Female infertility overview

Overview

Female infertility means that a woman has not been able to get pregnant after one year (or six months if she is over 35) of trying, with regular unprotected sex. It is not a single condition but a symptom that can have many causes.

Yes, infertility is common. Around 1 in 7 couples have difficulty conceiving. In half of those cases, female factors contribute.

Female infertility can affect women of any ethnicity or background, but it becomes more common with age, especially after 35. It can also affect women with certain medical conditions, such as polycystic ovary syndrome (PCOS) or endometriosis.

Symptoms

Common symptoms

• Not being able to get pregnant after a year of trying (or six months if over 35)
• Irregular or absent menstrual periods
• Pelvic pain or pain during sex
• Heavy or painful periods
• Changes in ovulation (for example, no ovulation)

Symptoms in older adults

• For women over 35, the time to get pregnant naturally may be longer. Fertility tests and specialist help are often recommended sooner.

Causes

Main causes

• Ovulation problems – the ovaries do not release eggs regularly. This can happen with PCOS, thyroid issues, or premature ovarian failure.
• Fallopian tube damage or blockage – often caused by pelvic inflammatory disease (PID), past surgery, or endometriosis.
• Endometriosis – tissue similar to the womb lining grows outside the womb, affecting the ovaries, tubes, or uterus.
• Uterine or cervical issues – fibroids, polyps, or an abnormally shaped uterus can prevent pregnancy.
• Age – as women get older, both the number and quality of eggs decline.

Risk factors

• Age over 35
• Smoking or using recreational drugs
• Being very overweight or underweight
• Excessive alcohol or caffeine
• Sexually transmitted infections (STIs) that go untreated
• Previous pelvic surgery
• Certain medical conditions (like PCOS, diabetes, autoimmune diseases)

When to see a doctor

See a doctor urgently if:

• If you have severe pelvic pain, abnormal bleeding, or fainting – seek emergency care.
• If you think you might have an STI or pelvic infection.

Book a routine appointment if:

• If you have been trying to conceive for a year (or six months if over 35) without success.
• If you have irregular, absent, or painful periods.
• If you have a known condition (like endometriosis or PCOS) and are having trouble getting pregnant.

Diagnosis

Your doctor will take a detailed history, including your menstrual cycle, any past pregnancies, and lifestyle. They may do a physical exam and order several tests to find out why you are having trouble getting pregnant.

Tests that may be done

• Blood tests to check hormone levels and see if you are ovulating
• Ovulation tracking – using home ovulation kits or blood/urine tests
• Pelvic ultrasound to look at the ovaries, uterus, and fallopian tubes
• Hysterosalpingogram (HSG) – an X-ray to see if the fallopian tubes are open
• Laparoscopy – a small camera inserted into the abdomen to look for endometriosis or scar tissue

What to expect at your appointment

Diagnosis can take several months and may involve multiple appointments. Your doctor will explain each test and what it can find. In many cases, the cause is identified and treatment can be planned. It's okay to ask questions and take your partner along for support.

Treatment

Treatment depends on the cause and your age. Many problems can be corrected with medicines, lifestyle changes, or simple procedures. If needed, assisted reproductive technologies (like IVF) are available on the NHS in many areas. Your doctor will discuss the best options for your situation.

Self-care at home

• Maintain a healthy weight through balanced diet and regular exercise
• Reduce stress – try relaxation techniques like yoga or meditation
• Limit alcohol to no more than 1-2 units per week (or avoid it altogether)
• Stop smoking – this improves fertility and overall health
• Track your menstrual cycle to know when you are most fertile

Medical treatments

Medicines can help if you are not ovulating regularly. These may be tablets or injections that stimulate the ovaries. Surgery (keyhole or open) can remove endometriosis, fibroids, or blocked tubes. If these do not work, fertility treatments like intrauterine insemination (IUI) or in vitro fertilisation (IVF) may be recommended. Your specialist will explain the options, success rates, and risks. Do not take any fertility medications without a prescription.

When is surgery considered?

Surgery may be offered if you have endometriosis, fibroids, polyps, or blocked fallopian tubes. It is usually done as keyhole surgery (laparoscopy) to avoid large scars. Your doctor will tell you if surgery is likely to help.

Living with this condition

Living with infertility can be stressful. You may need to schedule doctor appointments, track your cycle, and possibly take time off for procedures. It helps to plan ahead and involve your partner or a trusted friend.

Lifestyle tips

• Eat a healthy diet rich in fruits, vegetables, whole grains, and healthy fats
• Get regular, moderate exercise – too much or too little can affect fertility
• Get enough sleep – aim for 7-9 hours per night
• Reduce stress through hobbies, talking to friends, or counselling

Diet and exercise

A balanced diet helps with hormone balance and weight. Focus on folate-rich foods (leafy greens, fortified cereals), which are important for early pregnancy. Being either underweight or overweight can affect ovulation, so staying in a healthy range is best. Aim for 150 minutes of moderate exercise per week, like brisk walking or swimming.

Mental health and emotional wellbeing

Infertility can cause feelings of sadness, anxiety, guilt, or frustration. It is normal to grieve the pregnancy you hoped for. These feelings can strain relationships. Talking to a counsellor or joining a support group can help. Your GP can also refer you for talking therapies.

Prevention

Not all causes of infertility can be prevented, but you can reduce the risk by maintaining a healthy lifestyle, avoiding smoking and excessive alcohol, and treating STIs early. Regular check-ups can help manage conditions like PCOS or thyroid problems before they affect fertility.

Screening programmes

There is no routine screening for infertility. However, if you have risk factors (like irregular periods or a family history of early menopause), it may be worth discussing fertility with your doctor earlier.

Complications

If left untreated

• It may become harder or impossible to conceive naturally as you get older
• Underlying conditions like endometriosis or PCOS can worsen over time, causing more pain or other health issues
• Emotional distress, anxiety, or depression can develop

Long-term outlook

Many women with infertility eventually become parents, either naturally or with treatment. Even if natural pregnancy is not possible, options like IVF, donor eggs, or surrogacy exist. The outlook depends on the cause, but most couples find a path forward with medical help and support.

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