Female infertility
- Mr Luciano Nardo, Consultant in Obstetrics and Gynaecology, RCOG-accredited Subspecialist in Reproductive Medicine
This information looks at female infertility. You may also find it useful to find out more about male infertility.
Infertility is the term used to describe not being able to get pregnant naturally. You might hear the word ‘subfertility’ used too. This means a delay in getting pregnant. If you’re trying for a baby, you may need some extra help to increase your chances.
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. These problems may be for you, your partner or both of you.
Causes of female infertility
There are many reasons why you may have trouble getting pregnant. This could be a problem with your ovaries, womb (uterus) or fallopian tubes. But sometimes doctors can’t find any cause, even after they’ve done some tests and scans. This is called unexplained infertility.
Egg production problems
A problem with egg production is the most common reason for infertility in women. This may be caused by:
- conditions such as polycystic ovary syndrome
- problems relating to the balance of hormones in your body – for example, an early menopause
Conditions that affect your ovaries. You may have problems with your ovaries if:
- you’re very underweight
- you’ve had an operation on your ovaries
- you’ve had chemotherapy or radiotherapy
Sometimes your ovaries can stop working altogether.
Conditions that affect your fallopian tubes
Your fallopian tubes can be affected by:
- endometriosis
- scar tissue that develops after a sexually transmitted infection
- damage caused by pelvic inflammatory disease
Conditions that affect your womb
These conditions include:
- fibroids
- endometriosis
- damage or changes to the structure of your womb
You could also be born with a problem with your womb.
Your age
Your fertility naturally declines as you get older, particularly after the age of 35. This is because you produce fewer eggs, and their quality usually isn’t as good.
Your lifestyle
Certain aspects of your lifestyle could affect your chances of getting pregnant. These include:
- being under- or overweight
- smoking
- drinking too much alcohol
- taking certain medicines – for example, medicines for epilepsy
if you regularly take any medicine and are having problems getting pregnant, ask your gp if the medicine could be affecting your fertility.
Symptoms of female infertility
Infertility doesn’t cause any specific symptoms other than not getting pregnant. But if a medical condition is causing infertility, you may have some symptoms. These conditions include:
- polycystic ovary syndrome (PCOS)
- endometriosis
- fibroids
- an infection
If you have the following symptoms, speak to your GP:
- irregular periods, no periods or heavy bleeding during your period
- pain in your pelvis
- painful periods
- pain when you have sex or bleeding after you have sex
- excessive facial hair and acne (spots)
Diagnosis of 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 speak to your GP for advice.
If you’re over 35, speak to your GP sooner, 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 if you’ve had any problems with sex. They may also ask you about:
- your periods
- previous pregnancies or miscarriages
- sexually transmitted infections (STIs)
- long-term health problems, including childhood illnesses
- whether or not you smoke, drink alcohol or take drugs
- whether or not you're taking any medicines
- when you last used contraception and how long you used it for
Initial tests
Your GP is likely to:
- check your tummy and vagina
- do a blood test to check your hormone levels and if you’re ovulating (your body is releasing eggs each month)
Your GP may also suggest you have a transvaginal ultrasound scan to check your ovaries, womb and fallopian tubes. A consultant doctor or sonographer (a healthcare professional trained to use ultrasound) will carry out this test. They 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 test 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 if your fallopian tubes are blocked and if your womb looks normal.
- A laparoscopy and dye. This surgical procedure 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 a condition such as endometriosis is causing your fertility problems.
Your doctor may also offer you tests to check your ovarian reserve. This measures how likely your ovaries are 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 a pharmacist or your GP about the best way to give up smoking .
- 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, 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 expected. This can affect your relationships and your sex life. It can make getting pregnant more difficult too. Where possible, do what you can to reduce your stress levels. It may help 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. Some treatments can affect fertility – for example, cancer treatments. You may be able to store eggs before your treatment starts. Or you may want to preserve fertility if you’re getting older but aren’t yet ready to have a baby. Fertility preservation isn’t suitable for everyone. Your GP can discuss if the treatments are suitable for you. Freezing your eggs. Your eggs will be collected, then frozen. The eggs can then be thawed later on to be used in fertility treatment.
- Preserving your ovarian tissue. A surgeon will remove some tissue from one of your ovaries. This tissue is then frozen. The surgeon puts the tissue back into your other ovary at a later date to help restore your fertility.
If you need to preserve your eggs for medical reasons, you may be able to do so through the NHS. But this can depend on where you live. If you’re doing it because you’re not ready to start a family, you'll need to pay for private treatment. Ask your GP 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. You may find it helpful to read more information about infertility treatments. Medicines, surgery and assisted conception are the main treatments available.
Medicines
A specialist fertility doctor may prescribe medicines that can help to treat problems with ovulation (your body releasing eggs). These medicines stimulate your ovaries to make eggs. They include:
- clomifene citrate
- gonadotrophins such as menotrophin
These medicines can sometimes overstimulate your ovaries. This means your ovaries make too many eggs. If you take these medicines, you may have a multiple pregnancy (a pregnancy of 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:
- endometriosis
- blocked or damaged fallopian tubes
- fibroids
- scar tissue inside your womb
- polycystic ovary syndrome
Your doctor will talk to you about the type of surgery you might need and the possible benefits and risks of having the operation.
Assisted conception
Assisted conception means help to get pregnant using ways other than having sex. The right type of assisted conception for you will depend on why you’re finding it hard to get pregnant.
There are three main assisted conception methods.
- Intra-uterine insemination (IUI). Sperm is put directly inside your womb around the time you’re ovulating. You may need to take a medicine to help your ovaries make 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, you have blocked fallopian tubes or other treatments haven’t worked. It can also help if you’re using surrogacy to have a baby.
- 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 an 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. This can affect every aspect of your life. Feeling stressed, whatever the cause, can affect your relationships and your sex life. This in turn can make getting pregnant even harder. There’s also some evidence that stress can affect the success of certain fertility treatments.
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 – you can ask your fertility clinic to refer you or find a counsellor yourself.
Living with endometriosis? Looking for support?
The endometriosis support page in our Women's Health Hub offers a wide range of expert advice, information and tools.
Infertility doesn’t have any specific signs or symptoms – you just don’t get pregnant. But if a medical condition is causing infertility, you may have symptoms such as irregular periods, painful periods, excessive facial hair and acne.
For more information, see our section on symptoms of female infertility.
Female infertility has lots of possible causes. It may be due to a problem with egg production or a problem with your ovaries, fallopian tubes or womb. But sometimes doctors can’t find any cause. This is called unexplained infertility.
For more information, see our section on causes of female infertility.
The main cause of female infertility is a problem with egg production. This may be due to a condition such as polycystic ovary syndrome. Or it may be due to a problem with hormone levels – for example, early menopause.
For more information, see our section on causes of female infertility.
Infertility can often be treated. You may be able to take medicines to trigger ovulation (your body releasing eggs). Or you may need surgery to treat a health problem that’s affecting your fertility. Assisted conception methods such as in-vitro fertilisation (IVF) may help you get pregnant.
For more information, see our section on treatment for female infertility.
Gynaecological laparoscopy
In a gynaecological laparoscopy, your surgeon uses a camera (laparoscope) to see inside your lower abdomen (tummy). This means they will be able to see your womb (uterus), fallopian tubes and ovaries.
Treatments for infertility
Menopause
Male infertility
If your partner hasn’t got pregnant after a year of regular sex and no contraception, this could be a sign of fertility problems.
Other helpful websites
Discover other helpful health information websites
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- Victoria Goldman, Freelance Health Editor
