Female infertility

This factsheet is for women who are having trouble conceiving or anyone who would like information about female infertility.

Infertility is when a woman can’t get pregnant after two years of having sex without any contraception. A number of things can affect a woman’s ability to conceive, but often doctors can’t find a cause for infertility. This factsheet is about infertility in women – for information about infertility in men, please see Related topics.

About female infertility

Infertility is defined as not getting pregnant within two years of having regular sex without contraception. You may have primary infertility, which means you have never been pregnant, or secondary infertility, if you have conceived previously.

One in seven couples in the UK have trouble conceiving, but it's important to remember that it’s normal for conception to take some time. Over eight out of 10 couples will conceive within one year of having regular, unprotected sex, and more than nine out of 10 couples will do so within two years.

Infertility can be caused by a problem affecting 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.

Symptoms of female infertility

There aren't any specific symptoms of infertility except being unable to conceive. However, if the problem is caused by a particular medical condition, you may have symptoms as a result of it.

Causes of female infertility

There are various reasons why you may be having 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 decreases as you get older. However, with regular unprotected sex more than nine out of 10 women aged 35 will conceive within three years of trying, and nearly eight out of 10 women aged 38 will do so.

The most common reasons for infertility in women are:

• the ovaries not producing eggs
• damage to the 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 the ovaries aren't working properly, the most common cause of ovulation problems
• premature ovarian failure, when your ovaries stop working before the usual age of menopause, which 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 cancer

Problems affecting your fallopian tubes that may lead to infertility include:

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

Infertility can also be caused by problems with your cervix or womb. For example, having non-cancerous growths in your womb called fibroids, especially if they protrude into the womb lining.

It's possible that difficulty conceiving isn't the result of a problem with your reproductive organs. Some other things that can affect your fertility include:

• smoking – including being exposed to passive smoking or if your mother smoked during pregnancy
• drinking more than one to two units of alcohol once or twice a week
• using illegal drugs such as marijuana or cocaine
• being overweight – having a body mass index (BMI) of more than 29
• being underweight – having a BMI of less than 19
• taking certain medicines including non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, antipsychotics to treat conditions such as schizophrenia, or a diuretic called spironolactone
• treatment for cancer or HIV/AIDS
• certain jobs – for example if you're exposed to certain pesticides or solvents
• high levels of stress as this can affect your relationship and desire to have sex

Diagnosis of female infertility

See your GP if you’ve been trying to get pregnant for a year and you’re worried about your fertility. If possible, it's a good idea for you and your partner to go together.

Your GP is likely to ask how long you have been trying for a baby and whether you have had any problems having sex. He or she may ask you about your lifestyle and your medical history including:

• whether or not you have been pregnant or had an abortion or a miscarriage in the past
• questions about your menstrual cycle
• whether you have ever had any sexually transmitted infections (STIs), serious long-term diseases or other conditions that can affect fertility
• whether you're taking any medicines
• questions about your lifestyle, for example how much you exercise, or if you smoke, drink alcohol or take recreational drugs

Your GP may offer to do some tests. These include blood tests to check if you are ovulating and look at your hormone levels, and a urine test or swab for chlamydia. Your GP may also do a pelvic internal examination.

If your results and examination are normal, your GP may give you information about lifestyle changes and advise you to keep trying naturally, depending on how long you’ve been trying and your age.

If your test results or examination are abnormal or you’re over 35, your GP will refer you to a fertility doctor or a gynaecologist (a doctor who specialises in women's reproductive health) at a hospital or fertility clinic for more tests.

You may be offered an ultrasound scan to check your fallopian tubes, ovaries and uterus. Alternatively, your doctor may recommend a test called hysterosalpingography or a test called a laparoscopy and dye.

A hysterosalpingography can show if your fallopian tubes are blocked. It uses a type of X-ray procedure called fluoroscopy. This involves injecting a dye (contrast medium) that shows up on X-rays into your womb and fallopian tubes, and taking a series of X-rays that are displayed on a TV screen. If your tubes are clear, the dye will pass through them.

A laparoscopy and dye is a surgical procedure. It’s used to see if your fallopian tubes are blocked, as well as check your ovaries and womb. A medical telescope with an attached camera, called a laparoscope, is put into your abdomen through a small cut in your belly button (umbilicus). The pictures from the camera are sent to a television screen and magnified, so that your surgeon can clearly see the organs inside your abdomen. A dye is injected which pases through your fallopian tubes to check for any blockages.

Treatment of female infertility

If your infertility is caused by an underlying problem such as endometriosis, there may be treatments that can improve your chance of becoming pregnant. If your doctor can't find a particular cause for your infertility, there are a number of options that he or she may suggest.

Self-help

Having sex two to three times a week maximises your chance of becoming pregnant. Doctors don’t recommend trying to time intercourse with ovulation because it tends to put couples under too much stress.

Your doctor may also suggest making lifestyle changes, for example, stopping smoking and not drinking more than one to two units of alcohol once or twice a week. You may also be advised to lose excess weight or put some on.

Medicines
If your infertility is a result of a problem with ovulation, your doctor may prescribe a medicine such as clomifene citrate to stimulate your ovaries to produce eggs.

Surgery

Surgery may be an option if you have endometriosis, if your fallopian tubes are damaged or if you have fibroids or adhesions (fibrous scars) in your womb.

However, surgery won't be suitable for everyone, so it's important to talk to your doctor about the best treatment for you.

Assisted reproduction

There are several methods of assisted reproduction (or assisted conception) that may be available to you, depending on what is causing your infertility. The main methods are:

• intra-uterine insemination (IUI) – sperm are placed into your womb
• in vitro fertilisation (IVF) – an egg is fertilised with sperm outside the body and transferred into the womb
• intracytoplasmic sperm injection (ICSI) – sperm is injected into an egg outside the body and then transferred into the womb

Living with female infertility

Having trouble getting pregnant 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, leading to further difficulties conceiving.

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 doctor or clinic can give you details of a specialist fertility counsellor.

 

Produced by Kerry McKeagney, Bupa's Health Information Team, March 2012. 

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.