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Female infertility

Getting pregnant often takes a while. However, for the one in seven couples who has real trouble, it may be a sign of infertility. Infertility is defined as not getting pregnant within a year of having regular sex without using contraception.

There are two types of female infertility.

  • Primary infertility. This means you have never been pregnant.
  • Secondary infertility. This is when you have been pregnant before but are now having difficulty.

Not all couples get pregnant straight away when they start trying. That said, over eight out of 10 couples will conceive within one year of having regular, unprotected sex. And the majority of other couples will do so within two years.

Infertility can be caused by a problem that affects either partner. In about four out of 10 couples who can’t conceive, both partners have a condition that affects their ability to have a baby. Our information here will look at infertility in women – to read about infertility in men, see our Related information section.

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Details

  • Symptoms Symptoms of female infertility

    There aren't any specific symptoms of infertility except being unable to conceive. However, if a particular medical condition is causing your infertility, that could cause symptoms, such as:

    • irregular or no periods, which indicates you have ovulatory problems (problems releasing eggs from your ovaries
    • pain in your pelvis
    • painful periods
    • pain when you have sex

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  • Diagnosis Diagnosis of female infertility

    If you have been trying to get pregnant for a year and are worried about your fertility, see your GP. It's a good idea for you and your partner to go together.

    Your GP will need to ask you a range of questions. These will probably include how long you have been trying for a baby and whether you have had any problems having sex. They may ask you about your lifestyle and your medical history including:

    • if you have ever been pregnant or had an abortion or a miscarriage in the past
    • questions about your menstrual cycle
    • if you have ever had any sexually transmitted infections (STIs), serious long-term diseases or other health conditions (as these can affect fertility)
    • if you're taking any medicines

    Your GP may do some tests. These may include blood tests to check if you're ovulating and to look at your hormone levels. Your GP may also do a urine test, or swab for chlamydia. It’s possible that they’ll examine your abdomen (tummy) and do an internal examination of your vagina, uterus and other organs in your pelvis.

    Your GP may arrange for you to have an ultrasound scan to check your fallopian tubes, ovaries and uterus. An ultrasound uses sound waves to produce an image of the inside of your body.

    If everything comes back normal, your GP may give you information about lifestyle changes and advise you to keep trying to get pregnant. However, this will depend on how long you have been trying and your age.

    If your test results or examination show anything unusual, or you’re 36 or over, your GP can refer you to a fertility doctor or gynaecologist. A gynaecologist is a doctor who specialises in women's reproductive health. The doctor you see will suggest further tests at a hospital or fertility clinic, which may include the following.

    • A hysterosalpingography can show if your fallopian tubes are blocked. In this test, your doctor will inject a dye that shows up on X-rays into your womb and fallopian tubes. He or she will take a series of X-rays that are displayed on a monitor. If your tubes are clear, the dye will pass through them.
    • A hysterosalpingo-contrast-ultrasonography uses ultrasound to check whether your fallopian tubes are open.
    • A laparoscopy and dye is a surgical procedure that can show if your fallopian tubes are blocked, and check your ovaries and womb. Your surgeon will insert a medical telescope, called a laparoscope, into your abdomen through a small cut in your belly button. The laparoscope has a camera attached to it. Your surgeon will inject a dye, which passes through your fallopian tubes, to check for any blockages. Pictures from the camera are sent to a monitor so your surgeon can see your organs.  
  • Treatment Treatment of female infertility

    If your infertility is caused by an underlying health condition, getting treatment for this may improve your chance of becoming pregnant. If your doctor can't find a particular cause for your infertility, there are a number of options he or she may suggest.

    Self-help

    Having sex every two to three days will maximise your chance of becoming pregnant. You may find it helpful to try to time having sex with when you’re ovulating. You can buy an ovulation predictor kit or monitoring device from a pharmacy to help you work out when this is. These detect levels of certain hormones associated with your cycle. Other kits can detect changes in your temperature and give you information about the best time to try to get pregnant.

    Your doctor may suggest that you make some changes to your lifestyle. These may include stopping smoking and not drinking more than one to two units of alcohol once or twice a week. He or she may also advise you to lose excess weight if you're overweight, or put some on if you're underweight.

    Medicines

    If your infertility is a result of a problem with ovulation, your doctor may prescribe a medicine to stimulate your ovaries to produce eggs. One example is clomifene citrate. Your doctor will closely monitor your treatment as there is a risk of producing more than one egg, which could lead to a multiple pregnancy (twins or triplets).

