Fertility & infertility
NOTE: This article/page uses terms such as ‘male/man/men’ and ‘female/woman/women’. Please note, this is in reference to the sex assigned at birth. We know and understand that these terms may not fully encompass the experiences of transgender, non-binary, and gender-diverse individuals and couples. We recognise that all individuals, regardless of gender identity, deserve access to fertility support and resources.
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What is infertility?
Infertility is when a couple has trouble getting pregnant, even though they have regular unprotected sex. The World Health Organisation defines infertility as a condition of the reproductive system where a couple is unable to achieve a pregnancy after trying for 12 months or more.
In the UK, about 1 in 6 couples may face difficulties with conceiving. If you haven't been able to conceive after a year of having regular unprotected sex (regular is every 2 - 3 days), it's important to talk to your doctor. If you are over 35 years old or already know you have a health condition that can cause fertility issues, you should speak to them sooner.
There are many reasons why infertility might happen, and it can affect both partners. Sometimes, both partners might have fertility issues. In some cases, doctors might not be able to find a clear reason for the fertility problems; this is called unexplained infertility.
Causes of infertility
Infertility can be complex and challenging. There are many different causes of infertility and getting a better understanding of these can help with deciding how to go forward. It’s important to remember that infertility isn’t anyone’s fault, and it can happen to anyone.
Hormones are chemicals in your body that control many different processes, including reproduction. If there’s an imbalance in hormones, it can make getting pregnant harder.
Conditions like Polycystic Ovary Syndrome (PCOS) or thyroid problems can cause hormone levels to be unbalanced in women, which may lead to issues with fertility among other problems.
Low levels of testosterone or other hormone imbalances can affect sperm production.
Infertility can be related to problems with ovulation – the process where the ovaries release an egg each month as part of the female reproductive cycle. If there is no ovulation, pregnancy can’t occur during that cycle.
Some people may not ovulate at all, while others may ovulate irregularly. Conditions like PCOS (Polycystic Ovary Syndrome), thyroid issues or premature ovarian failure, among other conditions, can prevent regular ovulation.
Genetic conditions are due to changes affecting the genes or the amount of genetic material (like the number of chromosomes). Sometimes, genetic issues can affect fertility. Some people might be born with genetic conditions that affect their reproductive organs or how their bodies produce eggs or sperm.
For example, conditions like Klinefelter syndrome or Turner syndrome can lead to infertility. Klinefelter Syndrome (KS) is a condition that affects men. Chromosomes are packages of genes found in every cell in the body. There are two types of sex chromosomes that determine the genetic sex of a baby – these are named X or Y.
A male baby usually has one X and one Y chromosome (XY) and female babies have two chromosomes (XX). If you have Klinefelter syndrome, you’ll be born with an extra X chromosome (XXY).
KS is the most common type of chromosomal difference. It can affect how the body makes testosterone and this can lead to challenges with producing sperm.
Turner syndrome is a female-only genetic condition. Normally, girls have two X chromosomes, but girls with Turner syndrome have only one normal X chromosome and are missing part or all of the other X chromosome.
Most girls with Turner syndrome may have underdeveloped ovaries, which means they usually don't have periods and might not be able to have children.
What you eat and how active you are can impact your fertility. Being underweight or overweight can affect hormone levels, making it harder to conceive. Regular exercise is good, but too much intense exercise can also have a negative effect.
Smoking, alcohol and recreational drug use can all negatively affect fertility. For instance, smoking can damage eggs and sperm, making it more difficult to conceive.
High levels of stress can affect hormone levels and make it harder to get pregnant or maintain a healthy pregnancy.
Conditions like diabetes, autoimmune diseases and certain cancer treatments can affect fertility. Some illnesses might directly impact reproductive organs, while others might make it harder to get pregnant or cause complications during pregnancy.
Additionally, some medications needed to manage chronic conditions might have side effects that impact fertility. For example, some cancer treatments can affect both egg and sperm production.
If you think that any prescribed medication that you may be taking may be affecting your fertility, it is important to continue taking the medication as prescribed and speak to your prescriber about any concerns you may have.
Furthermore, using illegal drugs can also reduce sperm quality.
