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Female infertility


Expert reviewer, Miss Shirin Irani, Consultant Obstetrician and Gynaecologist
Next review due September 2021

Getting pregnant (conceiving) happens quickly for some women, but for others it can sometimes take a while. About eight in 10 couples conceive naturally within a year and nine in 10 couples within two years, if they have unprotected sex every two or three days. So, 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.

Infertility means not being able to get pregnant, and then needing investigations and treatment to conceive. You might hear the word ‘subfertility’ used too, which means a delay in getting pregnant for whatever reason.

This information looks at infertility in women. You may also find it useful to find out more about infertility in men.

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Symptoms of female infertility

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

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


Diagnosis of female infertility

Many couples don’t get pregnant straightaway when they start trying to conceive. But if you’ve been trying to get pregnant for a year or more, it’s a good idea for you and your partner to see your GP for advice. If you’re older than 35, you should see your GP after six months of trying. As women 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 having sex. They may ask you about your periods, your lifestyle and your medical history, including about:

  • previous pregnancies or miscarriages
  • sexually transmitted infections (STIs)
  • long-term health problems
  • whether you smoke, drink alcohol or take drugs
  • whether you're taking any medicines

Initial tests

Initial tests will include:

  • an examination of your abdomen and vagina
  • a blood test, to check your hormone levels and whether you’re ovulating

Your GP may suggest you have a transvaginal ultrasound scan to check your ovaries, womb and fallopian tubes. This is usually done at a hospital clinic. A sonographer will put a slim ultrasound probe into your vagina to see the structures and the organs inside your pelvis.

Further tests

If you haven’t conceived 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. Your GP may 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 or hysterosalpingo-contrast-ultrasonography. These tests help to show whether your fallopian tubes are blocked and whether your 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 uterus. Your doctor might suggest this test if they think you may have a condition such as endometriosis that is 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).

How can I boost my fertility?

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

  • 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.
  • 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, then 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 conceive.

Try our BMI calculator and get tailored health advice depending on your score.

Trying to get pregnant can be very stressful, especially if it’s taking longer than you had expected. That can affect your relationship with your partner and your sex life, which can make getting pregnant more difficult too. Where possible, do what you can to reduce your stress levels. Speaking to a counsellor can also help.

Treatment for female infertility

Most treatments 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 ovulation difficulties. Clomifene citrate and metformin can stimulate your ovaries to produce eggs, which can help if you have a condition such as polycystic ovary syndrome.

These medicines can sometimes over stimulate your ovaries though, so you produce too many eggs. Taking these medicines 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 will also need to have an ultrasound scan to check how these medicines are working.

If you’re not producing hormones that trigger ovulation, you may be prescribed medicines called gonadotrophins.

Surgery

Sometimes an operation can help to treat an underlying problem. You may be offered surgery if you have a health condition such as:


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

Assisted conception

Assisted conception means having help to get pregnant using other ways instead of having sex. What type of assisted conception is offered to 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 uterus around the time that you’re ovulating. You might also be asked to take a small amount of medicine to help your ovaries produce more eggs at the same time. IUI may be offered to you if having sex is difficult or if you’re in a same sex relationship.
  • In-vitro fertilisation (IVF). During IVF, an egg is taken from you (or a donor) and mixed with sperm in a laboratory. Fertilised eggs (embryos) are then put into your uterus using a thin tube. IVF can help if there doesn’t seem to be a specific cause for your infertility, if you have blocked fallopian tubes or if other treatments haven’t worked.
  • Gamete intrafallopian transfer (GIFT). During GIFT, an egg and sperm are transferred into your fallopian tubes before the egg fertilises.

There is another method of assisted conception called 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 uterus.

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).

Causes of female infertility

There are many reasons why you may have trouble getting pregnant. But in about two or three couples in every 10, doctors can’t find any specific cause. This is sometimes called unexplained infertility.

In women, there are usually three main reasons why they might be having trouble getting pregnant.