    Surgery

    Surgery may be an option if you have endometriosis. You may also be offered it if your fallopian tubes are damaged or if you have fibroids or adhesions (fibrous scars) in your womb. For some women, keyhole surgery is possible.

    A procedure called laparoscopic ovarian drilling may help improve your chance of getting pregnant if your fertility problems are caused by polycystic ovary syndrome (PCOS). For more information about this, see our FAQs.

    Assisted reproduction

    There are several methods of assisted reproduction (or assisted conception). The ones that are best for you will depend on what is causing your infertility. Some of these involve an egg or sperm donated from another person if you or your partner has a problem with egg or sperm production.

    The main methods are:

    • intra-uterine insemination (IUI) – sperm (from your partner or a donor) are placed into your womb around your time of ovulation
    • in vitro fertilisation (IVF) – an egg (taken from you or a donor) is fertilised with sperm in a laboratory and transferred into your womb
    • intracytoplasmic sperm injection (ICSI) – one sperm is injected into one of your eggs in a laboratory and then transferred into your womb
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  • Causes Causes of female infertility

    There are various reasons why you may have trouble getting pregnant, although in about a third of couples, doctors can’t find any cause.

    It's important to bear in mind that your fertility naturally decreases as you get older. Even so, more than nine out of 10 women aged 35 who have regular unprotected sex will conceive within three years of trying. This falls to just over seven out of 10 women aged 38.

    The most common reasons for infertility in women are:

    • your ovaries not producing eggs
    • damage to your fallopian tubes (the tubes that carry eggs from your ovaries to your womb)

    There are a number of reasons why you may not be producing eggs. These include:

    • polycystic ovary syndrome (PCOS), a condition in which your ovaries don't work properly
    • premature ovarian failure, when your ovaries stop working before the usual age of menopause – this can be temporary or permanent
    • disorders of the glands in your body that produce hormones, such as the thyroid and pituitary glands
    • long-term conditions, such as diabetes or epilepsy

    Problems that affect your fallopian tubes and can lead to infertility include:

    • infections, such as chlamydia, that damage or block your fallopian tubes
    • endometriosis, a condition where cells that normally line your womb (uterus) grow outside the lining of your womb in other parts of your body
    • damage as a result of surgery in your pelvic area or ovaries
    • damage caused by another condition, for example, a pelvic infection or burst appendix

    Infertility can also be caused by problems with your womb or cervix (neck of your womb). One example is fibroids (non-cancerous growths in your womb), especially if they have grown into its lining.

    Certain elements of your lifestyle can also affect your fertility, such as:

    • smoking – this includes passive smoking too
    • drinking alcohol – don't drink more than one to two units of alcohol once or twice a week if you're trying to get pregnant
    • using illegal drugs, such as marijuana or cocaine
    • being overweight – having a body mass index (BMI) of 30 or more
    • being underweight – having a BMI of less than 19
    • taking certain medicines, including non-steroidal anti-inflammatory drugs (NSAIDs), antipsychotics to treat conditions such as schizophrenia, or a diuretic called spironolactone
    • high levels of stress – this can affect your relationship and desire to have sex
    • chemotherapy treatment for cancer
    • your job – for example if you're exposed to certain pesticides or solvents in your work
  • Living with female infertility Living with female infertility

    If you're having trouble getting pregnant, it can be upsetting and stressful. Feeling stressed, whether it's caused by your problems conceiving, work or something else, may affect your relationship with your partner. This in turn can have an impact on your libido and how often you have sex, which can lead to further difficulties conceiving.

    It’s important to find ways to deal with this, and you may find it helps to talk to other people. There are support groups where you can meet with couples who are also having treatment for infertility. Alternatively, your GP or clinic can give you details of a specialist fertility counsellor.

  • FAQs FAQs

    Can complementary therapy help infertility?

    Answer

    No, there isn't any proof to show that complementary therapy can increase your chance of getting pregnant.

    Explanation

    Some people use complementary therapies, such as homoeopathy and aromatherapy, to try to improve fertility, but they don’t appear to have any effect. However, if a complementary therapy helps you to relax and feel less stressed, it might indirectly help as being stressed can reduce your libido.

    Some research has looked at whether acupuncture increases the chance of in vitro fertilisation (IVF) working. It looked at the effect of having acupuncture when an egg was taken from the womb, or around the time the fertilised egg was transferred back. However, there didn’t appear to be any benefit of having acupuncture at these specific times.

    More research is needed before scientists can be sure whether or not acupuncture, or any other complementary therapy, is effective.

