Infertility and fertility problems

Infertility affects a sizable proportion of the population - around 9 to 15% of couples in the UK will have fertility problems1. In this article we look at several of the things which can cause fertility problems in both men and women, as well as what infertility is and how it is diagnosed, what can increase the risk of fertility problems, what potential treatments are available, and more.

  • Approximately 30% of all cases of infertility relate to the female, a further 30% are male related and 30 to 40% can be linked to both partners or are unexplained1.
  • For women, infertility is often related to hormones, or issues with her fallopian tubes or uterus.
  • If a woman is not ovulating, identifying this as soon as possible can ensure her doctor can take appropriate action.
  • For men, infertility is often related to low sperm count or erectile dysfunction.
  • Lifestyle aspects such as weight, smoking and alcohol intake can lower fertility for both men and women.
  • If you have been trying for a baby for a year with no success, and are 35 or under, you should speak to your healthcare professional for further advice. If you are over 35, you should seek help after 6 months of trying, and straight away if you are over 40.

What is infertility?

Infertility is when a couple are trying for a baby but cannot conceive within a year despite having regular unprotected sex.

Many couples—half in fact—struggle to get pregnant because they are mistiming when to have intercourse,2 missing the woman’s fertile window.

However, if you’re having regular intercourse and you’re still struggling to get pregnant after a year (or after six months if you are over the age of 35), then it’s a good idea to talk to your doctor as there is a chance either you or your partner, or even both, could be infertile. 

FERTILITY FACTS & FIGURES

Did you know that 1 in 5 couples take more than 12 months to conceive?

NICE Clinical Guideline CG146 (2013) - www.nice.org.uk/guidance/CG156

See Fertility facts & figures

What are the symptoms and signs of infertility?

Infertility can have many different causes, so the symptoms can depend on what the underlying cause is.

The main, universal symptom is, of course, an inability to get pregnant. For women, another sign may be that her menstrual cycles are too long, too short, irregular or absent. This is because these can be an indication that ovulation is not happening.

Otherwise, there are no signs or symptoms that point to infertility.

You may want to see your doctor for advice if:

  • You’ve been trying for more than a year.
  • You’re over 35 and have been trying for 6 months.
  • You have any reason to be concerned about your fertility.

What can cause infertility and fertility problems?

There are many possible reasons for infertility in both men and women. Discover some of the most common conditions and other causes that can result in fertility problems in women, men and couples below. 

Keep in mind, this list is not exhaustive and your healthcare provider is the medical expert who will be able to make a diagnosis based on your individual situation.

What can cause infertility in women? 

For women, there are two common areas where things can go wrong, making it difficult to fall pregnant — problems with hormones, and problems with the fallopian tubes or uterus.

1. Hormone problems

Anovulation

Ovulation is controlled by fertility hormones. If for any reason your hormone levels are disturbed, ovulation can be affected. Anovulation is when a woman’s ovary doesn’t produce, mature or release an egg. Signs of possible ovulation problems are very irregular or no periods.

Most women will experience anovulatory menstrual cycles at some point during their reproductive lives. This is most common in young women who have just started their periods or older women approaching the menopause, but anovulatory cycles also happen amongst healthy, regularly menstruating women.

Some women suffer from chronic anovulation, and this may be an indication of an underlying hormonal condition, such as Polycystic Ovarian Syndrome (PCOS), which can make natural conception difficult3.

Hormonal disturbance that affects ovulation can be caused by many factors. These include dramatic changes in weight, stress, strenuous exercise and illness.

If a healthy, regularly menstruating woman is using ovulation tests, or the Clearblue Advanced Fertility Monitor, and detects an occasional anovulatory cycle, be reassured that this is normal, and it should have no impact on your fertility. However, if you fail to detect the LH surge with ovulation tests (‘peak’ on a Clearblue Advanced Ovulation Test) for three consecutive cycles it would be worth speaking to your healthcare professional.

Polycystic Ovarian Syndrome (PCOS)

The term ‘polycystic ovaries’ describes ovaries that contain lots of small ‘cysts’ or egg-containing follicles that haven’t developed properly, often due to a hormone imbalance. 

Symptoms can include irregular or no periods, weight gain, excess hair growth as well as problems trying to conceive. It is estimated that about 1 in 10 women in the UK have polycystic ovaries4. However, it is possible for a woman to have multiple ovarian cysts without having PCOS.  

