility history, and may carry out a physical examination.

Women may have tests to check the levels of hormones in their blood and how well their ovaries are working.

They may also have an ultrasound scan or X-ray to see if there are any blockages or structural problems.

Men may be asked for a semen sample to test sperm quality.

If IVF is the best treatment for you, the specialist will refer you to an assisted conception unit.

Read more about diagnosing infertility and when IVF is offered on the NHS.

At the assisted conception unit

Once you're accepted for treatment at the assisted conception unit, you and your partner will have blood tests for HIV, hepatitis B and hepatitis C.

Your cervical screening tests should also be up-to-date.

The clinic should also check that you've been offered a screening blood test for sickle cell and thalassaemia if your ancestors come from a country where these conditions are more common.

Anyone can ask to have this test for free on the NHS from their GP or local sickle cell and thalassaemia centre.

If you're planning to use donor eggs, check that these have been screened. All IVF clinics in the UK are required to screen donor eggs and sperm.

The specialist will investigate the number of eggs in your body (your ovarian reserve) to estimate how your ovaries will respond to IVF treatment.

This can be assessed by measuring a substance called anti-mullerian hormone (AMH) in your blood, or by counting the number of egg-containing follicles, known as your antral follicle count (AFC), using a vaginal ultrasound scan.

Your specialist will then discuss your treatment plan with you in detail and talk to you about any support or guidance you may find helpful.

Read more about what happens during IVF and the support available during IVF.

What happens during IVF may differ slightly from clinic to clinic, but a typical treatment follows the main steps below.

For women

Step 1: suppressing the natural menstrual cycle

You're given a medication that will suppress your natural menstrual cycle. This can make the medicines used in the next stage of treatment more effective.

This medication is given either as a daily injection that you'll be taught to give yourself, or as a nasal spray. You continue this for about 2 weeks.

Step 2: boosting the egg supply

Once your natural cycle is suppressed, you take a fertility hormone called follicle stimulating hormone (FSH). This is another daily injection you give yourself, usually for about 10 to 12 days.

FSH increases the number of eggs your ovaries produce. This means more eggs can be collected and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.

Step 3: checking progress

The clinic will keep an eye on you throughout the treatment. You'll have vaginal ultrasound scans to monitor your ovaries and, in some cases, blood tests.

About 34 to 38 hours before your eggs are due to be collected, you'll have a final hormone injection that helps your eggs to mature.

Step 4: collecting the eggs

You'll be sedated and your eggs will be collected using a needle that's passed through the vagina and into each ovary under ultrasound guidance. 

This is a minor procedure that takes about 15 to 20 minutes.

Some women experience cramps or a small amount of vaginal bleeding after this procedure.

Step 5: fertilising the eggs

The collected eggs are mixed with your partner's or the donor's sperm in a laboratory. After 16 to 20 hours, they're checked to see if any have been fertilised.

In some cases, each egg may need to be injected individually with a single sperm. This is called intra-cytoplasmic sperm injection or ICSI. The Human Fertilisation and Embryology Authority (HFEA) has more information about ICSI.

The fertilised eggs (embryos) continue to grow in the laboratory for up to 6 days before being transferred into the womb. The best 1 or 2 embryos will be chosen for transfer.

After egg collection, you'll be given hormone medicines to help prepare the lining of the womb to receive the embryo. This is usually given either as a pessary placed inside the vagina, an injection, or a gel.

Step 6: embryo transfer

A few days after the eggs are collected, the embryos are transferred into the womb. This is done using a thin tube called a catheter that's passed into the vagina.

This procedure is simpler than egg collection and similar to having a cervical screening test, so you won't normally need to be sedated.

The number of embryos that will be transferred should be discussed before treatment starts.

It usually depends on your age:

• Women under 37 in their first IVF cycle should only have a single embryo transfer. In their second IVF cycle, they should have a single embryo transfer if one or more top-quality embryos are available. Doctors should only consider using 2 embryos if no top-quality embryos are available. In the third IVF cycle, no more than 2 embryos should be transferred.
• Women aged 37 to 39 years in the first and second full IVF cycles should also have single embryo transfer if there are 1 or more top-quality embryos, and double embryo transfer should only be considered if there are no top-quality embryos. In the third cycle, no more than 2 embryos should be transferred.
• Women aged 40 to 42 years may have a double embryo transfer.

If any suitable embryos are left over, they may be frozen for future IVF attempts.

The HFEA has more about decisions to make about your embryos.

For men

Around the time your partner's eggs are collected, you'll be asked to produce a fresh sperm sample.

The sperm are washed and spun at a high speed so the healthiest and most active sperm can be selected.

If you're using donated sperm, it's thawed before being prepared in the same way.

Finding out if you're pregnant

Once the embryos have been transferred into the womb, you'll be advised to wait around 2 weeks before having a pregnancy test to see if the treatment has worked.

Some clinics may suggest carrying out a normal urine pregnancy test at home and letting them know the result, while others may want you to come into the clinic for a more accurate blood test.

