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Female infertility

Expert reviewer Mr Luciano Nardo, Consultant in Obstetrics and Gynaecology, RCOG accredited subspecialist in Reproductive Medicine
Next review due April 2025

Female infertility is the term used to describe not being able to get pregnant naturally. You might hear the word ‘subfertility’ used too, which means a delay in getting pregnant. If you’re trying for a baby, you may need some extra help to increase your chances.

This information looks at female infertility. You may also find it useful to find out more about male infertility.

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About female infertility

Getting pregnant (conceiving) happens quickly for some people, but for others it can sometimes take a while. If you don’t get pregnant straightaway, there’s normally no need to worry. But, if you haven’t managed to get pregnant after a year or two of trying, it could be a sign of fertility problems for you or your partner, or sometimes for both of you.

Causes of female infertility

There are many reasons why you may have trouble getting pregnant. But sometimes doctors can’t find any cause even after they have done investigations. This is called unexplained infertility.

There are usually four main causes of female infertility.

  • Egg production problems. This is the most common reason for infertility in women. It can be caused by conditions, such as polycystic ovary syndrome or problems that relate to the balance of hormones within your body.
  • Conditions that affect your ovaries. These can develop if you’re underweight or if you’ve had an operation on your ovaries, or chemotherapy or radiotherapy. Sometimes your ovaries can stop working altogether.
  • Conditions that affect your fallopian tubes. These include endometriosis and scar tissue that develops because of a sexually transmitted infection, or pelvic inflammatory disease.
  • Conditions that affect your womb. These include fibroids, endometriosis and damage or changes to the structure of your womb. You can also be born with a problem.

Your fertility naturally declines as you get older, particularly after 35. This is because you produce fewer eggs and the quality of them isn’t usually as good.

Your lifestyle can have an impact on your chances of getting pregnant. If you’re under or overweight, smoke and drink too much, can all affect your fertility. Some medicines can have an impact too. If you regularly take any medicine and are having problems getting pregnant, talk to your GP about whether it might be affecting your fertility.

Symptoms of female infertility

Infertility doesn’t cause any specific symptoms, other than not getting pregnant. But if there’s a medical condition that’s the cause of infertility, then you may have symptoms. This includes conditions, such as polycystic ovary syndrome (PCOS), endometriosis, fibroids or an infection.

If you have any of the following symptoms, go and see your GP.

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Diagnosis of female infertility

If you’ve been trying to get pregnant for a year or more, you and your partner (if you have one), may wish to see your GP for advice. If you’re over 35, go earlier, after six months of trying. As you get older, the chances of getting pregnant go down naturally, so it’s a good idea to get advice early on.

Common questions

Your GP will ask you how long you’ve been trying for a baby and whether you’ve had any problems with sex. They may ask you about your periods, your lifestyle and your medical history, including about:

Initial tests

Initial tests will include:

  • an examination of your tummy (abdomen) and vagina
  • a blood test, to check your hormone levels and whether you’re ovulating (your body is releasing eggs each month)

Your GP may suggest you have a transvaginal ultrasound scan to check your ovaries, womb and fallopian tubes. A consultant doctor or sonographer (a healthcare professional with training in using ultrasound) will put a slim ultrasound probe into your vagina to see inside your pelvis.

Further tests

If you haven’t got pregnant after a year or more of trying and all your tests results are normal, your GP may refer you to a fertility specialist or clinic. They’ll probably refer you sooner if you’re over 35, or if you’re likely to need treatment to increase your chances of getting pregnant. Further tests may include the following.

  • Hysterosalpingography (HSG) – or hysterosalpingo-contrast-ultrasonography (HyCoSy). These tests help to show whether your fallopian tubes are blocked and whether your womb (uterus) looks normal.
  • A laparoscopy and dye. This is a surgical procedure that uses a thin telescope, called a laparoscope, to look at your fallopian tubes, ovaries and womb. Your doctor might suggest this test if they think you may have a condition, such as endometriosis, that’s causing your fertility problems.