On April 13, 2020 my husband and I found out we were going to be parents. FINALLY. We were on the road to conceive for 1.5 years.
I was diagnosed with PCOS at 16 and never thought that it would be possible for me to conceive. We fought through it and never gave up. I’m now 27 and can’t wait for December to meet our baby. 
Thank you Clearblue for giving me such clear results!

Andrea, USA (2020) – See more stories at #Conceivinghood 
 

Short luteal phase

If the number of days between when you ovulate and when your next period starts is too few (less than 10), this can mean that, although you may conceive, the fertilised egg may be expelled before it can implant in the lining of the womb. 

You may notice you have a short luteal phase if are using an ovulation test or fertility monitor to check for the day you ovulate, and notice your period comes soon after this (less than 10 days).

To check how long your luteal phase is, count the number of days between your second peak fertile day and when your period starts. If you think your luteal phase is too short, talk to your doctor, as this condition may be treatable.

I have very short cycles, is that why I can't get pregnant?

Professor Michael Thomas

The normal cycle range is usually 23 to 35 days. Cycles shorter or longer than that range can be associated with fertility issues. Over the course of a woman's reproductive life span, her typical cycle lengths will fall in this time frame. If your cycles are usually less than 23 days, you should see your physician. The use of a home fertility monitor or ovulation test will help to predict the time of ovulation.

Early menopause

Once you have reached menopause, pregnancy is not possible, and in the lead up to menopause (the perimenopause) it can be very difficult to become pregnant. If your mother had an early menopause, then your chances for an early menopause are much higher, so, try to find out at what age your mother started menopause. If she had an early menopause it may be worth talking to a healthcare professional about your future plans for pregnancy.

2. Problems with the fallopian tubes and uterus

Fallopian tubes carry the eggs from the ovary to the uterus. A blockage in your fallopian tubes can prevent sperm getting to the egg; a growth in the uterus can stop a fertilised egg from implanting. Below we describe some of these potential problems in more detail.

Untreated chlamydia infection

The most common cause of blocked Fallopian tubes is a chlamydia infection that has been left untreated. Chlamydia is a common infection that is easily transmitted during unprotected sex. 

Some women may be completely unaware that they ever had a chlamydia infection due to the lack of symptoms. If there’s a chance you could have contracted chlamydia, go to your doctor for a test.

Fibroids

These are abnormal growths of muscular tissue in the uterus that can block the Fallopian tubes or stop a fertilised egg from implanting. Please visit your doctor for further advice.

Endometriosis

This is when the tissue that lines the uterus grows outside the uterus. It can obstruct the fallopian tubes, preventing fertilisation. Endometriosis can cause heavy or very painful periods. It can be treated by medication or by removing the extra tissue. Your doctor will be able to tell you more.

I suffer from endometriosis and am worried I won’t be able to get pregnant, is that true?

Professor William Ledger, Fertility Specialist

Many women with mild endometriosis will conceive normally although chances of incurring some fertility problems are higher. Severe endometriosis can damage the Fallopian tubes and ovaries, and the adhesions that can come with endometriosis can also block the Fallopian tubes. Your gynaecologist will be able to advise you on what to do about this. Don't try for more than a few months without getting advice, if you do have endometriosis.


What can cause infertility in men? 

Did you know that up to 50% of cases in which couples can’t get pregnant are due, at least in part, to a problem with the man5? There are three main issues that affect a man’s fertility: low sperm count or poor sperm quality, erectile dysfunction and a group of other less common causes. Read on for more information on each of these.

Low sperm count or poor sperm quality

If there aren’t as many sperm as usual in the male ejaculate, the chances of a sperm fertilising the egg are reduced. If the sperm quality is poor they may be unable to reach the egg or break through the egg’s membrane to fertilise it.

Sperm production can be lowered if the testes aren’t kept cool. Wearing loose underwear can help ensure the testes don’t get too hot. Sperm count and quality can be assessed by a simple test which you can get via your doctor.

Erectile dysfunction

If the man has trouble getting or maintaining an erection, for physical or psychological reasons, he may find it difficult to have sex. There is help available, so see your doctor for additional information.

Other causes

Much less common causes of male infertility include a blockage in the tube that carries sperm from the testicles, genetic conditions, hormone problems or other rarer conditions. Your doctor will be able to diagnose the presence of any of these problems through tests.


What can increase the risk of infertility?

There are other factors, which can affect both the man’s and woman’s fertility.

Drinking alcohol

Fertility in both men and women can be affected by drinking too much alcohol. Reducing the amount of alcohol you drink can help you to conceive. Also, drinking during pregnancy can affect your baby’s health, so if you are trying for a baby it is worth cutting down (or not drinking at all) because you never know when you are going to be successful.

