Infertility In Women

Overview

Infertility means not being able to get pregnant after a year of having regular sex without using birth control. If you are 35 or older, doctors usually suggest checking things out after 6 months, because fertility lowers with age. Infertility is a medical condition, not a personal failure. In women, it can happen when something affects the eggs, the fallopian tubes (the tubes that carry the egg), the hormones that control the monthly cycle, or the womb. Often more than one thing is involved, and sometimes no clear cause is found.

Yes. It is very common — roughly 1 in 7 couples worldwide have difficulty conceiving at some point. Because it is so common, you are not alone, and there is a lot of support and treatment available.

Anyone who is trying to have a baby can be affected, at any age, and it affects all genders. Some medical conditions raise the chance, such as polycystic ovary syndrome (PCOS — a hormone problem that can affect periods and ovulation), endometriosis (when tissue like the womb lining grows elsewhere and can cause pain), and past pelvic infections. Fertility is also affected by age, weight, smoking, and some medical treatments. Single people and same-sex couples who want to conceive can also ask for fertility advice.

Symptoms

Common symptoms

• Often there are no symptoms at all — the only sign is not getting pregnant
• Periods that are irregular, very infrequent, or absent
• Very painful periods or pain during sex
• Very heavy periods
• Unusual vaginal discharge or pain in the pelvis
• Signs of a hormone imbalance, such as acne, extra facial or body hair, or weight changes
• Milky discharge from the breasts when not breastfeeding
• Having had one or more miscarriages
• Periods that have stopped much earlier than expected (before age 40)

Causes

Main causes

• Ovulation problems — the ovary not releasing an egg regularly. Polycystic ovary syndrome, thyroid problems, and high levels of a hormone called prolactin are common reasons.
• Blocked or damaged fallopian tubes, often after an infection such as chlamydia or a pelvic infection, or after pelvic surgery
• Endometriosis — tissue similar to the womb lining growing elsewhere, which can affect the tubes and ovaries
• Problems inside the womb, such as fibroids (non-cancerous growths), polyps (small growths), scar tissue, or an unusual shape
• Egg supply running low earlier than expected, sometimes called premature ovarian insufficiency
• Age-related decline in egg number and quality
• Past cancer treatment such as chemotherapy or radiotherapy to the pelvis
• Sometimes no cause is found, even after full testing

Risk factors

• Being over 35
• Smoking, including being around other people's smoke
• Drinking a lot of alcohol
• Being significantly over or under a healthy weight
• Past sexually transmitted infections or pelvic infections
• Endometriosis or polycystic ovary syndrome
• Past surgery on the ovaries, tubes, or womb
• Cancer treatment in the past
• A family history of early menopause
• Very intense exercise that stops periods
• Long-term heavy stress can affect cycles, though its role is not fully clear

When to see a doctor

See a doctor urgently if:

• Severe or sudden pelvic pain, especially with fainting or a positive pregnancy test
• Fever with pelvic pain or unusual discharge
• Heavy bleeding that soaks a pad every hour
• Pain that is stopping you from eating, sleeping, or walking normally

Book a routine appointment if:

• You have been trying for a baby for a year without success
• You are 35 or older and have been trying for 6 months
• Your periods are very irregular, very painful, or have stopped
• You have a known condition such as polycystic ovary syndrome or endometriosis
• You have had a pelvic infection or a sexually transmitted infection in the past
• You have had cancer treatment and want to talk about fertility
• You have had two or more miscarriages
• You are single or in a same-sex relationship and want to explore options for having a child

Diagnosis

Your doctor will start by talking with you about your periods, your medical and family history, any past pregnancies or infections, your lifestyle, and how long you have been trying. Your partner will also be asked about their health. From there, the doctor can suggest tests to look at ovulation, the tubes, the womb, and hormone levels. Usually both partners are tested, because fertility depends on both people.

Tests that may be done

• Blood tests to check hormone levels and to see whether you are ovulating
• A blood test to check how many eggs you have left (often called ovarian reserve testing)
• A pelvic ultrasound scan to look at the ovaries and womb
• A test to check whether the fallopian tubes are open, using a special scan or X-ray
• A swab or urine test for infections such as chlamydia
• A semen analysis for your partner, which is one of the first and most important tests
• Sometimes a keyhole surgery (laparoscopy) to look directly at the pelvis

What to expect at your appointment

Testing usually happens in steps and can take a few weeks, sometimes a few months, because some tests need to be done on particular days of your cycle. Most tests are quick and can be done at your GP surgery or a local clinic. If a cause is found, or if tests are normal but you still are not conceiving, your doctor may refer you to a fertility clinic. Try to go to appointments together with your partner if you can — it helps to hear the same information, and it shares the load.

