The situations where surgical infertility treatments may be an option include:

• Fallopian tube problems - surgery may help some women with infertility caused by Fallopian tube problems. For example, if your Fallopian tubes have been blocked or scarred from a previous disease, infection, or other problem. Some women who have had a tubal tie (sterilisation) in the past for contraception may be able to have their fertility restored by tubal surgery. These days, most surgery to the Fallopian tubes is done by keyhole surgery.
• Endometriosis (a condition that occurs when cells from the lining of the womb (uterus) grow in other areas of the body) - surgery may help to improve fertility in women with endometriosis.
• Polycystic ovary syndrome - an operation on the ovaries may be suitable for some women with PCOS. The procedure is sometimes called ovarian drilling or ovarian diathermy. Using keyhole surgery, a heat source (diathermy) is usually used to destroy some of the tiny cysts (follicles) that develop in the ovaries. It is usually done if other treatments for PCOS haven't worked.
• Fibroids - for women with fibroids, surgery (to remove the fibroid) may be considered if there is no other explanation for the infertility. However, expert opinion is still unsure whether all fibroids cause infertility.
• Male infertility - when sperm are blocked by an abnormality in the epididymis (a coiled tube inside the scrotum that is used to store sperm) in the testis, surgery may help. Varicoceles (like varicose veins of the testes) that occur in men who have an abnormal sperm count may be repaired. See separate leaflet called Varicocele for further details.

Commonly known as fertility drugs, ovulation induction medications can be taken either orally or through injections to stimulate a woman's ovaries to release multiple mature eggs. This improves chances for fertilization and ultimately pregnancy.

Success rates vary depending on the method of ovulation induction used to treat the infertility, though in general they are high. Risks include increased chances of multiple births and ovarian cysts, both of which are reduced by closely monitoring patients

Intrauterine insemination (IUI) is also commonly known as artificial insemination. This procedure involves placing a sperm sample that has been prepared (or "washed") directly into a woman's uterus near the time of ovulation. It is often coupled with ovulation induction, especially in couples who have infertility due to male factors, such as low semen volume, low sperm concentration or decreased sperm motility. It can also be used to treat infertility due to cervical mucus problems.

The main purpose of "washing" a semen sample is to separate the seminal fluid from the sperm cells.  Seminal fluid contains prostaglandins, which can cause severe cramping in the uterus. Depending on the quality of the semen specimen, the sperm wash can also filter out cellular debris, round cells (including white blood cells), and dead sperm so that the final preparation that is used for the IUI contains a high concentration of sperm that have a good-to-fast-forward progression.

By processing the semen and placing the sperm directly into the uterus, IUI increases the number of sperm that move through the reproductive tract to the fallopian tubes - where fertilization usually occurs. This relatively simple procedure takes just a few minutes and is performed in our office without any sedation. In certain cases, back-to-back inseminations may be performed over the course of two consecutive days to further increase the amount of sperm in the reproductive tract during this key time in the reproductive cycle. This may enhance to the chance of achieving pregnancy, particularly in the case of donor sperm insemination procedures where no additional sperm reaches the fallopian tubes through sexual intercourse. 

In vitro fertilisation (IVF)

IVF means fertilisation outside of the body. In vitro literally means in glass (that is, in a laboratory dish or test tube). IVF is mainly used in couples whose infertility is caused by blocked Fallopian tubes, or unexplained infertility.

IVF involves taking fertility medicines to stimulate the ovaries to make more eggs than usual. When the eggs have formed, a small operation is needed to harvest them (egg retrieval). Each egg is mixed with sperm. This is obtained either by the male partner masturbating, or from a donor. The egg/sperm mixture is left for a few days in a laboratory dish. The aim is for sperm to fertilise the eggs to form embryos.

One or two embryos which have formed are then placed into the woman's womb using a fine plastic tube passed through the cervix. Any other embryos which have formed in the dish are either discarded or, if you wish, frozen for further attempts at IVF at a later date. You may also be asked to consider donating any spare embryos to be used for research, or to be donated to other infertile couples.

Your chance of success with IVF may be higher if:

• The female partner is under the age of 39.
• The female partner has been pregnant before.
• The female partner has a body mass index (BMI) between 19 and 30 (they are a good weight).

It is recommended that when IVF is used:

• Three cycles are offered to women aged under 40 years
• One cycle is usually offered to women aged 40-42 years if they have not had IVF in the past

Intracytoplasmic sperm injection (ICSI)

This technique involves an individual sperm being injected directly into an egg. (It is injected into the outer part of the egg - the cytoplasm.) This method bypasses any natural barriers that may have been preventing fertilisation. For example, some cases of infertility are due to the sperm of a male partner not being able to penetrate the outer part of the egg to fertilise the egg. ICSI can also be used when a male partner has a low sperm count, as only one sperm is needed.

If needed, a sperm can also be obtained by a small operation to the testis. This may be done when sperm cannot be produced in the usual way. For example, if the male partner has a blocked vas deferens, or has had a vasectomy.

The egg containing the sperm is then placed in the womb in the same way as with IVF. ICSI is used for couples who have failed to achieve fertilisation through IVF, or where the quality or number of sperm is too low for normal IVF to be likely to succeed.