As people age, their fertility naturally declines. This is true for both those with ovaries and those with sperm. For women, the number and quality of eggs decrease with age, especially after the age of 35. Men also experience a decline in sperm quality as they get older.
Sexually transmitted infections (STIs) like chlamydia and gonorrhoea can cause damage to the reproductive organs if not treated, possibly leading to infertility.
If left untreated, inflammation caused by these infections can cause structural damage in the reproductive organs such as blocking fallopian tubes (structures that connect the ovaries to the womb) or damaging sperm ducts.
Certain infections that are not sexually transmitted can also affect fertility. For example, mumps (if caught after puberty) can cause inflammation of the testicles, potentially leading to infertility.
Sometimes, the shape or structure of reproductive organs can cause infertility. For example, blocked fallopian tubes, fibroids (non-cancerous growths in the womb), or issues with the shape of the womb.
Sperm are made and stored in the testicles, so any damage to the testicles can affect sperm quality. This damage could come from things like testicular cancer or surgery, infections, or injuries. There might be blockages in the tubes that carry sperm or issues like a varicocele (enlarged veins in the scrotum) can affect sperm quality.
Surgeries on reproductive organs, whether for treating health conditions or other reasons, can sometimes leave scar tissue. This scar tissue can block eggs from travelling through the fallopian tubes or affect sperm movement.
Sometimes, despite all tests and evaluations, the cause of infertility can’t be found. If this happens, your doctor can discuss the next steps with you.
Secondary infertility
Secondary infertility happens when someone who has had one or more pregnancies before is finding it difficult to conceive again. Just like primary infertility, secondary infertility can be very challenging and upsetting.
How is secondary infertility treated?
The treatment for secondary infertility is usually the same as for primary infertility. It might include medications to help with ovulation, or assisted conception techniques like IVF (in vitro fertilisation) or intrauterine insemination (IUI).
Age & fertility
As people get older, it can take longer to become pregnant because fertility tends to decline with age. That’s why it’s important to get a diagnosis as soon as possible. Couples who have had a pregnancy together before are often more likely to have another successful pregnancy, even if they need some help from fertility treatments.
Fertility testing
After speaking to your doctor, they might refer you for some tests or perform physical examinations.
Physical examinations
The doctor might weigh you to check your body mass index (BMI) and examine your pelvic area to check for signs of conditions including (but not limited to):
- Fibroids
- Ovarian tumours
- Endometriosis
- Pelvic inflammatory disease
The GP might also check your:
- Testicles to see if you have any deformities or lumps
- Penis to see if there are any issues with the structure or shape
Tests
Some of the tests you might be referred for include:
- Blood tests – these tests can check if you’re ovulating by measuring your hormone levels. If your periods are irregular, other hormones might be tested as well
- Chlamydia test – chlamydia is a type of sexually transmitted infection (STI) that can affect fertility and is treated with antibiotics. If you think you might’ve been exposed to chlamydia, you can find out using the Boots Online Doctor Chlamydia Home Test Kit2 – there’s a test for women and one for men
- Ultrasound scan – this scan can check your ovaries, womb and fallopian tubes. It can look for conditions that might affect fertility and pregnancy
- X-ray – an X-ray called a hysterosalpingogram (HSG) can show if there are any blockages in your fallopian tubes
- Laparoscopy – this is a type of keyhole surgery where a camera is used to look at your reproductive organs. It’s usually only done if there’s a reason to suspect there’s an issue
- Semen analysis – this test checks your sperm for things like the sperm count and movement to try and identify any issues
Can I check my fertility at home?
Fertility tests can give you a helpful starting point to help you understand your fertility and help you make informed decisions, whatever situation you’re in. It’s important to know that at-home fertility tests don’t give you all the answers and cannot replace an accurate diagnosis made by a medical professional.
It’s important to remember that while these tests can be helpful, they don’t replace seeing a doctor if you’re worried about your fertility. If you’ve been trying to get pregnant for a year and you haven’t conceived, make sure to speak to your doctor.
For women, there are ovulation tests that can help you figure out when you’re most likely to get pregnant. These tests work by checking for a rise in luteinising hormone in your wee (this is a hormone that increases just before you ovulate). Knowing when you ovulate can help you understand your fertile days, however, these tests don’t tell you everything about your overall fertility. We’ve put together a guide on what you need to know about ovulation tests.