Smoking

Compared to non-smokers, men who smoke can have a lower sperm count and a higher number of abnormal sperm. In women, smoking can affect fertility and trigger early menopause. It can also increase the risk of miscarriage and premature labour. Smoking is very bad for the health of your unborn baby and it is best to stop smoking before you become pregnant.

Both you and your partner should try to stop smoking if you’re trying to conceive.

Recreational Drugs

There are many different sorts of recreational and illegal drugs used today and how they affect fertility is not well studied. As many drugs can have bad effects on a developing baby, you should stop using any recreational drugs when trying to conceive (if it’s illegal of course it should be stopped!).

Body Building Drugs

Some body builders may use drugs, which can have affect fertility: 

  • Testosterone. Supplemental testosterone (also known as testosterone replacement) can negatively affect sperm production. Taking testosterone signals the testicles make more testosterone, and sperm production is blocked. Additionally, natural testosterone also stops, causing the level in the testicles to drop sharply, and is too low to support strong sperm production. The good news is it can be reversed by stopping testosterone, but it may take 6 to 12 months for sperm production to go back to normal.  
  • Anabolic steroids. Like with supplemental testosterone, anabolic steroids can interfere with the hormone signals needed to produce sperm. The damage depends on the drug taken, the dose, and how long it’s taken from. Fortunately, men will recover sperm production in 3 to 12 months after stopping the drug
     

Weight

Being underweight or overweight can alter your menstrual cycle and reduce your chances of conception. Overweight men can have a lower sperm count and poorer sperm quality. 

Speak to your doctor or nurse to know the ideal weight for you and for practical advice on gaining or losing weight if it’s necessary.

Medication

If you or your partner are taking any medication, check with your doctor that it won’t affect fertility. If it does reduce fertility, there may be alternatives available.

Lubricants

Certain vaginal lubricants, non-friendly sperm lubricants, used during sex to combat vaginal dryness can hinder sperm motility, which can affect chances of conception.

Vaginal dryness is more common than you may think. In a study across 11 countries involving around 6,500 women, up to 18% of women aged 18–34 years reported always or usually experiencing vaginal dryness6. This can become worse when trying to conceive as there is a tendency to have lots of baby-making sex. 

Some of the most commonly available lubricants can be harmful to sperm; use of such lubricants can therefore reduce your chances of becoming pregnant. Sperm-friendly lubricants are available.

Age

A woman is born with a lifetime’s supply of eggs and the number reduces gradually with age. After age 38 to 40, the rate of loss increases and the quality of the eggs declines. 

If you’re over 35, it’s a good idea to visit your doctor after around 6 months of trying for a baby and if you’re over 40, ask your doctor for advice as soon as you’re ready to start trying to conceive. 

Unexplained infertility

Sometimes all clinical tests will be reported as normal but after years of trying you’re still not pregnant. This can be very frustrating and distressing because there is nothing to focus on that can be rectified or treated. 

In the UK, around 1 in 4 of couples have unexplained infertility. If a woman has unexplained fertility and still hasn’t been able to conceive after 2 years of regular unprotected sex, should be offered IVF treatment7.  

My husband, Joel, and I had been trying to conceive for many months without success. We tried using the apps and even got the smiley from the Clearblue Ovulation Test, but we were having no luck.
Finally, after months of waiting, frustration and hopefulness on the first day of lockdown in NYC, we took the test. We were pregnant!! Everything happens for a reason and in its own time.
Thank you Clearblue
💙
Madison, USA (2020) – See more stories at #Conceivinghood 
 

How is infertility diagnosed?

Your doctor may do a physical exam, ask you about your lifestyle, check any medication you are taking, talk to you about how often and when you’re having sex, and ask about any other factors that could affect your fertility.

Your doctor may also check: 

  • If you have a healthy body mass index (BMI). 
  • If you are a woman, examine your pelvic area for any lumps or tenderness which could be a symptom of other health concerns like endometriosis, fibroids or other conditions that can cause infertility. 
  • If you are a man, examine the testicles for any lumps and the penis to note its shape, structure and to check for any abnormalities. 

Afterward, your doctor may prescribe some tests or refer you to a fertility specialist to diagnose and determine the cause of infertility. 