  • Problems producing eggs. This is the most common reason for infertility. 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 glands. These can develop because of lifestyle factors such as being underweight. Sometimes your ovaries can stop working altogether.
  • Conditions that affect your fallopian tubes. This includes endometriosis and scar tissue that develops because of a sexually transmitted infection or pelvic inflammatory disease.
  • Conditions that affect the uterus. This includes fibroids, endometriosis and damage or changes to the structure of your uterus.

Your fertility naturally goes down as you get older too, particularly after the age of 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. Being under or overweight, smoking and drinking too much alcohol can all affect your fertility. Taking certain medicines can also have an impact. If you’re regularly taking any medicine and you’re trying to get pregnant, talk to your GP about whether it may be affecting your fertility.

Living with fertility problems

Having 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 relationship with your partner and your sex life, which in turn can make getting pregnant even harder. There is also some evidence that stress can affect how successful certain treatments are.

Some couples 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. Others find it helps to talk to someone who doesn’t know you or your partner, and isn’t involved in your treatment. If you’re having fertility problems, you should be offered counselling to help you talk about the impact it’s having. Ask your fertility clinic to refer you or find a counsellor.

Frequently asked questions

  • Some people use complementary approaches to try to improve their fertility, such as taking herbal remedies, practising yoga or having acupuncture. However, there’s no proof that any complementary therapies can increase your chance of getting pregnant. In fact, taking high doses of some supplements, especially unlicensed produced you can buy online, may even hinder your changes of conceiving.

    It’s worth finding out all you can if you're thinking about trying any complementary therapy and telling your doctor if you decide to go ahead. Some complementary therapies can be harmful to a developing baby if you become pregnant. If you decide to go ahead, check that your therapist is registered with a professional body, such as the British Acupuncture Council.

  • Early or premature menopause means starting the menopause before you’re 40. It happens when your ovaries stop producing eggs and you stop having periods.

    Premature menopause can run in families. It can also be caused by genetic conditions, certain health problems and treatments. These include chemotherapy for cancer, autoimmune conditions, such as Addison’s disease and type 1 diabetes, and surgery to remove the ovaries. For most women, there’s no clear cause.

  • Laparoscopic ovarian drilling may improve your chances of getting pregnant if you have polycystic ovary syndrome (PCOS). You may be offered it if the medicines that help your ovaries produce more eggs won’t work for you. The aim of the procedure is to induce (start) ovulation.

    During the procedure, which is done under a general anaesthetic, your surgeon will use a laser or small needle-like instrument to puncture holes in your ovaries. This means they produce less testosterone. Your body then produces more follicle stimulating hormone, which causes your ovaries to produce eggs more regularly.

    The procedure doesn’t work for everyone, but it can increase your chances of getting pregnant. Around six in 10 women who have the procedure get pregnant afterwards.


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Related information

    • Infertility. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2018
    • Infertility in women. BMJ Best Practice. bestpractice.bmj.com, last reviewed April 2019
    • Reproductive endocrinology. Oxford Handbook of Endocrinology and Diabetes. Oxford Medicine Online. oxfordmedicine.com, published March 2014
    • Transvaginal ultrasound. The Royal Australian and New Zealand College of Radiologists. www.insideradiology.com.au, last modified August 2018
    • Infertility – female. PatientPlus. patient.info, last edited April 2016
    • Diagnostic laparoscopy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published 2017
    • Fertility problems: assessment and treatment. National Institute for Health and care Excellence (NICE) 2017. www.nice.org.uk
    • Ovarian hyperstimulation syndrome. PatientPlus. patient.info, last edited July 2015
    • Uterine fibroids. BMJ Best Practice. bestpractice.bmj.com, last reviewed April 2019
    • Coping strategies. Fertility Network UK. fertilitynetworkuk.org, published 2016
    • Infertility. Healthtalk. www.healthtalk.org, last reviewed July 2017
    • Infertility treatments. PatientPlus. patient.info, last edited April 2016
    • Menopause. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2017
    • Polycystic ovary syndrome. BMJ Best Practice. bestpractice.bmj.com, last reviewed April 2019
  • Reviewed by Alice Windsor, Specialist Health Editor, Bupa Health Content Team, September 2019
    Expert reviewer, Miss Shirin Irani, Consultant Obstetrician and Gynaecologist
    Next review due September 2021



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