Infertility and spontaneous
National Institute for Clinical Excellence. Fertility: assessment and treatment for people with fertility problems [Internet]. London: RCOG
Press; 2004 Feb [cited 2009 March 8]. 216 p. Available from:
Key priorities for implementation
Screening for Chlamydia trachomatis
- Before undergoing uterine instrumentation women should be offered
screening for Chlamydia trachomatis using an appropriately sensitive
Assessing tubal damage
- Women who are not known to have co-morbidities (such as pelvic inflammatory
disease, previous ectopic pregnancy or endometriosis) should be offered
hysterosalpingography (HSG) to screen for tubal occlusion because this
is a reliable test for ruling out tubal occlusion, and it is less invasive
and makes more efficient use of resources than laparoscopy.
- Couples with mild male factor fertility problems, unexplained fertility
problems or minimal to mild endometriosis should be offered up to six
cycles of intra-uterine insemination because this increases the chance
In vitro fertilisation treatment
- Couples in which the woman is aged 23–39 years at the time of treatment
and who have an identified cause for their fertility problems (such
as azoospermia or bilateral tubal occlusion) or who have infertility
of at least 3 years’ duration should be offered up to three stimulated
cycles of in vitro fertilisation treatment.
- Human menopausal gonadotrophin, urinary follicle-stimulating hormone
and recombinant follicle-stimulating hormone are equally effective in
achieving a live birth when used following pituitary down-regulation
as part of in vitro fertilisation treatment. Consideration should be
given to minimising cost when prescribing.
- Couples should be informed that the chance of multiple pregnancy
following in vitro fertilisation treatment depends on the number of
embryos transferred per cycle of treatment. To balance the chance of
a live birth and the risk of multiple pregnancy and its consequences,
no more than two embryos should be transferred during any one cycle
of in vitro fertilisation treatment.
- Embryos not transferred during a stimulated in vitro fertilisation
treatment cycle may be suitable for freezing. If two or more embryos
are frozen then they should be transferred before the next stimulated
treatment cycle because this will minimise ovulation induction and egg
collection, both of which carry risks for the woman and use more resources.
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Edited by Aldo Campana,