Fertility

A woman is fertile when she is able to bear a child. Fertility problems relate to the inability to become pregnant or the inability to carry a pregnancy to a live birth.

Why is this important?

If you've tried unsuccessfully to get pregnant for a year or more through regular unprotected sex, you should seek advice from your GP.

If you're over 35, or if you think that you or your partner may have a fertility problem, see your GP after six months of trying.

There are many things that might affect your ability to conceive or carry a pregnancy to full term, and there are various options for treatment or assisted conception.

Who does it affect?

Around one in seven couples in the UK may have fertility problems. Many couples with fertility problems go on to conceive, with or without treatment. Both men and women can experience difficulties with fertility.

What could be affecting your fertility?

It can be difficult to understand the causes of infertility, and for 25% of couples, a cause cannot be identified.

Subfertility is commonly caused by problems with ovulation, when eggs are not released each month, or are released some months and not others. Ovulation problems can be caused by:

  • Polycystic ovary syndrome, where small growths or cysts can inhibit the release of the egg
  • Endometriosis, where small pieces of the lining of the womb start growing in other places such as the ovaries
  • Thyroid problems which can prevent ovulation.

You could also experience problems if you’ve had:

  • Surgery that may have scarred or affected your reproductive organs
  • Some medications and treatments, including chemotherapy
  • Complications in previous pregnancies or births
  • A sexually transmitted infection (STI), such as Chlamydia
  • Pelvic inflammatory disease (PID)
  • It may also take time for certain types of contraception to stop working and for your reproductive cycle to return to normal.

Your lifestyle can also affect your fertility - smoking, drinking alcohol, being overweight and stress can all affect your chances of conceiving.

Age and fertility

Fertility starts to decrease when a woman reaches her mid-thirties.

These figures show typical ability to conceive after one or two years of trying:

Fertility1
Fertility2

Talking to your partner

The process of trying to conceive can be emotional, so you will need to support each other as much as possible. Stress is just one of the things that can affect fertility. The problem could be with either a male or female partner, so it’s important that both of you speak to a clinician.

If you decide to get treatment or explore different options for having a child, it may be costly, time-consuming and stressful, so you should talk through what is right for both partners and for your relationship in the longer term.

Get tested

Prepare

When you first seek advice from a fertility clinic or GP, the clinician may recommend you keep trying for a while if you’ve been having regular, unprotected sex for less than a year.

If you've been trying for more than a year, your clinician may recommend a range of tests to determine what's stopping you from conceiving. You may also be offered counselling to support you if you’re struggling to conceive.

What kind of tests are there?

For women, a number of tests can be used to try and establish the cause of infertility:

  • Hormone tests - a clinician will take a blood sample to check the hormones that affect ovulation
  • Checking your ovaries - this could be a blood test or an ultrasound scan to examine your ovaries for any problems
  • Chlamydia test - a soft cotton swab is used to collect some cells from your cervix to test for chlamydia. You can take the swab by yourself. It can be a little uncomfortable but should not hurt. If you have chlamydia, you will be prescribed antibiotics to treat it
  • Hysterosalpingogram (HSG) - an x-ray of your womb and fallopian tubes after a special dye has been inserted. This will detect any blockage of the fallopian tubes
  • Hysterosalpingo-contrast-ultrasonography (HyCoSy) - an ultrasound scan that uses a small amount of fluid to check if fallopian tubes are damaged or blocked.
  • Laparoscopy - a clinician will make a small cut in your lower abdomen (tummy), then use a thin, tubular telescope to look at your womb, fallopian tubes and ovaries. It is usually carried out under general anaesthetic and is only used if there is a high chance that there is an internal problem.

Your partner may be asked to do a sperm test to see whether something may be affecting their fertility. Read about male fertility here.

What to do next

Whether or not a clear cause is found, your fertility clinician or GP can talk you through the next steps. This may include referral for further investigation or treatment. Access to free fertility treatment on the NHS varies in different parts of the UK, and waiting lists can be long.

You may wish to seek private treatment, though you should research your clinic carefully and make sure any quote includes all costs and details of treatment options. Make sure that a private clinic is licensed by the Human Fertilisation and Embryology Authority (HFEA), which regulates and inspects fertility clinics in the UK.

Next steps could include a course of medicine to improve fertility, surgery, or assisted conception. Read more about assisted conception in our Questions section.

More support

Questions?

There is no evidence to suggest that taking the pill affects your fertility after you stop taking it.

There is no single test for fertility. There are many factors that could influence your fertility and the different tests investigate each of these. In up to 25% of cases no cause for infertility is found.

You can calculate approximately your most fertile time by taking the average length of your cycle in days and subtracting 14. This will give you an approximate estimate of when you ovulate.

The injectable contraception, Depo Provera, can delay the return of your fertility for several months after you stop using it, but your fertility will return to normal after this.

If you are over 35 and have been having regular unprotected sex for six months, or are under 35 and have been having regular unprotected sex for one year, then you should see your GP. If you are aware that you may have fertility problems due to previous health issues, you can talk to your GP before you start trying.

Subfertility may be caused by the male or female partner or a combination of factors from both partners. Read more about male fertility here.

This depends on your circumstances (e.g. health, age). Subfertility problems can affect both men and women. In women, common causes are not producing an egg each month, endometriosis, or damage to the fallopian tubes following infection. In men, common causes are low sperm count or low sperm activity. Some of these problems can be treated while others may continue to affect your fertility.

Women who are aged over 50 years and have not had a period for one year are likely to have very low levels of fertility and can stop using contraception. Read more about menopause.

Assisted conception is the use of technology to facilitate conception, for example, intrauterine insemination when sperm is introduced into the womb (uterus) via a fine tube, or in vitro fertilisation where the fertilisation of the egg occurs outside the body and is then placed inside the womb during a clinical procedure.