    It’s worth finding out all you can if you're thinking about trying any complementary therapy. If you decide to go ahead, check that your therapist is registered with a recognised authority, such as the British Acupuncture Council.

    What causes premature menopause?

    Answer

    There are a number of things that can cause premature menopause, including certain health conditions and treatments. It can also be genetic – if your mother or grandmother had a premature menopause, you may be slightly more at risk of it. However, for most women it isn't possible to find a cause.

    Explanation

    Premature menopause is defined as going through the menopause before the age of 40. It means your ovaries no longer produce any eggs and you don't have periods.

    Premature ovarian failure is a common cause of premature menopause. It affects about one woman in 100 under the age of 40, and one in 1,000 women under 30. Premature ovarian failure is when your ovaries don't work properly and you may not produce an egg every month. But this doesn't always mean that your ovaries will never produce eggs again. Up to 15 in 100 women with premature ovarian failure do produce eggs from time to time and some even get pregnant.

    There are a number of causes for premature ovarian failure. These include the following.

    • An autoimmune disease where your body's immune system attacks your own healthy body tissue. It may attack your ovaries and damage them so they can't produce eggs properly.
    • Radiotherapy to your pelvic region. This can damage your ovaries to the point that they can no longer produce eggs.
    • Chemotherapy. This can cause ovarian failure. However, this will depend on the type of chemotherapy medicine you have, as well as the dose, time interval between treatments and your age.
    • Surgery to remove your ovaries, for example to treat cancer.
    • An infection such as mumps or tuberculosis. Generally your ovaries will start working again once the infection has cleared up.

    I've heard that a procedure called ovarian drilling can help you get pregnant – what is this?

    Answer

    Laparoscopic ovarian drilling may help improve your chances of getting pregnant if your fertility problems are caused by polycystic ovary syndrome (PCOS).

    Explanation

    If you have PCOS, you probably have irregular periods, higher than usual levels of the hormone testosterone and cysts on your ovaries. It’s also likely that you’re not ovulating regularly or at all.

    If you’ve already tried medicines to trigger ovulation but they haven't worked, you may be offered laparoscopic ovarian drilling, also known as ovarian diathermy. This surgical procedure involves using an electric current to heat up tiny areas on your ovaries to destroy some of the extra tissue. This is done by your surgeon making small cuts in your abdomen (tummy) and then inserting a narrow, tube-like telescopic camera so he or she can see your ovaries.

    This treatment aims to reduce the amount of testosterone that your body produces and so bring about ovulation.

  • Resources Resources

    Further information

    Sources

    • Gurunath S, Pandian Z, Anderson RA. Defining infertility – a systematic review of prevalence studies. Hum Reprod 2011; 17(5):575–88. doi:10.1093/humupd/dmr015
    • Infertility. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2013
    • Female infertility. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 11 November 2010
    • Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Care Excellence (NICE), February 2013. www.nice.org.uk.
    • Fertility basics. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 1 June 2012
    • Map of Medicine. Infertility. International View. London: Map of Medicine; 2014 (Issue 1)
    • Infertility – female. PatientPlus. www.patient.co.uk/patientplus.asp, published 9 April 2013
    • Ovarian insufficiency. Medscape. www.emedicine.medscape.com, published 17 June 2013
    • Infertility. Medscape. www.emedicine.medscape.com, published 10 June 2013
    • Endometriosis. PatientPlus. www.patient.co.uk/patientplus.asp, published 31 January 2013
    • About infertility. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 1 June 2012
    • What to expect at a fertility clinic. Human Fertilisation and Embryo Authority. www.hfea.gov.uk, published 18 May 2012
    • Contraception – natural family planning – the fertility awareness-based method. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2012
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 6 June 2014
    • Infertility treatments. PatientPlus. www.patient.co.uk/patientplus.asp, published 9April 2013
    • Cheong YC, Dix S, Hung Yu Ng E, et al. Acupuncture and assisted reproductive technology. Cochrane Database of Systematic Reviews 2013, Issue 7. doi:10.1002/14651858.CD006920.pub3
    • Practitioner search. British Acupuncture Council. www.acupuncture.org.uk, accessed 22 May 2014
    • Menopause. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2013
    • Polycystic ovarian syndrome. Medscape. www.emedicine.medscape.com, published 11 November 2013
    • Farquhar C, Brown J, Marjoribanks J. Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2012, Issue 6. doi:10.1002/14651858.CD001122.pub4
    • Polycystic ovarian syndrome treatment and management. Medscape. www.emedicine.medscape.com, published 11 November 2013
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