Infertility

Infertility is when you are unable to become pregnant.

Not all of the information on this page will be relevant for everyone. All couples, including same-sex couples and couples where one or both partners are trans or non-binary, can access NHS fertility services if they meet the treatment access criteria.

80% of women under 40 years of age will naturally become pregnant within a year if they have regular unprotected sex. For some people it can be more difficult. For couples, infertility is when you or your partner are unable to get pregnant after 12 months or more of regular unprotected sex.

About 1 in 7 of couples struggle to become pregnant. Not all of these couples require fertility treatment as some couples will get pregnant naturally.

Some couples need extra help to be able 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 might be overwhelming at times. There are charities that provide support, advice and information such as Fertility Alliance and Fertility Network UK. The Human Fertility and Embryology Authority also provides information for patients.

What can affect fertility?

Fertility is affected by various factors, including:

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

Lifestyle changes can improve your fertility, such as:

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

Further information about your mental health and wellbeing

Causes of infertility

Some causes of infertility include:

  • semen quality or no sperm in an 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) – this prevents the sperm getting to the egg or a fertilised eggs getting to the womb
  • genetics, such as Klinefelters Syndrome

Sometimes the causes of infertility are unknown.

When to get medical advice

Speak to your GP practice if:

  • 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 have a health condition which affects your periods like endometriosis, PCOS or adenomyosis
  • you’re a woman over 36 years of age and have been trying as a couple for a baby for 6 months

Diagnosing infertility

You may feel worried about speaking to your GP, but infertility is common and they can provide support.

When you speak to your doctor about your fertility they will take a medical history.

They may carry out some of the following tests on you and your partner, for example:

  • semen analysis – you’ll produce a semen sample to be analysed by a laboratory
  • hormone analysis – you’ll have a blood test which will then be sent for analysis

Your doctor will discuss your results with you and you can ask any questions that you might have.

Treatments for infertility

Things you can do

There are lifestyle changes that might help improve your fertility, as well as your health and the health of any future pregnancy.

Do

  • have a BMI of 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 can affect ovulation and sperm production

Don’t

Further information about preconception health

Treatments from your healthcare professional

Your healthcare professional will discuss your treatment options with you and you can ask any questions that you might have.

Ovulation induction

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

Surgery

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

In vitro fertilisation (IVF)

For IVF, fertility hormones are used to stimulate the ovaries to produce eggs. The eggs are collected (removed from the body) and mixed with sperm in a laboratory. If an egg is fertilised by the sperm this becomes an embryo which is then transferred into the womb.

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

Intracytoplasmic sperm injection (ICSI)

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

Surgical Sperm Retrieval (SSR)

In some cases, there may not be sperm in the sample. This could be because of a blockage or a genetic problem. Sperm may be collected directly from the testicles (balls) using minor surgery. The sperm is then used with ICSI.

Intrauterine insemination (IUI)

IUI is a procedure where sperm is introduced directly into the womb using medical equipment. IUI is commonly used by people who are using donated sperm in their treatment.

Same sex couples

Options can include:

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

A surrogate may also be needed if neither person is able to carry a pregnancy.

Non-binary or transgender patients

Treatment options are available for all couples, including non-binary or transgender people, as long as they meet the NHS IVF treatment access criteria.

Trans and non-binary people who are unable to get pregnant because they’ve had gender reassignment (including surgery) will still be able to access treatment if all other access criteria are met.

For more information, visit the HFEA website or contact your GP for a referral to fertility services to discuss options.

Treatment on the NHS

Not all patients will be eligible for NHS treatments. For example, if you and your partner already have a child together you will not be eligible for IVF or ICSI.


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Last updated:
08 July 2024