Fertility problems

In short

  • Most couples get pregnant within a year; for some it takes longer.
  • Not pregnant after 1 year of regular sex without contraception? See your GP. If you are 36 or older, or there may be a fertility problem, see your GP sooner.
  • The cause can lie with the woman, with the man, or with both. Often no cause is found.
  • A gynaecologist can carry out an initial fertility work-up to look for possible causes.
  • If treatment such as IUI or IVF is needed, this takes place in a specialised fertility centre.

When to seek help if you are not getting pregnant?

See your GP if you have not become pregnant after 1 year of trying. If you are 36 or older, or there is a known reason why getting pregnant may be harder, do not wait a full year — go sooner.

Of couples where the woman is under 40, more than 8 out of 10 conceive within a year if they have regular sex without contraception (about every 2 or 3 days). Around 1 in 7 couples have difficulty conceiving.

Your GP can do the first checks and estimate your chance of conceiving. If that chance is low, or there is a clear reason for further investigation, the GP can refer you to a gynaecologist, for example when:

  • the man’s semen quality appears reduced;
  • the woman is 38 or older and has not conceived after at least 1 year of trying;
  • the menstrual cycle is often longer than 35 days, or it is unclear whether ovulation happens (for example with PCOS);
  • the fallopian tubes may be blocked, for example after chlamydia, endometriosis or previous abdominal surgery.

What can stop you getting pregnant?

There are many possible causes, in the woman as well as in the man. Common causes are:

  • lack of regular ovulation (the monthly release of an egg);
  • reduced semen quality;
  • blocked or damaged fallopian tubes;
  • endometriosis (tissue similar to the womb lining growing outside the womb).

In about a quarter of couples no cause is found. That can be hard to hear, but it does not mean pregnancy is impossible.

What can you do yourself to get pregnant?

Lifestyle affects fertility, in women and in men:

  • Weight. Being obese (a BMI of 30 or over) reduces fertility. In women, being severely underweight can also disturb ovulation.
  • Smoking. Smoking, including passive smoking, lowers your chance of conceiving and reduces semen quality.
  • Alcohol. The safest approach is not to drink alcohol at all when trying for a baby. Drinking too much also affects sperm quality.
  • STIs. Sexually transmitted infections such as chlamydia can harm fertility.
  • Stress and environment. Long-term stress can affect ovulation, sperm production and your sex drive. Exposure to certain pesticides, solvents and metals can also reduce fertility, particularly in men.

What does a fertility work-up involve?

At our practice you can have an initial (orienting) fertility work-up: the first, exploratory investigation of you and your partner.

The work-up starts with a conversation. The gynaecologist asks about your periods, how long you have been trying and how sex is going. Some questions are personal; they are only asked to help you well. If you keep track of your cycle, bring that overview with you.

After the conversation, these tests usually follow.

  • Physical examination of the woman, including an internal examination of the womb and ovaries.
  • Internal (transvaginal) ultrasound of the womb, fallopian tubes and ovaries.
  • Blood tests, including a check for chlamydia antibodies and, if needed, hormone levels.
  • Semen analysis for the man: a laboratory checks how many sperm cells there are and how well they move. If the result is below normal, the test is repeated after about 2 months; one poor result can be chance.

Sometimes further tests are needed afterwards, such as an X-ray with contrast fluid to see whether the fallopian tubes are open, or keyhole surgery under general anaesthetic. These take place in a hospital; we refer you for them.

What happens after the work-up?

Once all the results are in, the gynaecologist discusses them with you and your partner. What happens next depends on the outcome:

  • A cause is found. Treatment is sometimes possible, for example surgery for endometriosis or medication when ovulation does not occur.
  • No cause is found and your chance of pregnancy is reasonable. The usual advice is then to keep trying yourselves for another six months to a year.
  • Your chance is low, or there is a clear reason. Fertility treatment such as IUI (insemination) or IVF may then be an option.

We do not perform fertility treatments such as IUI or IVF ourselves. If such treatment is an option for you, we refer you to a specialised fertility centre.

Trying for a baby without success can bring a lot of sadness and strain. Please feel free to raise this during your appointment; how you are coping matters too.

Frequently asked questions about fertility

How long does it normally take to get pregnant?

Of couples where the woman is under 40, more than 8 out of 10 conceive within a year of regular sex without contraception. Regular means about every 2 or 3 days.

When should I see a doctor if I am not getting pregnant?

After 1 year of trying without a pregnancy. If you are 36 or older, or there is a known reason why getting pregnant may be harder, see your GP sooner.

Does lifestyle affect getting pregnant?

Yes. Obesity or being severely underweight, smoking, alcohol and STIs such as chlamydia all reduce fertility, in women and in men. Long-term stress can also affect ovulation and sperm production.

Is a cause always found in a fertility work-up?

No. In about a quarter of couples no cause is found. That does not mean pregnancy is impossible; the usual advice is then to keep trying yourselves for another six months to a year.

Related care

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