What is infertility?

If you’ve made the decision to start a family, it can be an exciting time but also stressful if it doesn’t happen straight away. Many women spend their early adult years trying to avoid getting pregnant, convinced that it’s super easy to conceive. Because of this, when the time comes to try for a baby you may be expecting that soon after you stop using contraception you’ll get pregnant quite quickly. For many people trying to become parents, that’s not always the case. Getting pregnant can take a while. So if you don’t get pregnant straight away, there’s normally no need to worry. But if you haven’t managed to get pregnant after a year of regular, unprotected sex, it could be a sign of fertility problems. If you’re struggling to conceive and you’re finding it difficult to cope, speak with your GP.

We know infertility is a sensitive topic that can sometimes be difficult to talk about but we’re here to explain what it is, the possible causes and what you should do if you’re worried about your fertility.

What does it mean to be infertile?

It’s very difficult to estimate how long it will take a couple to get pregnant as everyone is different. Sometimes pregnancy happens quickly, sometimes it doesn’t. Around 84 percent of couples will conceive naturally within a year if they have regular unprotected sex (every two or three days). In general , infertility is when a couple can't get pregnant despite having regular unprotected sex for at least a year. It’s much more common than most people think, with around one in seven couples struggling to get pregnant.

Infertility can sound like a scary word but it doesn’t necessarily mean you won’t be able to get pregnant naturally. It's a good idea to speak with your GP if you haven't conceived after a year of trying. Women aged 36 and over and anyone who's already aware they may have fertility problems, should see their GP sooner.

What can cause infertility?

There are a number of lifestyle factors that can affect fertility in both men and women. These include:

Age

Female fertility and, to a lesser extent, male fertility declines with age. In women, the biggest decrease in fertility begins during the mid-30s.

Weight

Being overweight or obese can reduce fertility.

Sexually transmitted disease (STDs)

Several STDs, including chlamydia and gonorrhoea can affect fertility.

Smoking

In women, smoking can affect fertility, while in men it may reduce sperm quality.

Alcohol

Drinking alcohol can affect fertility in both men and women. It can reduce fertility levels in women and affect sperm quality in men. If you’re pregnant or trying to get pregnant, the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum.

Certain medicines

The side effects of some medicines can affect fertility.

Female infertility

In women, common fertility problems can include:

Ovulation

A lack of regular ovulation (the release of an egg) around once a month can cause fertility problems. Polycystic ovary syndrome (PCOS), thyroid disease and premature ovarian failure (where a woman's ovaries stop working normally before the age of 40) can affect ovulation and cause infertility. These conditions can stop an egg being released at all, or prevent an egg being released during some cycles but not others.

Damaged or blocked fallopian tubes

The fallopian tubes connect the ovaries and the uterus and are where the sperm and egg meet. If these tubes are blocked or damaged, it can cause infertility. The chances of having blocked tubes are higher if you have or have had surgery in the pelvis, a sexually transmitted disease (like gonorrhoea or chlamydia) or endometriosis.

Endometriosis

Endometriosis is a condition where tissue that’s similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes, and which can affect fertility. Endometriosis can affect women of any age.

Fibroids

Fibroids are non-cancerous growths that develop in or around the womb. They can prevent a fertilised egg attaching to the womb and can also block the fallopian tubes. Many women are unaware they have fibroids because they don't often cause symptoms.

Polyps

Polyps are soft growths that can form in the lining of the uterus and the cervix. They are usually small but can grow in size. Polyps may be linked to a lower fertility in women.

Male infertility

Infertility can affect men as well as women. Possible reasons for male infertility include:

Semen quality

Poor-quality semen (the fluid containing sperm ejaculated during sex) is the most common cause of infertility in men. There are a few possible reasons for abnormal semen including:

• A lack of sperm – either a very low sperm count or no sperm at all

• Sperm that aren't moving properly – this will make it harder for sperm to swim to the egg

• Abnormal sperm – if sperm are an abnormal shape, it can make it harder for them to move and fertilise an egg

Testicles

The testicles are responsible for producing and releasing semen. If they are damaged, it can have an impact on fertility. Injury, testicular surgery and undescended testicles (where one or both of the testicles haven't descended into the scrotum) can all affect semen quality and production.

Sterilisation

If a man doesn’t want to have any or anymore children, he can choose to have a vasectomy. This involves cutting and sealing off the tubes that carry sperm out of the testicles meaning any semen produced contains no sperm. Although a vasectomy can be reversed, reversals don’t always work and can affect fertility.

What should I do if I’m worried about my fertility?

If you haven't conceived after a year of trying, and are worried about this, speak with your GP. Book an appointment sooner if you are a woman aged 36 or over and trying to get pregnant or you have any other reason to be concerned about your fertility. For example, if you've had treatment for cancer or you think you might have had an STD. Don’t be afraid to reach out and ask for help. Couples who've been trying to conceive for more than three years without success, have a likelihood of 25 percent or less of getting pregnant naturally within the next year.

Your GP will be able to carry out an initial assessment to try and identify why you’re struggling to conceive. They may recommend making changes to your lifestyle to increase your chances of conceiving. You'll probably be asked how often you have sex and whether you have any difficulties during sex. You may feel uncomfortable or embarrassed discussing your sex life with your GP, but it's best to be open and honest. They may also ask you questions about your medical history and symptoms and if you’re taking any medication.

Investigations may include a blood test to check some of your hormones, chlamydia testing, checking the quality of sperm or referring you to a specialist for further tests. If needed, the fertility treatment you're offered will depend on what's causing the problem but your GP or specialist will talk you through your options and advise what your next steps are.