One in seven couples have difficulty conceiving. A doctor may use the word ‘infertility’ if you’re not pregnant after one year of having regular sex without using contraception. But this still doesn’t mean you won’t get pregnant naturally – some couples take two years or more to conceive.
There are two types of female infertility.
- Primary infertility – this means you’ve never been pregnant.
- Secondary infertility – this is when you’ve been pregnant before but are now having problems conceiving.
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. In women, there may be a problem with ovulation (releasing an egg from her ovaries) or a blockage of her fallopian tubes. The most common reason for male infertility is a problem with the man’s sperm.
More than eight out of 10 couples will conceive within one year of having regular, unprotected sex. Most couples will get pregnant within two or three years without having any medical help. If you’re still finding it difficult to get pregnant after a year of trying, there may be an underlying reason. It’s important to speak to your GP, as help is available.
Infertility doesn’t cause any specific symptoms, other than not being able to get pregnant. But sometimes a particular medical condition, such as polycystic ovary syndrome or endometriosis, may be causing your infertility. If so, you may experience symptoms related to these conditions.
For endometriosis, symptoms can include:
- irregular or no periods
- pain in your pelvis
- painful periods
- pain when you have sex
For polycystic ovary syndrome, symptoms may include:
- irregular or no periods
- being overweight or having problems losing weight
- having extra facial hair and acne (spots)
Many couples don’t get pregnant straight away when they start trying to conceive. But if you’ve been trying to get pregnant for a year and you’re worried about your fertility, see your GP. It's a good idea for you and your partner to see your GP together.
Your GP will need to ask you lots of questions. These will probably include how long you’ve been trying for a baby and whether you’ve had any problems having sex. They may ask you about your lifestyle and your medical history including:
- if you’ve ever been pregnant or had an abortion or a miscarriage in the past
- questions about your menstrual cycle
- if you’ve ever had any sexually transmitted infections (STIs), serious long-term diseases or other health conditions (because these can affect fertility)
- if you're taking any medicines
If you find it difficult to talk about any of these issues with your partner present, you may prefer to make separate appointments with your doctor.
Your GP may ask you to have some tests. They may ask you to have blood tests to check you're ovulating and to look at your hormone levels. They may ask for a urine test or swab for chlamydia. They may also check your abdomen (tummy) and do an internal examination of your vagina, uterus and other organs in your pelvis.
Your GP may suggest you have an ultrasound scan to check your ovaries, womb and fallopian tubes. This test is carried out in a hospital clinic, and involves placing an ultrasound probe in your vagina.
If your tests or examination show anything unusual or you’re aged 36 or over, your GP may refer you to a fertility doctor or gynaecologist for further investigations. This will depend on local guidelines though. A gynaecologist is a doctor who specialises in women's reproductive health. You may be advised to have further tests at a hospital or fertility clinic. These may include the following.
- A hysterosalpingography – this is a type of X-ray that uses a dye to show if your fallopian tubes are blocked.
- A hysterosalpingo-contrast-ultrasonography – this is a special type of ultrasound test, using a fluid injected into your womb to check for blockages in your fallopian tubes.
- A laparoscopy and dye – this is a surgical procedure that uses a medical telescope, called a laparoscope, to look at your fallopian tubes, ovaries and uterus.
Your doctor may also offer you tests to check your ovarian reserve. This is a measure of the potential of your ovaries to produce eggs. It’s used to predict how well you may respond to treatment with IVF. These tests may include testing for a hormone called anti-mullerian hormone (AMH), or counting the follicles in your ovaries during an ultrasound scan (antral follicle count).
If you’ve been trying to get pregnant for less than a year, your GP may suggest you keep trying to conceive naturally. They may also suggest this if tests haven’t shown any problems and you’re under 36. Some couples take two or three years to become pregnant without any medical help.
Best timing for conception
Having sex every two to three days will maximise your chance of becoming pregnant. Don’t use lubricants during sex as these can make sperm less likely to fertilise an egg.
You may find it helpful if you have sex when you’re ovulating (releasing an egg from your ovary). You usually ovulate in the middle of your menstrual cycle. If you have a regular monthly period, you’re likely to be ovulating every month.
