16083 Infertility

Overview

Infertility is when a couple has regular unprotected sex for a year or more without the woman becoming pregnant. It can also mean a woman has trouble carrying a pregnancy to full term.

Yes, infertility is common. In the UK, about 1 in 7 heterosexual couples experience difficulty getting pregnant.

Infertility can affect anyone of reproductive age, both men and women equally. It can happen for many different reasons, and the cause may be in one partner or both.

Symptoms

Common symptoms

• The main symptom is not getting pregnant after 12 months of regular unprotected sex.
• Some women may have irregular, painful, or absent periods.
• Some men may notice changes in sexual desire, erectile function, or pain or swelling in the testicles.

Causes

Main causes

• In women: ovulation problems, such as polycystic ovary syndrome (PCOS) or thyroid conditions.
• In women: blocked or damaged fallopian tubes, often from pelvic infection or endometriosis.
• In men: low sperm count, poor sperm movement, or blockages in the reproductive tract.
• Sometimes both partners have contributing factors, and in some cases no cause is found (unexplained infertility).

Risk factors

• Age — fertility declines with age, especially for women over 35.
• Smoking and heavy alcohol use.
• Being significantly overweight or underweight.
• High stress levels.
• Exposure to certain chemicals, radiation, or infections that affect the reproductive organs.
• Some medical conditions and treatments, such as chemotherapy.

When to see a doctor

See a doctor urgently if:

• If you or your partner experience any of the emergency symptoms listed above, such as sudden severe pelvic pain, heavy bleeding, or acute testicular pain, seek immediate care.

Book a routine appointment if:

• If you are under 35 and have not conceived after 1 year of regular unprotected sex.
• If you are 35 or older and have been trying for 6 months.
• If you have irregular periods, known endometriosis, previous abdominal or pelvic surgery, or a history of testicular injury.

Diagnosis

A doctor will ask about your medical history, lifestyle, sexual habits, and any previous pregnancies. Both partners are usually involved. Tests are then arranged to look for possible causes.

Tests that may be done

• Semen analysis for the male partner – checks sperm count, shape, and movement.
• Blood tests to check hormone levels in women (and sometimes men).
• Ultrasound scan of the pelvis to check the womb, ovaries, and fallopian tubes.
• A test called a hysterosalpingogram (an X-ray dye test) to see whether the fallopian tubes are open.

What to expect at your appointment

You and your partner will be asked personal questions about your relationship and sexual health. This is normal and nothing to be embarrassed about. The process may take a few months, and you will be referred to a fertility specialist if needed.

Treatment

Treatment depends on the cause, how long you have been trying, your age, and your personal preferences. Options range from lifestyle changes to simple medical treatments, and in some cases assisted conception like IVF.

Self-care at home

• Stop smoking and avoid recreational drugs.
• Reduce alcohol intake – no more than 1 to 2 units a week is often advised.
• Try to reach a healthy weight through balanced eating and moderate exercise.
• Have sex every 2–3 days, without putting too much pressure or timing stress on each other.
• Learn to manage stress with relaxation techniques, hobbies, or counselling.

Medical treatments

Medical treatments may include medicines to stimulate ovulation or correct hormone imbalances. For some couples, procedures like intrauterine insemination (IUI) or in vitro fertilisation (IVF) are used. These are done under the guidance of a fertility specialist in a licensed clinic.

When is surgery considered?

Surgery may help in cases like blocked fallopian tubes, endometriosis, or certain testicular conditions. For men, sperm can sometimes be retrieved directly from the testicles or epididymis for use in IVF.

Living with this condition

Coping with infertility can be emotionally and physically draining. It can affect your relationship, work, and self-esteem. It helps to keep open communication with your partner, take breaks from 'trying' when you need to, and continue doing things you enjoy.

Lifestyle tips

• Maintain a healthy weight and keep active with moderate exercise.
• Avoid smoking, excessive alcohol, and recreational drugs.
• Limit caffeine – most guidelines suggest under 300mg per day (about 2–3 cups of coffee).
• Seek professional support if anxiety or low mood becomes overwhelming.

Diet and exercise

A balanced diet with plenty of fruits, vegetables, whole grains, and lean proteins supports overall health and fertility. Moderate exercise like brisk walking, swimming, or yoga is helpful. Very intense exercise can disrupt menstrual cycles, so try to keep it moderate.

Mental health and emotional wellbeing

Infertility can cause anxiety, depression, and feelings of isolation or grief. These feelings are normal and valid. Counselling, support groups, and talking to trusted people can make a real difference.

Prevention

Some causes of infertility can be prevented by healthy lifestyle choices, such as avoiding smoking, limiting alcohol, keeping a healthy weight, and using condoms to prevent sexually transmitted infections that can damage the fallopian tubes. However, many causes, like age-related decline or genetic factors, cannot be prevented.

Screening programmes

Being screened for sexually transmitted infections, especially chlamydia, is important because untreated infections can cause scarring and blockages in the reproductive tract. You can ask your GP or local sexual health clinic about this.

Complications

If left untreated

• The main complication is difficulty achieving pregnancy.
• Underlying conditions like endometriosis or PCOS may also cause chronic pelvic pain or other health issues.
• Emotional distress and relationship strain are common when infertility is not addressed.

Long-term outlook

The outlook is generally hopeful. Many couples who have difficulty conceiving eventually do have a child, either naturally or with medical help. Fertility treatments, including IVF, have improved significantly and offer real hope. With the right support, most people find a path that works for them.

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