Infertility

Overview

Infertility means not being able to get pregnant after a year of regular, unprotected sex. If you are 35 or older, doctors may suggest checking after 6 months. It can affect anyone trying to conceive, and it is not anyone’s fault. Many people with infertility go on to have a baby, with or without treatment.

Yes. Infertility is common. About 1 in 7 couples worldwide have difficulty conceiving. Many need some help, and many eventually have a baby.

Anyone trying to conceive can be affected. This includes people of all genders, single people using donor sperm or eggs, and LGBTQ+ people building a family. Age can affect fertility, especially for women, but infertility is not only a woman’s issue. Male factors play a part in about half of cases.

Symptoms

Common symptoms

• The main sign is not getting pregnant after 12 months of regular unprotected sex, or after 6 months if you are 35 or older.
• Periods that are very irregular, very painful, very heavy, or absent.
• Pelvic pain or pain during sex.
• For men: trouble with ejaculation, low sex drive, pain or swelling in the testicles, or small testicles.
• Sometimes there are no other signs at all.

Causes

Main causes

• Problems with sperm, such as low sperm count, poor sperm movement, or blocked tubes.
• Problems with ovulation, such as polycystic ovary syndrome or thyroid problems.
• Blocked or damaged fallopian tubes, often from infection or endometriosis.
• Age — fertility drops as women get older, especially after 35.
• Unknown causes — in about 1 in 4 couples, tests do not find a clear reason.

Risk factors

• Age, especially for women over 35.
• Smoking, heavy alcohol use, and recreational drugs.
• Being very overweight or very underweight.
• Sexually transmitted infections that are not treated.
• Medical conditions like endometriosis, polycystic ovary syndrome, or previous cancer treatment.
• Work or environment exposure to certain chemicals or radiation.
• Stress is not a proven cause, but it can affect relationships and sex drive.

When to see a doctor

See a doctor urgently if:

• Severe pelvic or testicular pain.
• Fever with pelvic pain or unusual discharge.
• Heavy bleeding with dizziness or fainting.
• A new lump in the testicle or breast.
• Thoughts of harming yourself or feeling you cannot cope.

Book a routine appointment if:

• You have been trying to conceive for 12 months without success, or 6 months if you are 35 or older.
• You have irregular periods, very painful periods, or no periods.
• You have had pelvic infections, endometriosis, or surgery on your reproductive organs.
• You or your partner have a history of testicular problems, cancer treatment, or fertility problems.
• You are a same-sex couple or single person seeking fertility options.

Diagnosis

A doctor will ask about your health, periods, sex life, and medical history. Both partners are usually checked, because infertility can involve either or both people. Tests are often simple and can be done by your family doctor or a fertility clinic. The doctor will look for causes and talk with you about next steps.

Tests that may be done

• Blood tests to check hormones and ovulation.
• An ultrasound scan of the pelvis to look at the womb and ovaries.
• Semen analysis to check sperm count, shape, and movement.
• Tests to check if the fallopian tubes are open, such as a special X-ray or scan.
• Sometimes blood tests for infections or genetic conditions.
• For men, a physical exam and sometimes blood tests.

What to expect at your appointment

You may need more than one appointment. Some tests are quick, and others need to be timed with your period. Both partners may be asked to attend. The process can feel personal, so ask questions and take your time. You can bring someone with you for support.

Treatment

Treatment depends on the cause, your age, and your preferences. Options include lifestyle changes, medicines to help ovulation or sperm production, surgery for blocked tubes or endometriosis, and assisted reproduction such as IVF (in vitro fertilisation, where an egg is fertilised outside the body). Many people do not need the most complex treatment. Your doctor will explain the benefits and risks of each option, including emotional and financial costs.

Self-care at home

• Stop smoking and avoid recreational drugs.
• Limit alcohol — both partners should aim to drink little or no alcohol.
• Eat a balanced diet and stay active at a healthy weight.
• Ask your doctor or pharmacist about any vitamins or supplements that are safe when trying to conceive.
• Track your cycle to help time sex, but do not let it take over your life.
• Reduce stress where you can — talk, rest, and make time for things you enjoy.

Medical treatments

Doctors may suggest medicines to help release eggs, balance hormones, or improve sperm production. These are prescribed and monitored by a specialist. Other treatments include intrauterine insemination, where sperm is placed directly in the womb, and IVF. Some people use donor eggs, sperm, or embryos. Treatment is personal — your doctor will discuss success rates, risks, and what feels right for you.

When is surgery considered?

Surgery may help if you have blocked fallopian tubes, endometriosis, fibroids, or a varicocele (swollen veins in the scrotum). Surgery can also remove scar tissue or correct problems in the womb. Not everyone needs surgery. Your doctor will explain if it could help your situation and what recovery involves.

Living with this condition

Trying to conceive can bring hope, worry, and grief — sometimes all in one day. It can affect your relationship, sleep, work, and mood. Try to keep talking with your partner or a trusted person. Plan small breaks from fertility tracking. Ask your doctor what to expect at each step so you feel more in control.

Lifestyle tips

• Keep phone and laptop use in perspective — there is no strong evidence that everyday devices harm fertility.
• Avoid very hot baths, saunas, or tight underwear if you are trying to improve sperm health.
• Get regular sleep and move your body most days.
• Avoid smoking and secondhand smoke.
• Stay up to date with sexual health checks.

Diet and exercise

A balanced diet with plenty of vegetables, fruit, whole grains, and protein supports general health and fertility. Limit processed foods and sugary drinks. Moderate exercise — like walking, swimming, or cycling — is good. Very intense exercise can sometimes affect periods, so aim for balance. Ask your doctor if you need advice about weight.

Mental health and emotional wellbeing

Infertility can cause sadness, anxiety, anger, and feelings of loss. It is common to feel isolated. These feelings are valid. Talking to a counsellor who understands fertility can help. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support service right away. You deserve support.

Prevention

Not all infertility can be prevented, but you can lower some risks. Protect your fertility by not smoking, limiting alcohol, staying at a healthy weight, and getting prompt treatment for sexually transmitted infections. If you are planning cancer treatment, ask about fertility preservation before treatment starts.

Vaccines

Some infections that can affect fertility, such as rubella and HPV, can be prevented by vaccines. Ask your doctor which vaccines are recommended for you.

Screening programmes

There is no routine screening test for infertility itself. If you have a sexually transmitted infection risk, get tested. Regular cervical screening and breast checks are part of general health. If you have a family history of early menopause or fertility problems, tell your doctor.

Complications

If left untreated

• Ongoing distress, anxiety, or depression.
• Strain on relationships and sex life.
• Financial costs and stress from fertility treatment.
• Some underlying causes, like untreated infections or thyroid problems, can get worse.
• If an underlying cause is not checked, you may miss treatment that could help.

Long-term outlook

The outlook is hopeful. Many people with infertility become parents through treatment, donor eggs or sperm, surrogacy, adoption, or without treatment. Others find fulfilling lives without children. Your doctor can help you make choices that fit your values and health. There is no single right path.

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