IVF and fertility treatments explained

Fertility treatment covers a wide range of things, from a course of tablets to a laboratory procedure on a single egg. The names overlap, clinics use them loosely, and the same treatment can appear under three different labels on three different websites. This guide sets out the main treatments in the order people usually meet them: the tests that come first, the simpler treatments, IVF and the laboratory steps built on it, donor treatment, surgery and surrogacy.

Each section says what the treatment is, where Indian law places it, and links to a fuller page in the treatments index, which quotes its sources in full and lists the clinics that name it. Clinical descriptions are quoted from the UK's fertility regulator, the HFEA, and from the NHS, because their patient pages are plainly written and openly sourced. Indian law is quoted from the Acts and Rules themselves. Nothing here tells you which treatment is right for you; that is a clinical decision for the doctor treating you.

Tests come first

Treatment starts with finding a cause, and infertility is investigated on both sides. For men the first test is usually a semen analysis, a laboratory check of a semen sample; the wider field of male fertility care is described on the andrology page. For women, tests look at ovulation, the womb and the fallopian tubes.

Two procedures that look directly at the reproductive organs often come up at this stage. A hysteroscopy is, in the NHS's words, “a test to look inside a woman's womb, using a thin tube with a small camera inside it.” A laparoscopy is “a type of keyhole surgery used to diagnose and treat conditions.” The HFEA describes the laparoscopy and dye test as “used to inspect the entire pelvis to confirm that the tubes are open and healthy and check if there's any endometriosis or adhesions.” Both can also be used to treat what they find.

Ovulation induction

Ovulation induction means using fertility drugs to bring about or regulate ovulation. The HFEA says “Depending on your diagnosis, you can either take fertility drugs on their own or in combination with other treatments such as intrauterine insemination (IUI) or in vitro fertilisation (IVF).” It is often the first treatment tried where ovulation is irregular, and the HFEA is plain that “You should only take medication under the care of a specialist.” The main risks it names are too many follicles developing, which can lead to a multiple pregnancy, and ovarian hyperstimulation syndrome with injected hormones.

IUI

IUI, intrauterine insemination, is described by the HFEA as “a type of fertility treatment in which the better quality sperm are separated from sperm that are sluggish, non moving or abnormally shaped. These sperm are then injected directly into the womb.” Fertilisation then happens inside the body. It can be done with a partner's sperm or with donor sperm, with or without fertility drugs.

It is not suitable for everyone. The HFEA says “You can only have IUI if your fallopian tubes are open and healthy.” In India, IUI has a particular place in the law: it is the one treatment the ART Rules, 2022 allow a Level 1 clinic to carry out, since a Level 1 clinic is one where “only IUI is carried out as part of treatment.” So IUI can be offered at clinics of either level.

IVF

IVF, in vitro fertilisation, is “a type of fertility treatment where fertilisation takes place outside the body.” The HFEA describes the usual sequence: “Usually in IVF, the woman has medicines (fertility hormones) to stimulate the ovaries to produce several eggs. The eggs are then collected and mixed with sperm in a laboratory.” After fertilisation, “the embryos are allowed to develop for between two and six days,” and one is transferred to the womb.

A cycle has several stages and takes time: “For most people, one cycle of IVF will take between four and six weeks.” IVF is Level 2 work in India. A Level 1 clinic may carry out only IUI as treatment, so the laboratory part of IVF has to happen at a clinic registered at Level 2. The guide to clinic levels and the National ART Registry explains how to check a clinic's level.

ICSI, and choosing the sperm

ICSI, intracytoplasmic sperm injection, changes one step of IVF. Instead of leaving eggs and sperm together in a dish, “a skilled embryologist (embryo specialist) will inject a single sperm into the egg.” The HFEA describes it as “performed as part of in vitro fertilisation (IVF)”, and it is most often used where there is a problem with the sperm. It is also how sperm collected surgically is used.

Two variations, IMSI and PICSI, change how the sperm for injection is chosen rather than the injection itself. The HFEA lists both as treatment add-ons; the sperm selection page explains what that means.

Growing and freezing embryos

Several treatments are really choices about the laboratory part of an IVF or ICSI cycle. Blastocyst culture means growing embryos for longer before transfer; the HFEA says “Blastocyst stage embryos are selected on day five of their development.” It is candid about the trade-off: “not all embryos that are left to the blastocyst stage will survive and in some cases a couple could have no embryos available to transfer to the womb.”