Fertility tests for women

Your doctor may offer a range of tests to help determine infertility or problems with fertility. These may include: 

  • Blood tests. A blood test can assess the levels of a hormone called progesterone and the doctor can use this test to check if you’re ovulating. If you have irregular periods, you may be offered another test to measure your gonadotrophin hormones, which stimulate the ovaries to produce eggs.  
  • Chlamydia test. This checks for the STI (sexually transmitted disease) called chlamydia which can cause infertility. 
  • Ultrasound scan. An ultrasound scan can be used to check the ovaries, uterus and fallopian tubes to determine if you have any conditions that may prevent pregnancy (such as fibroids or endometriosis) or to check for blockages in the fallopian tubes. 
  • X-ray. An X-ray of your uterus or fallopian tubes after a special dye has been injected, also known as a hysterosalpingogram, can also be used to find any blockages in the fallopian tubes. 
  • Laparoscopy. This is a kind of keyhole surgery where a thin tube with a camera is inserted to examine the uterus, fallopian tubes and ovaries. This type of test is only used if you’ve had pelvic inflammatory disease in the past or other scans show a possible blockage in the fallopian tubes.

Fertility tests for men

If a man is suspected of having fertility problems, the doctor may recommend tests like: 

  • Semen analysis. The main cause of infertility in men is low sperm count or poor sperm quality, i.e. not enough motile sperm (sperm that moves properly). A semen analysis can help the doctor better understand what issues may be at play.
  • Chlamydia test. Chlamydia can also affect male fertility. 

Is there any treatment for infertility?

Possible treatment for infertility really depends on the cause. Your doctor can give you your options about whether your infertility can be treated based on your personal situation.  You may also be offered more information about alternatives, like ART (assisted reproductive technology). 

What is secondary infertility? 

Secondary infertility is when a woman struggles with conceiving despite already having had a baby in the past. Infertility can be due to either partner. Many causes of secondary infertility overlap with that of primary infertility, but some of the common causes are: 

  • impaired sperm production in the man
  • damage to the fallopian tube
  • ovulation disorders 
  • endometriosis 
  • uterine conditions 
  • complications related to prior pregnancy or abdominal surgery 
  • risk factor changes to your or your partner, for example, age, gaining or losing too much weight, or catching an STD like chlamydia 
  • certain medications. 

FAQs about infertility

  • What can cause infertility in a woman?

    There are several different possible causes of infertility in women, but the most common is anovulation (when ovulation is not taking place). Other possible causes could be a chlamydia infection, PCOS, or a blockage in the fallopian tubes. Also, age is another factor, as women approaching menopause may struggle to get pregnant.

  • Can you have a baby if you’re infertile?

    It depends on the cause of the infertility. Many infertile couples go on to conceive without treatment, and after trying to get pregnant for two years, about 95% of couples are successful8.

    However, in some cases it won’t be possible to get pregnant without ART or another form of treatment.

  • How can you tell if a woman is infertile?

    If a woman has abnormally short or long periods, or irregular or missing periods, she may not be ovulating, and this is one of the main causes of infertility.

  • When should I be concerned about infertility?

    If you’ve been trying to conceive for over a year or 6 months if you’re a woman over 35, it’s best to talk to your doctor.

  • How can I test my fertility?

    If infertility is a concern, your doctor may recommend certain tests and exams in order to diagnose or rule out any problems.

The bottom Line

If you’ve been trying for a baby for a while and have not been able to get pregnant, it’s natural to think that maybe you’re infertile. However, it’s important to note that there are many couples who have been trying to conceive for year, who eventually go onto have healthy pregnancies. However, if you have been trying for more than a year it’s possible that there are some issues that cause infertility.   

Infertility—trying for a baby for more than a year—is also more common than you may think. There are numerous possible causes for infertility and it can affect both men and women. Struggling to conceive could be simply due to getting the timing for intercourse wrong, but it could also be something that requires treatment. Fortunately, there are many options out there for couples trying to get pregnant, like certain treatments or even ART, which allow them to go onto have healthy, and happy babies. If you are concerned about infertility, talk to your doctor. 

  1. https://www.britishfertilitysociety.org.uk/fei/what-is-infertility/ (accessed April 2021)
  2. Johnson SR., et al. Hum. Repro. (2011) 26: i236
  3. Hambridge HL., et al. Human Reproduction. (2013) 28: 1687–1694
  4. NHS. Polycystic ovary syndrome.(accessed April, 2021)
  5. Kumar n, et al. Journal of human reproductive sciences (2015) 8(4)
  6. Leiblum SR., et al. J Sex Med. (2009) 6: 2425–2433.
  7. https://www.nhs.uk/conditions/infertility/ (accessed April 2021)
  8. https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308 (accessed April 2021)

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