Female infertility

Expert reviewer, Raj Mathur, Consultant Gynaecologist
Next review due: February 2020

Getting pregnant (conceiving) often takes a while. So if you don’t get pregnant straight away, there’s normally no need to worry. If you haven’t managed to get pregnant after a year of regular sex and no contraception though, it could be a sign of fertility problems.

This information looks at infertility in women – to read about infertility in men, see our Related information section.

Symptoms of female infertility

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)

Diagnosis of female infertility

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 it might be worth seeing your GP for advice. Think about seeing your GP sooner than this if you’re older than 35. It's a good idea for you and your partner to see your GP together.

Common questions

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.

Initial tests

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.

Further tests

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).

How can I boost my fertility?

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.

Lifestyle changes

Making some changes to your lifestyle may improve your chances of conceiving. This may involve stopping smoking and drinking alcohol. Current guidelines are that it’s best for women not to drink at all if you’re pregnant or trying for a baby. 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.

Treatment for female infertility

Most treatments for female infertility need to be prescribed by a specialist fertility doctor. Our infertility treatments topic provides more detailed information about treatments available for both male and female infertility, and when you can be referred.

Fertility drugs

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.

Surgery

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.

Assisted conception

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 mixed with sperm in a laboratory. Fertilised eggs (embryos) are then 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). See our related information section for website link.

Causes of female infertility

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

Living with fertility problems

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.