You can buy an ovulation predictor kit or monitoring device from a pharmacy to help you work out when you’re ovulating. These tests check for levels of certain hormones associated with your menstrual cycle. You may need to use them every day for a few days. Other methods of predicting ovulation may detect changes in your body temperature but these aren’t always accurate.
Making some changes to your lifestyle may improve your chances of conceiving. This may involve stopping smoking and cutting down on alcohol, so you’re not drinking more than one or two units of alcohol, once or twice a week. Your GP may also advise you to lose excess weight if you're overweight, or put some weight on if you're underweight.
Having trouble getting pregnant can be stressful. Stress can affect your relationship and may mean you have sex less frequently. So it’s important to try to relax. You may want to consider counselling (talking therapy) to discuss your thoughts and feelings. For more information, see the Living with fertility problems section.
Your doctor may be able to prescribe some medicines to improve your fertility and increase your chances of getting pregnant.
If you’re not ovulating, or not ovulating regularly, your doctor may prescribe a medicine that stimulates your ovaries to produce eggs. Clomifene citrate is often the first medicine that doctors recommend. An alternative you may be offered is metformin.
If you’re not producing hormones that trigger ovulation, you may be prescribed medicines called gonadotrophins.
Medicines that stimulate your ovaries can result in you producing more than one egg, which could lead to a multiple pregnancy (twins or triplets). They can also cause a complication known as ovarian hyperstimulation syndrome, where your ovaries respond more than normal to the hormones. This normally only has mild symptoms, but potentially can be serious. Your doctor will closely monitor your treatment.
Depending on the cause of your fertility problems, some types of surgery may help to treat the underlying problem, and help you to get pregnant.
If you have mild endometriosis, your doctor may recommend surgery to remove any tissue or cysts that are affecting your fertility. Surgery may improve your fertility if your endometriosis is moderate to severe, but you may still need further help.
You may be offered surgery if your fallopian tubes are damaged or if you have fibroids or adhesions (fibrous scars) in your uterus.
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 FAQ on Ovarian drilling.
If other treatments don’t work, or aren’t appropriate for you, your doctor may recommend assisted conception. There are several methods of assisted conception. The ones that will work best for you will depend on what’s causing your infertility. Some of these involve using an egg donated from another person if you have a problem with egg production. If it’s your partner who has fertility problems, you can also use these techniques with donor sperm.
Intra-uterine insemination (IUI)
This involves placing sperm (from your partner or a donor) into your uterus around your time of ovulation. You may be given some medicines that trigger your ovaries to produce eggs. IUI may be suitable if you have problems having sex. It may also be recommended if you have mild endometriosis.
In vitro fertilisation (IVF)
If you have IVF, an egg (taken from you or a donor) is fertilised with sperm in a laboratory and transferred into your uterus. This is suitable for most forms of infertility. IVF may be recommended if you have blocked fallopian tubes or other forms of assisted reproduction haven’t worked.
Gamete intrafallopian transfer (GIFT)
This is similar to IVF, but the egg and sperm are transferred into your fallopian tubes before fertilisation. The egg and sperm then fertilise naturally. This won’t be recommended for you if you have a problem with your fallopian tubes.
Assisted reproduction techniques involve giving you hormone injections to encourage eggs to develop in your ovaries. This increases your chance of having a multiple pregnancy. It also puts you at risk of developing ovarian hyperstimulation syndrome – a complication where your ovaries respond more than normal to the hormones. Your doctor will closely monitor your treatment.
More detailed information about all types of assisted conception, including their success rates and risks, is available from the Human Fertilisation and Embryology Authority (HFEA).
There are many reasons why you may have trouble getting pregnant. But in about a quarter of couples, doctors can’t find any specific cause.
Sometimes, infertility is related to your age. Your fertility naturally decreases as you get older. More than nine out of 10 women aged 35 who have regular unprotected sex will get pregnant within three years of trying. This drops 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 uterus)
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 the menopause – this can be temporary or permanent
- disorders of the glands in your body that produce hormones, such as your thyroid and pituitary glands
- long-term conditions, such as diabetes or kidney disease
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 uterus grow outside the lining of your uterus in other parts of your body
- damage caused by surgery in your pelvic area
- damage caused by another condition, for example, a pelvic infection or burst appendix
Infertility can also be caused by problems with your uterus or cervix (neck of your uterus), such as fibroids. Fibroids are common non-cancerous growths in your uterus. You may not know you have fibroids as they don’t always cause symptoms. But fibroids can stop a fertilised egg from attaching itself to the wall of your uterus.
