Infertility

Infertility means you are unable to become pregnant. Not everything on this page will apply to everyone.

80% of women under 40 years of age will become pregnant naturally within a year if they have regular unprotected sex. For some people it's more difficult. For couples, infertility means that you or your partner haven't been able to get pregnant after 12 months or more of regular unprotected sex.

About 1 in 7 couples struggle to become pregnant. Not all of them need fertility treatment, because some will get pregnant naturally.

Some couples do need extra help to have a baby. For example:

• drugs to help release eggs
• IVF/ICSI
• use of donated eggs or sperm
• more rarely, treatment with a surrogate

Infertility and trying for a baby can bring challenges that feel overwhelming at times. Charities such as Fertility Alliance and Fertility Network UK provide support, advice and information. The Human Fertility and Embryology Authority also provides information for patients.

Several things can affect your fertility, including:

• the health of your reproductive organs
• hormones
• your age (fertility decreases as you get older)

Some lifestyle changes can improve your fertility, such as:

• maintaining a healthy weight (or BMI)
• stopping smoking
• not drinking alcohol
• reducing stress and anxiety

There are things you can do to reduce stress and anxiety, such as:

• gentle exercise, like going for a walk or a cycle
• eating a healthy, balanced diet
• trying to get 7 to 8 hours of sleep a night
• yoga, breathing exercises and meditation

Some causes of infertility include:

• poor semen quality, or no sperm in the ejaculation (this affects about 1 in 3 couples who are seeking fertility treatment)
• lack of ovulation (releasing an egg) or ovulatory dysfunction (a sign of this may be having irregular periods)
• blocked fallopian tubes (the tubes connecting the ovary to the womb), which stop the sperm getting to the egg or a fertilised egg getting to the womb
• genetics, such as Klinefelters Syndrome

Sometimes the cause of infertility is not known.

• you're a couple and you have been trying for a baby for more than a year (having regular unprotected sex) and have not become pregnant
• you know that you need donated eggs or sperm to have a baby
• you're trying for a baby and are worried about irregular or no periods, or you have a health condition that affects your periods, like endometriosis, PCOS or adenomyosis
• you're a woman over 36 years of age and you and your partner have been trying for a baby for 6 months

You may feel worried about speaking to your doctor, but infertility is common and your doctor can support you.

When you talk to your doctor about your fertility, they will first take your medical history. They may then carry out some tests on you and your partner, for example:

• semen analysis: you'll produce a semen sample, which a laboratory will analyse
• hormone analysis: you'll have a blood test, and the sample will be sent off for analysis

Your doctor will go through the results with you, and you can ask any questions you have.

Some changes to how you live may help improve your fertility. They can also make you healthier and give any future pregnancy a better footing.

• Keep your BMI between 19 and 25. Being underweight or overweight reduces fertility and can also lead to complications in pregnancy.
• Quit smoking if you smoke. Smoking reduces semen quality and can cause issues in pregnancy.
• Avoid passive smoking.
• Reduce stress where possible. Stress can affect your relationships and sex drive, and in severe cases it can affect ovulation and sperm production.

• Don't drink alcohol. It affects sperm quality and can cause serious problems in pregnancy, such as fetal alcohol spectrum disorder.
• Don't take recreational drugs. They affect fertility and can cause problems in pregnancy.

Your doctor will go through the treatment options with you, and you can ask whatever questions you have.

Ovulation induction uses hormone therapy to help your ovaries release an egg. It's often the treatment used for people with PCOS.

Some people have surgery to treat or remove areas of endometriosis.

With IVF, fertility hormones are used to stimulate the ovaries so they produce eggs. The eggs are collected (taken out of the body) and mixed with sperm in a laboratory. If the sperm fertilises an egg, it becomes an embryo, and the embryo is then transferred into the womb.

IVF is carried out when the sperm quality is considered to be normal.

ICSI is like IVF, but it's used when the sperm is of lower quality. The sperm is injected into the egg outside the body.

Sometimes there is no sperm in the sample. This could be because of a blockage or a genetic problem. In that case, sperm may be collected directly from the testicles (balls) using minor surgery, and then used with ICSI.

IUI is a procedure where sperm is placed directly into the womb using medical equipment. People who are using donated sperm in their treatment commonly use IUI.

The options can include:

• using donor sperm with IUI
• using donor eggs with IVF or ICSI
• using donor sperm with IVF or ICSI

If neither person is able to carry a pregnancy, a surrogate may also be needed.