Offer IVF treatment to women with unexplained infertility who have not conceived after two (2) years (this can include up to one (1) year before their fertility investigations) of regular unprotected sexual intercourse. insemination Intrauterine insemination Consider unstimulated intrauterine insemination as a treatment option in the following groups as an alternative to vaginal sexual intercourse: people who are unable to, or would find it very difficult to, have vaginal intercourse because of a clinically diagnosed physical disability or psychosexual problem who are using partner or donor sperm; people with conditions that require specific consideration in relation to methods of conception (for example, after sperm washing where the man is HIV positive); people in same-sex relationships. For those people who have not conceived after six (6) cycles of donor or partner insemination, despite evidence of normal ovulation, tubal patency and semen analysis, offer a further six (6) cycles of un-stimulated intrauterine insemination before IVF is considered For people with unexplained infertility, mild endometriosis or 'mild male factor infertility', who are having regular unprotected sexual intercourse: do not routinely offer intrauterine insemination, either with or without ovarian stimulation (exceptional circumstances include, for example, when people have social, cultural or religious objections to IVF) advise them to try to conceive for a total of two (2 years (this can include up to one (1) year before their fertility investigations) before IVF will be considered. of IVF success Female age Inform women that the chance of a live birth following IVF treatment falls with rising female age Number of previous treatment cycles Inform people that the overall chance of a live birth following IVF treatment falls as the number of unsuccessful cycles increases. Previous pregnancy history People should be informed that IVF treatment is more effective in women who have previously been pregnant and/or had a live birth. Body mass index Women should be informed that female BMI should ideally be in the range 19–30 before commencing assisted reproduction, and that a female BMI outside this range is likely to reduce the success of assisted reproduction procedures. Lifestyle factors
For women aged 37–39 years: In the first and second full IVF cycles use single embryo transfer if there are one (1) or more top-quality embryos. Consider double embryo transfer if there are no top-quality embryos. For women aged 40–42 years consider double embryo transfer. For women undergoing IVF treatment with donor eggs, use an embryo transfer strategy that is based on the age of the donor. No more than two (2) embryos should be transferred during any one (1) cycle of IVF treatment. Where a top-quality blastocyst is available, use single embryo transfer. When considering double embryo transfer, advise people of the risks of multiple pregnancy associated with this strategy. Offer cryopreservation to store any remaining good-quality embryos after embryo transfer. Advise women who have regular ovulatory cycles that the likelihood of a live birth after replacement of frozen–thawed embryos is similar for embryos replaced during natural cycles and hormone-supplemented cycles. Luteal phase support after IVF Offer women progesterone for luteal phase support after IVF treatment. Do not routinely offer women human chorionic gonadotrophin for luteal phase support after IVF treatment because of the increased likelihood of ovarian hyperstimulation syndrome. Inform women undergoing IVF treatment that the evidence does not support continuing any form of treatment for luteal phase support beyond 8 weeks' gestation. Gamete intrafallopian transfer and zygote intrafallopian transfer There is insufficient evidence to recommend the use of gamete intrafallopian transfer or zygote intrafallopian transfer in preference to IVF in couples with unexplained fertility problems or male factor fertility problems. sperm injection Indications for intracytoplasmic injection The recognised indications for treatment by ICSI include: severe deficits in semen obstructive azoospermia non-obstructive azoospermia.