Embryo freezing keeps suitable spare embryos for a later transfer. The HFEA notes that “Not all embryos are suitable for freezing so only good quality embryos will be chosen to freeze.” Indian law limits storage: section 28(2) of the ART Act says “The gamete of a donor or embryo shall be stored for a period of not more than ten years”. Under section 22(2), clinics may not freeze embryos or gametes “without specific instructions and consent in writing from all the parties seeking assisted reproductive technology”.

Egg freezing and fertility preservation

Egg freezing “involves collecting a woman's eggs, freezing them and then thawing them later on so they can be used in fertility treatment.” The collection is the first half of an IVF cycle, so it is Level 2 work. Thawed eggs are fertilised by ICSI. The HFEA is direct about the limits: “The major risk is that it won't work”.

Fertility preservation is the wider term. The HFEA says “Preserving your fertility involves freezing your eggs, sperm, embryos or reproductive tissue so that you can hopefully have a biological family in the future.” Its first example is someone facing cancer treatment, because “some of the drugs used in cancer treatment can cause infertility, especially in high doses.”

Testing embryos: PGT

PGT, preimplantation genetic testing, checks embryos created in IVF before one is transferred. The older names PGD and PGS refer to two of its forms. Every form needs IVF: “Because the embryos need to be tested in a lab, you will need to have IVF, even if you and your partner have no fertility problems.”

Indian law is specific here. Section 25(1) of the ART Act says “The Pre-implantation Genetic testing shall be used to screen the human embryo for known, pre-existing, heritable or genetic diseases only.” Section 26(1) adds that “the clinic shall not offer to provide a couple or woman with a child of a pre-determined sex.”

Donor eggs and donor sperm

Treatment with donor eggs or donor sperm is used where a person's own eggs or sperm cannot be used. In India the donor must come through a registered ART bank: section 27(1) says “The screening of gamete donors, the collection, screening and storage of semen; and provision of oocyte donor, shall be done only by a bank registered as an independent entity under the provisions of this Act.” The Act also limits donors. Under section 27(4), “An oocyte donor shall donate oocytes only once in her life”. The HFEA's advice applies anywhere: “Using donated sperm, eggs or embryos is a major decision and you should take your time to think about whether it's right for you.”

Collecting sperm surgically

Where there is no sperm in the semen, it can sometimes be collected directly from the body and used in ICSI. TESA and PESA draw sperm through a fine needle, usually under local anaesthetic. Micro-TESE is a larger operation; the HFEA says “MicroTESE involves examining the testicle with an operating microscope to find areas (tubules) where sperm are being made.” It is also clear that finding sperm is not the end point: “Successfully extracting sperm doesn't guarantee you'll have a baby.”

Surrogacy

Surrogacy is governed by its own law, the Surrogacy (Regulation) Act, 2021, which defines it as “a practice whereby one woman bears and gives birth to a child for an intending couple with the intention of handing over such child to the intending couple after the birth”. Only altruistic surrogacy is allowed, and commercial surrogacy is prohibited. A clinic needs a separate surrogacy registration, which its ART level does not show.

Risks and extras worth knowing about

Two risks run through much of fertility treatment. The first is a reaction to fertility drugs: the HFEA lists “ovarian hyperstimulation syndrome (a severe reaction to fertility drugs)” among the risks of IVF. The second is multiple pregnancy, “which can cause serious health problems to both mum and babies.” That is one reason the HFEA says “It's best practice to have only one embryo put back.”

Many clinics also offer optional extras alongside IVF. The HFEA warns that “You may be offered 'treatment add-ons' which are optional extras, often charged at an extra cost,” and that “there is no conclusive evidence that any of the commonly offered add-ons increase the chance of a pregnancy.” Ask what each extra is for in your case.

Finding a clinic for a treatment

Each treatment page lists the clinics in this directory that name the treatment on their own website, grouped by state, with each clinic's registry level. In larger cities there are pages for a single treatment, such as IVF in Chennai or IUI in Bengaluru. You can also browse a city, such as Chennai or Bengaluru, start from the clinics index, look up a doctor in the fertility doctors index, or return to the directory home. The guide on how to choose an IVF clinic in India sets out what to check once you have a shortlist.

Where this guide comes from

Clinical descriptions are quoted from the Human Fertilisation and Embryology Authority (HFEA) and the NHS. Indian law is quoted from the Assisted Reproductive Technology (Regulation) Act, 2021, paragraph 10.1 of the Assisted Reproductive Technology (Regulation) Rules, 2022, and the Surrogacy (Regulation) Act, 2021. This directory publishes no success rates and no prices, because it holds none it could stand behind. Nothing in this guide is clinical advice, and nothing in it is sponsored.