Infertility

Infertility means you haven't been able to get pregnant despite having regular unprotected sex for 12 months or more. It's sometimes called subfertility and it can affect either partner or both.

Symptoms of infertility

The main sign of infertility is simply not becoming pregnant despite having regular, unprotected sex. Infertility itself doesn't usually cause other physical symptoms, although some of its underlying causes can.

You might also notice:

• absent or irregular periods
• very painful or heavy periods
• pain during sex
• difficulties with erections or ejaculation.

If a woman can get pregnant but keeps having miscarriages, this is also classed as a form of infertility.

Causes of infertility and who is at risk

Infertility can be caused by problems affecting either partner, and in around a quarter of cases, no clear cause is found. Common causes in women include:

• not ovulating regularly, or at all
• blocked or damaged fallopian tubes
• problems with the womb, such as fibroids, polyps or scarring
• endometriosis, where tissue similar to the womb lining grows elsewhere in the body
• hormone conditions such as polycystic ovary syndrome (PCOS), now known as polyendocrine metabolic ovarian syndrom (PMOS) or thyroid disease.

Common causes in men include:

• a low sperm count
• poor sperm quality or movement
• a blockage preventing sperm being released
• problems with erections or ejaculation, which can make it difficult to have sex

You may be more likely to have fertility problems if you:

• are an older woman, as fertility declines with age, particularly from your mid-30s
• have a BMI of 30 or over, or are significantly underweight
• have had a sexually transmitted infection (STI), such as chlamydia
• smoke, including passive smoking
• drink too much alcohol
• are regularly exposed to certain pesticides, solvents or metals
• are under a lot of stress

Are there different types of infertility?

There are two main types of infertility:

• primary infertility, where you've never been able to get pregnant
• secondary infertility, where you've had one or more pregnancies in the past, but are now struggling to conceive again.

How infertility is diagnosed

Your GP will ask both you and your partner about your medical and sexual history, including any previous pregnancies, how long you've been trying to conceive, and your general health and lifestyle. They'll usually examine you both physically, checking a woman's pelvic area and a man's testicles and penis for anything that could explain fertility problems.

If needed, you may be referred for further tests. For women, these can include blood tests to check hormone levels and ovulation, an ultrasound scan of the ovaries, womb and fallopian tubes, an X-ray called a hysterosalpingogram to check for blocked tubes, or a laparoscopy (keyhole surgery) to look at your reproductive organs directly. For men, the main test is a semen analysis, which checks for problems with sperm count, shape or movement.

How infertility is treated

Treatment depends entirely on what's causing your fertility problems and may involve one partner or both.

Medication can help correct hormonal imbalances or stimulate ovulation, and antibiotics can treat infections that may be affecting your fertility. Tracking ovulation, for example using your body temperature or an ovulation predictor kit, can also help you time sex to improve your chances of conceiving.

Surgery may be recommended for structural problems, such as treating endometriosis, repairing damaged fallopian tubes, or removing scarring inside the womb or abdomen.

If these approaches aren't successful, assisted conception may be recommended, such as intrauterine insemination (IUI) or in vitro fertilisation (IVF). These treatments can carry some risks, including a higher chance of a multiple pregnancy (such as twins) if more than one embryo is used, and a slightly increased risk of ectopic pregnancy.

When to see a doctor

See a GP if you haven't conceived after a year of trying through regular unprotected sex. You should see a GP sooner if:

• you're a woman aged 35 or over
• you've had treatment for cancer
• you think you might have had a sexually transmitted infection
• you're already aware of a reason to be concerned about your fertility.

It's best for both partners to see the GP together, as fertility problems can affect either or both of you.