Fertility Problems
Approximately 1 in 7 couples in the UK face fertility challenges, though many eventually conceive with or without treatment.
Fertility problems can affect anyone, regardless of sex or age. Identifying the cause of fertility problems can be difficult, and in 25% of cases, no clear reason is found.
If you’ve been trying to conceive for over a year with regular, unprotected sex without success, it’s advisable to consult your GP. If either you or your partner is over 35, or if you suspect a fertility-related issue, seek advice after six months of trying.
What could be causes of fertility problems?
Ovulation problems are the most common cause of subfertility, affecting the body’s ability to release an egg monthly. These issues can result from:
- Polycystic Ovary Syndrome (PCOS): Small cysts on the ovaries can hinder egg release.
- Endometriosis: Tissue similar to the womb lining grows elsewhere, like on the ovaries.
- Thyroid Disorders: Conditions like hyperthyroidism can prevent ovulation.
- If you’ve recently stopped using contraception, it might take some time for your menstrual cycle to normalise.
Low sperm count or poor-quality semen can also cause fertility issues. Up to 1 in 5 young men have a low sperm count, which affects about 20% of couples struggling to conceive. Causes include:
- Hormonal Imbalances: Conditions like hypogonadism, where the testicles produce few or no hormones.
- Genetic Issues: Inherited problems can affect sperm production.
- Undescended Testicles: Testicles that didn’t descend properly.
- Genital Infections or Conditions: Such as chlamydia, gonorrhoea, prostatitis, or varicocele.
Fertility problems can also arise if one partner has had:
- Surgery that affected reproductive organs.
- Certain medications or treatments, like testosterone replacement, steroids, or chemotherapy.
- Complications from previous pregnancies or births.
- A sexually transmitted infection (STI).
- Pelvic inflammatory disease (PID).
Lifestyle factors such as smoking, alcohol consumption, being overweight, and stress can also impact fertility. Smoking, for instance, can reduce sperm count, but quitting can help recover it.
Fertility declines with age. For women and people with ovaries, fertility starts decreasing in the mid-thirties, while for men and people with penises, it starts around age 40-45.
- Ages 19-26: 92% conceive after one year, and 98% after two years.
- Ages 35-39: 82% conceive after one year, and 90% after two years.
When should I get tested?
If you’ve been trying to conceive for less than a year, a clinician may advise you to keep trying. If it’s been over a year, various tests can help determine the cause of fertility problems. These may include:
- Physical Examination: Checking the penis and testicles for abnormalities.
- Hormone Tests: Blood samples to check ovulation-related hormones.
- Ovarian Checks: Blood tests or ultrasounds to examine ovarian health.
- Semen Analysis: Evaluating sperm count and motility.
- STI Tests: Treating infections like chlamydia or gonorrhoea with antibiotics.
- Hysterosalpingogram (HSG): An X-ray of the womb and fallopian tubes using a dye.
- Hysterosalpingo-contrast-ultrasonography (HyCoSy): An ultrasound with fluid to check for blockages.
- Laparoscopy: A minor surgery to inspect the womb, fallopian tubes, and ovaries under general anaesthetic.
What treatment options are available for me?
Regardless of whether a clear cause is found, your clinician can guide you through next steps, which may involve further investigation or treatment. NHS fertility treatment options vary by location and eligibility, with some areas having long waiting lists.
Private treatment is also an option. Ensure any clinic you consider is licensed by the Human Fertilisation and Embryology Authority (HFEA). Treatment options may include medications to stimulate ovulation, surgery to repair reproductive organs, or assisted conception methods.
More detailed information about treatments is available on the NHS website.