This 2-week wait can be a very difficult period because of the anxiety of not knowing whether the treatment has worked. Some people find it the hardest part of the treatment process.

During this period, you may find it useful to speak to a counsellor through the fertility clinic, or to contact other people in a similar situation to you through the HealthUnlocked IVF community.

If you do become pregnant, ultrasound scans will be carried out during the following weeks to check things are progressing as expected.

You'll then be offered the normal antenatal care given to all pregnant women.

Unfortunately, IVF is unsuccessful in many cases and you should try to prepare yourself for this possibility.

You may be able to try again if treatment doesn't work, although you shouldn't rush straight into it.

You may find counselling or fertility support groups helpful during this difficult time. 

Read more about the support available during IVF.

Before starting IVF, it's important to be aware of the potential problems that could occur.

Some of the main risks are outlined below.

Medication side effects

Many women will have some reaction to the medications used during IVF. Most of the time, the side effects are mild.

They may include:

• hot flushes
• feeling down or irritable
• headaches
• restlessness
• ovarian hyperstimulation syndrome

Contact the fertility clinic if you experience persistent or worrying side effects during treatment.

Multiple births

If more than one embryo is replaced in the womb as part of IVF treatment, there's an increased chance of producing twins or triplets.

Having more than one baby may not seem like a bad thing, but it significantly increases the risk of complications for you and your babies.

Problems more commonly associated with multiple births include:

• miscarriage
• pregnancy-related high blood pressure and pre-eclampsia
• gestational diabetes
• anaemia and heavy bleeding
• needing a caesarean section

Your babies are also more likely to be born prematurely or with a low birth weight, and are at an increased risk of developing life-threatening complications such as neonatal respiratory distress syndrome (NRDS) or long-term disabilities, such as cerebral palsy.

National Institute for Health and Care Excellence (NICE) guidelines recommend that double embryo transfers should only be considered in women aged 40 to 42.

Younger women should only be considered for a double embryo transfer if there are no top-quality embryos to choose from.

Read more about the risks of multiple births on the One at a time website.

Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is a rare complication of IVF.

It occurs in women who are very sensitive to the fertility medication taken to increase egg production. Too many eggs develop in the ovaries, which become very large and painful.

OHSS generally develops in the week after egg collection.

The symptoms can include:

• pain and bloating low down in your tummy
• feeling and being sick
• shortness of breath
• feeling faint

Severe cases can be dangerous. Contact your clinic as soon as possible if you have any of these symptoms. 

It may be necessary to cancel your current treatment cycle and start again with a lower dose of fertility medication.

Ectopic pregnancy

If you have IVF, you have a slightly higher risk of an ectopic pregnancy, where the embryo implants in the fallopian tubes rather than in the womb.

This can cause pain in the tummy, followed by vaginal bleeding or dark vaginal discharge.

If you have a positive pregnancy test after IVF, you'll have a scan at 6 weeks to make sure the embryo is growing properly and that your pregnancy is normal.

Tell your doctor if you experience vaginal bleeding or stomach pain after having IVF and a positive pregnancy test.

Risks for older women

IVF treatment becomes less successful with age. In addition, the risk of miscarriage and birth defects increases with the age of the woman having IVF treatment.

Your doctor will discuss the increased risks that come with age and can answer any questions you may have.

Having IVF can be emotionally and physically draining, but help and support is available if you need it.

Your fertility clinic will offer you an opportunity to talk to a counsellor, and you may find it useful to join a fertility support group or online forum for support.

Counselling

The National Institute for Health and Care Excellence (NICE) recommends that counselling should be offered before, during and after IVF treatment regardless of the outcome.

They recommend counselling should be offered by someone not directly involved in the management of the couple's fertility problems.

Counselling is a type of talking therapy that allows a person to talk about their problems and feelings in a confidential and dependable environment.

It can help couples to understand the implications of treatment and offer support at a critical time, such as when an IVF cycle has been unsuccessful.

Read more about the benefits of counselling and how to access it on the Human Fertilisation and Embryology Authority (HFEA) website.

Unsuccessful IVF treatment

In many instances, IVF treatment is unsuccessful. Under these circumstances, it's a good idea to wait for a couple of months before thinking about trying again.

This will give you a break from the stresses of treatment and allow your body time to recover.

This break can give you a chance to talk with the clinic about the reasons the IVF was unsuccessful, to talk to your partner about how you both feel, and consider your options going forward.

It can help to talk to other people who have been through IVF. A support group or online forum, such as the HealthUnlocked IVF community, may be helpful.

Read advice on what to do when fertility treatment fails on the HFEA website.

Adapting to parenthood

Some couples who have successfully started a family with IVF can find it difficult to adjust to their new life.

It's important to seek help from health professionals (such as your fertility consultant, GP, midwife or health visitor) if you think you need it.

Read more about services and support for parents.

Contacting a fertility support group and talking with others who can empathise with your experiences can also be helpful.

Fertility Network UK and Fertility Friends both have online forums where you can find other people who have dealt with the same issues.