Assisted reproduction

Assisted reproduction embraces all techniques involving the direct retrieval of oocytes from the ovary. The concept was first pioneered in the 1970's by Steptoe and Edward.

In outline, all assisted reproduction involves initially:

• ovulation induction - by clomiphene, hMG or pure FSH
• egg recovery - hCG added once the leading follicle has reached 16 mm to to complete maturation; oocytes collected 35 hours later

In the technique of gamete intrafallopian transfer or GIFT, the oocytes and partner's sperm are then placed immediately in the fallopian tubes.

In the techniques of in vitro fertilisation, IVF, and zygote intrafallopian transfer, ZIFT, egg recovery is followed by:

• in vitro fertilisation of the oocytes
• culture to the four cell stage
• implantation of the fertilised embryo's in the uterine cavity - IVF - or in the fallopian tubes - ZIFT

The main complications are those of:

• hyperstimulation
• multiple pregnancy

NICE suggest access criteria for IVF (1):

• when considering IVF as a treatment option for fertility problems, discuss the risks and benefits of IVF in accordance with the current Human Fertilisation and Embryology Authority (HFEA) Code of Practice
• ovarian reserve should be taken into account when discussing the option of IVF treatment
• IVF treatment should be offered to women, and trans men and non-binary people with female reproductive organs who have not yet reached their 42nd birthday, if:
  • there is a diagnosed cause of infertility for which other treatments are not suitable or have not been successful, or
  • they have unexplained fertility problems and have not conceived after 2 years of regular unprotected vaginal intercourse, with or without intrauterine insemination (IUI)
  • they have not conceived after 12 cycles of artificial insemination (where 6 or more cycles are by IUI)

• if the woman, or trans man or non-binary person with female reproductive organs is under 40 years and meets the criteria, offer an initial 3 full cycles of IVF treatment
  • if they reach their 40th birthday without conceiving, complete any current full cycle of IVF but do not offer any more cycles
• if the woman, or trans man or non-binary person with female reproductive organs is under 40 years and has not conceived after 3 full cycles of IVF treatment:
  • discuss the probability of success and the implications of more treatment, and
  • consider up to 3 further full cycles of IVF treatment

• if they reach their 40th birthday without conceiving, complete any current full cycle of IVF but do not offer any more cycles

• if the woman, or trans man or non-binary person with female reproductive organs is 40 or 41 years, meets the criteria and has not had IVF treatment before, offer 1 full cycle of IVF treatment

Reference

1. NICE. Fertility problems: assessment and treatment. Clinical guideline CG156. Published February 2013, last updated March 2026.