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 IVF (in-vitro fertilisation).

Self-help for female infertility

There are lots of things you can do to help increase your chances of getting pregnant and boost your fertility.

  • If you’re having unprotected vaginal sex to get pregnant, have sex regularly, every two or three days.
  • If you regularly drink alcohol, try to cut down to no more than one or two units a couple of times a week, or don’t drink at all.
  • If you smoke, stop. Ask your GP to refer you to a stop smoking service for help.
  • If you’re overweight, losing some weight may help. If you have a body mass index (BMI) of 30 or over, losing weight is likely to increase your chances of getting pregnant.
  • If you’re underweight, with a BMI of less than 19, and your periods aren’t regular, then gaining weight is likely to help you get pregnant.

Try our BMI calculator and ask your doctor about your score and how it may affect your chances of getting pregnant.

Trying to get pregnant can be very stressful, especially if it’s taking longer than you had expected. This can affect your relationships and your sex life, which can make getting pregnant more difficult too. Where possible, do what you can to reduce your stress levels. You might find it helps to speak to a counsellor.

Preserving fertility

You may decide that you’d like to preserve your fertility to give you the possible option of having a baby in the future. People do this for many reasons. For example, some treatments, such as cancer treatments, can affect fertility so you may be able to store eggs prior to having these. Or you may not be at a point in your life where you are ready to have a baby but are getting older.

One option may be to freeze your eggs, although this isn’t possible for everyone. Your eggs will be collected, then frozen. They can then be thawed later on to be used in fertility treatment. Ask your doctor if this is an option for you.

If you need to preserve your eggs for medical reasons, you may be able to go through the NHS but it can depend on where you live. But if you are doing it because you’re not ready to start a family, you'll need to pay for private treatment. Ask your GP about what’s available to you.

If you decide to store your eggs, you may be offered some counselling to talk things through.

Treatment for female infertility

Most treatments for infertility need to be prescribed by a specialist fertility doctor. There are lots of treatment choices and you may find it helpful to read more information about infertility treatments.

These are the main treatments available.

Medicines

There are medicines that can help to treat difficulties with ovulation (your body releasing eggs). Clomifene citrate, for example, and gonadotrophins can stimulate your ovaries to produce eggs.

These medicines can sometimes over stimulate your ovaries, so you produce too many eggs. If you take these medicines, it can lead to a multiple pregnancy (having twins or more). Your doctor will keep a close watch on how your body responds to the medicines. You’ll also need to have an ultrasound scan to check how these medicines are working.

Surgery

Sometimes an operation can help to treat a health problem that affects your fertility. Surgery may be an option for you if you have:

Your doctor will talk to you about the type of surgery you might need, as well as the possible benefits and risks of having the operation.

Assisted conception

Assisted conception means help to get pregnant using ways other than having sex. What type of assisted conception is an option for you will depend on the reasons why you’re finding it hard to get pregnant.

These are the main assisted conception methods.

  • Intra-uterine insemination (IUI). Sperm is put directly inside your womb around the time that you’re ovulating. You may need to take a medicine to help your ovaries produce more eggs at the same time. IUI may be an option for you if having sex is difficult, or if you’re in a same sex relationship.
  • In-vitro fertilisation (IVF). During IVF, eggs are taken from you (or a donor) and mixed with sperm in a laboratory. Fertilised eggs (embryos) are then put into your womb. IVF can help if there doesn’t seem to be a specific cause for your infertility, if you have blocked fallopian tubes, or other treatments haven’t worked. It can also help if you’re using surrogacy to have a baby.
  • Gamete intrafallopian transfer (GIFT). During GIFT, an egg and sperm are transferred into your fallopian tubes before the egg fertilises.
  • Intracytoplasmic sperm injection (ICSI). This can be an option if your partner has fertility problems, such as a low sperm count. It involves injecting a single sperm directly into the egg. The embryo is then put into your womb.