Some aspects of your lifestyle can also affect your fertility, such as:
- smoking and passive smoking
- drinking excessive amounts of alcohol
- using illegal drugs, such as marijuana or cocaine
- being obese – having a body mass index (BMI) of 30 or more
- being underweight – having a BMI below 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
- having chemotherapy treatment for cancer
- being exposed to certain pesticides or solvents in your work
If there’s no underlying reason for your fertility problems, your doctor will reassure you that it can take time to get pregnant. It can take some couples two or three years to get pregnant naturally without any specific medical help. But having trouble getting pregnant, for any length of time, can be upsetting and stressful. Even if there’s a chance you may become pregnant naturally, it’s reassuring to know that help and support are available.
It’s important to find ways to deal with any stress. Feeling stressed, whatever the cause, may affect your relationship with your partner. This in turn can reduce your desire to have sex, and how often you have sex, which can lead to further difficulties conceiving. You may feel your family and friends are putting pressure on you to have children too. This can also affect your relationship.
You may wish to speak to other people who understand what you’re going through. You can join a support group to meet with other couples who are also having tests and treatments for infertility. This can reassure you that you’re not alone. You can find local support groups and access online support through the charity, Fertility Network UK (see our Further information section).
Sometimes it helps to talk to someone who doesn’t know you or your partner and isn’t involved in your treatment. You may want to consider talking to a specialist fertility counsellor. They may be able to help you explore your feelings and find ways to cope if you’re struggling. You can also talk through the different treatments and which options are available to you.
Some people use complementary therapies, such as herbal remedies and acupuncture, to try to improve their fertility. But there’s no proof that any complementary therapies can increase your chance of getting pregnant.
Some research has looked at whether acupuncture can help to improve ovulation in women with polycystic ovary syndrome. But there’s not enough research to show it works.
Some complementary therapies may help you relax and feel less stressed. This may indirectly help with infertility, because being stressed can reduce your desire to have sex.
It’s worth finding out all you can if you're thinking about trying any complementary therapies. Some complementary therapies can be harmful if you do become pregnant, causing problems with the baby’s development. If you decide to go ahead, check that your therapist is registered with a recognised authority, such as the British Acupuncture Council.
Premature menopause affects women before the age of 40. It’s caused by premature ovarian failure. This means your ovaries no longer produce any eggs and you don’t have periods any more.
Premature menopause can run in families. It may also be caused by some other genetic problems, health conditions and treatments. These include:
- an autoimmune disease, where your body's immune system attacks your ovaries, which then can't produce eggs properly
- radiotherapy to your pelvic area, damaging your ovaries so they no longer produce eggs
- chemotherapy, which stops your ovaries working
- surgery to remove your ovaries
- an infection such as mumps or tuberculosis, although this may be a short-term effect
For many women, it isn’t possible to find a cause of their premature menopause.
Premature ovarian insufficiency is a common cause of premature menopause. This means you don’t produce an egg every month. But unlike a premature menopause, it isn’t always permanent. Up to one in 10 women with premature ovarian insufficiency get pregnant because their ovaries suddenly produced an egg that was then fertilised.
Laparoscopic ovarian drilling may improve your chances of getting pregnant if your fertility problems are caused by polycystic ovary syndrome (PCOS). This procedure is also called ovarian diathermy. It may be offered to you if you’ve already tried medicines to trigger ovulation but they haven’t worked.
If you have PCOS, you will have extra tissue on your ovaries and probably higher than usual levels of the hormone testosterone. You’re likely to have low – or no – fertility because you’re not ovulating regularly or at all. Your periods will be irregular (usually fewer than nine periods a year).
Laparoscopic ovarian drilling is a safe and effective treatment for PCOS. The surgeon uses an electric current to heat up tiny areas on your ovaries to destroy some of the extra tissue. This reduces how much testosterone your body produces.
Laparoscopic ovarian drilling restores ovulation in up to nine in every 10 women who have the procedure. Eight in every ten of these women get pregnant within eight months of this treatment.
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Reviewed by Pippa Coulter, Bupa Health Content Team, February 2017
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