Treatment

Treatment depends on what the tests show, your age, and what matters most to you. Options range from simple changes and support, to medicines that help with ovulation, to surgery for specific problems, to assisted conception such as intrauterine insemination or IVF (in vitro fertilisation — where an egg is fertilised outside the body and then put into the womb). Sometimes the best plan is to keep trying naturally with better timing. Your doctor will talk you through the options, including the chances of success, the time involved, and any costs.

Self-care at home

• Stop smoking, and try to avoid second-hand smoke
• Keep alcohol low, or avoid it if you are trying to conceive
• Aim for a healthy weight — even a small change can help regular ovulation
• Eat a balanced diet with plenty of vegetables, fruit, whole grains, and healthy proteins
• Move your body regularly, but avoid extreme training that stops your periods
• Ask your pharmacist or doctor about vitamins that are recommended before pregnancy
• Have sex every 2 to 3 days across the month, rather than saving up for one 'perfect' day
• Track your cycle so you know roughly when you ovulate
• Cut back on caffeine if you have a lot
• Get enough sleep and find ways to manage stress

Medical treatments

Doctors may offer medicines to help your ovaries release an egg more regularly, or treatment for underlying hormone problems such as thyroid issues or high prolactin levels. If the tubes are blocked or there is endometriosis or scarring, surgery may be discussed. Assisted conception treatments include intrauterine insemination (where prepared sperm is placed in the womb) and IVF. Some people are offered a treatment called ovulation induction with careful monitoring. Your fertility team will explain which options suit your situation and what the realistic chances are.

When is surgery considered?

Surgery may be suggested if you have fibroids, polyps, or scar tissue in the womb, endometriosis, or blocked fallopian tubes. It can also be used to treat some causes of pelvic pain. Surgery is not right for everyone, and your doctor will explain the possible benefits and risks before you decide.

Living with this condition

Trying to conceive can take over your life if you let it. It can help to set some limits — for example, deciding not to talk about fertility every single day, and planning things you enjoy that have nothing to do with trying. Keep doing the things that make you feel like yourself. Regular, relaxed sex rather than timed pressure can also help your relationship and your mood.

Lifestyle tips

• Keep a simple diary of your periods and how you feel — it helps at appointments
• Share how you feel with your partner, a friend, or a counsellor
• Take breaks from fertility apps and forums if they make you feel worse
• Keep up hobbies, exercise, and time with friends
• Be gentle with yourself around dates like Mother's Day or baby showers — it is fine to say no
• Plan something to look forward to that is not connected to pregnancy

Diet and exercise

A balanced, varied diet and regular gentle-to-moderate exercise support hormone balance and general wellbeing. Try to include plenty of vegetables, fruit, whole grains, beans, and protein, and limit highly processed foods and sugary drinks. If your weight is far from the healthy range, your doctor can help you make a safe plan — crash diets are not helpful. If your periods stop because of intense exercise, it is important to talk to a doctor.

Mental health and emotional wellbeing

Fertility problems can be emotionally heavy. It is common to feel sad, anxious, angry, jealous, or numb, and to feel grief each month. These feelings are real and understandable. If you notice you feel low most days, have lost interest in things you enjoy, cannot sleep, or are struggling to cope, please talk to a doctor — support is available and it helps. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support service in your country straight away. You deserve help, and you do not have to manage alone.

Prevention

Not all infertility can be prevented, because some causes are genetic or just part of how the body works. But some steps can protect your fertility: avoid smoking, keep alcohol low, aim for a healthy weight, protect yourself from sexually transmitted infections by using condoms with new partners, and get infections treated promptly. If you are having cancer treatment, ask about ways to preserve fertility before treatment starts, as this can sometimes be done.

Vaccines

Staying up to date with routine vaccines supports your general health. The HPV vaccine helps protect against the virus that can cause cervical changes, and rubella (German measles) vaccination protects against an infection that is harmful in pregnancy. Ask your doctor or pharmacist which vaccines are recommended for you.

Screening programmes

Regular cervical screening and testing for sexually transmitted infections, particularly chlamydia, help protect your reproductive health, because infections without symptoms can damage the fallopian tubes. If you have a family history of early menopause or a condition such as endometriosis, talk to your doctor about whether earlier fertility checks make sense for you.

Complications

If left untreated

• Ongoing difficulty getting pregnant, which can be distressing over time
• Strain on relationships and on mental health, including anxiety and low mood
• Undiagnosed conditions, such as endometriosis or thyroid problems, continuing without treatment
• Untreated infections that can cause more pelvic damage over time
• Financial and practical pressure if treatment is delayed or repeated

Long-term outlook

The outlook is genuinely hopeful. Many women with fertility problems do go on to have a baby — some with treatment, some naturally, and some through other routes such as donor eggs or adoption. Even when pregnancy is not possible, good support and clear information help people find a path that feels right for them. Fertility care has improved a lot, and your doctor can help you understand your own realistic chances and choices.

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