You can find out more about all types of assisted conception, including their success rates and risks, from the Human Fertilisation and Embryology Authority (HFEA).

Living with female infertility

Trouble getting pregnant, for any length of time, can be upsetting and stressful. Many people find the monthly cycle of hope and then disappointment takes an emotional toll, and that can affect every aspect of your life. Feeling stressed, whatever the cause, can affect your relationships and your sex life, which in turn can make getting pregnant even harder. There’s also some evidence that stress can affect how successful certain treatments are.

You may find it helpful to get support from others going through the same thing. You can find local support groups and access online support through the charity, Fertility Network UK. Or it may help to talk to someone who doesn’t know you or your partner, and isn’t involved in your treatment. Counselling may help you talk about the impact it’s having – ask your fertility clinic to refer you, or find a counsellor yourself.

Frequently asked questions

  • There aren’t any signs or specific symptoms of infertility, you just don’t get pregnant. But if a medical condition is the cause of infertility, you may have symptoms. For example, if you have polycystic ovary syndrome (PCOS), you may have excessive hair growth, acne, hair loss and irregular and infrequent periods. You may be overweight too.

    See our section: Symptoms of female infertility above for more information.

  • There are different types of infertility based on what the cause is. Although sometimes doctors can’t find any cause, which is called unexplained infertility. But in general, there are usually four main causes, which are egg production problems, conditions that affect your ovaries, conditions that affect your fallopian tubes, and conditions that affect the womb.

    See our section: Causes of female infertility above for more information.

  • Yes, there are treatments for infertility. These include medicines to treat difficulties with ovulation (your body releasing eggs), to operations to treat a health problem that affects your fertility. There are also assisted conception methods to help you get pregnant, such as in-vitro fertilisation (IVF).

    See our section: Treatment for female infertility above for more information.



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Related information

  • Discover other helpful health information websites

    • Infertility in women. BMJ Best Practice. bestpractice.bmj.com, last reviewed 10 December 2021
    • Infertility. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2018
    • Personal communication, Mr Luciano Nardo, Consultant in Obstetrics and Gynaecology, 3 March 2022
    • Fertility problems: assessment and treatment. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated 6 September 2017
    • Guidance. Health matters: reproductive health and pregnancy planning. Public Health England. www.gov.uk, published 26 June 2018
    • Infertility. Medscape. emedicine.medscape.com, updated 30 January 2020
    • Exploratory (diagnostic) laparoscopy periprocedural care. Medscape. emedicine.medscape.com, updated 28 January 2020
    • Code of practice. Human Fertilisation and Embryology Authority. www.hfea.gov.uk, revised October 2017
    • Fertility preservation. Human Fertilisation and Embryology Authority. www.hfea.gov.uk, published 18 February 2021
    • Egg freezing. Human Fertilisation and Embryology Authority. www.hfea.gov.uk, published 15 March 2021
    • Clomifene citrate. NICE British National Formulary. bnf.nice.org.uk, last updated 3 February 2022
    • Menotrophin. NICE British National Formulary. bnf.nice.org.uk, last updated 3 February 2022
    • Uterine fibroids. BMJ Best Practice. bestpractice.bmj.com, last reviewed 10 December 2021
    • Intrauterine insemination (IUI). Human Fertilisation and Embryology Authority. www.hfea.gov.uk, published 2 December 2022
    • In vitro fertilisation (IVF). Human Fertilisation and Embryology Authority. www.hfea.gov.uk, published 12 November 2021
    • Intracytoplasmic sperm injection (ICSI). Human Fertilisation and Embryology Authority. www.hfea.gov.uk, published 19 November 2021
    • Polycystic ovary syndrome. BMJ Best Practice. bestpractice.bmj.com, last reviewed 10 December 2021
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, April 2022
    Expert reviewer Mr Luciano Nardo, Consultant in Obstetrics and Gynaecology, RCOG accredited subspecialist in Reproductive Medicine
    Next review due April 2025

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