Another way to track your fertility is by monitoring your body temperature. We’ve covered this in the ‘When are you most fertile?’ section of the page.
For men, there are at-home sperm tests, like the one that can give you an idea of how many sperm there are in your semen. While these tests can be a starting point, they might not show other important factors like how well the sperm are moving or if they have the right shape.
Diagnosing infertility
Most couples will become pregnant naturally within a year if they have regular unprotected sex. Regular unprotected sex means having sex every 2 to 3 days without using any contraception.
If you’ve been trying to get pregnant for a year and you haven’t conceived, it’s a good idea to see your doctor. However, you should consider seeing a doctor sooner if:
- You’re a woman aged 36 or older – fertility can decrease faster after your mid-30s
- You have concerns about your fertility, like if you’ve had cancer treatment or a sexually transmitted infection, or have an existing condition(s) that you know may affect your fertility
The doctor will check for anything that might be causing difficulties and help guide you on what to do next. It’s a good idea for both partners to see the doctor since fertility issues can affect either or both of you.
What should I expect from my doctor?
When you visit the doctor, they might ask questions to understand your situation better. Your GP may suggest changes to improve your chances of getting pregnant. Here’s what they might ask about:
Previous pregnancies
If you’re a woman, the doctor will ask about any previous pregnancies and if there were any complications or miscarriages. If you’re a man, they’ll ask if you’ve had children from previous relationships.
How long you’ve been trying
The doctor will want to know how long you’ve been trying to get pregnant. If it hasn’t been very long and you’re under 40, they might suggest you keep trying for a little while longer.
Sexual activity
The doctor will ask how often you have sex and if you have any difficulties. It might feel awkward, but being honest can help find solutions to any problems.
Contraception history
You’ll need to tell them about any contraception that you’ve used in the past and when you stopped. Some types of contraception can take a while to stop working, which might affect your fertility.
Medical history
The doctor will discuss any medical conditions you’ve had, including sexually transmitted infections. If you have periods, they’ll ask if your periods are regular and if you experience any unusual bleeding.
Medicines
Some medicines can affect fertility. The doctor will ask about any medications you’re taking, including herbal remedies and supplements.
Lifestyle factors
Your lifestyle can sometimes impact your fertility. The doctor may ask:
- If you smoke
- How much you weigh
- How much alcohol you drink
- If you use any illegal drugs
- If you’re feeling stressed
Treating infertility
Infertility treatment can sometimes feel like a long journey, but it’s important to remember that there are a number of different ways to help.
The treatment that’s appropriate for you will depend on the cause of your infertility. We know and understand there’s no ‘one size fits all’ approach when it comes to fertility.
If you have a high BMI, doctors often recommend working on getting closer to a healthy weight, as this can improve your chances of getting pregnant and having a healthy pregnancy. Other lifestyle changes that can help include quitting smoking, reducing alcohol intake and avoiding recreational drugs.
There are three main types of fertility treatment:
- Assisted conception – this includes treatments like in vitro fertilisation (IVF), where the sperm and egg are combined outside the body before being implanted in the womb. Sometimes donor sperm or eggs might be needed, especially if there are issues with sperm quality or if age is a factor
- Medication to help you ovulate – there are medicines available that can help trigger the release of eggs
- Surgery on the reproductive system – if there are issues like blocked fallopian tubes, endometriosis or fibroids, surgery might be needed. These surgeries can help to clear any blockages or remove growths that might be preventing pregnancy
Assisted conception
Assisted conception is the use of medical techniques that help people become pregnant. The most well-known method is in-vitro fertilisation (IVF), but there are other options like intrauterine insemination (IUI).
IVF is a process where you take medicine to encourage your ovaries to produce more eggs than usual. These eggs are then collected and fertilised with sperm in a lab.
Usually, the eggs and sperm are mixed together to allow the sperm cells to fertilise the eggs, but if there are issues like a low sperm count or poor sperm quality, a single sperm can be directly injected into an egg. This is called intracytoplasmic sperm injection (ICSI), and it can improve the chances of conception since the sperm doesn’t need to penetrate the egg on its own.
After fertilisation, the eggs are placed in the womb with the hope that they will grow and develop into a pregnancy.
You can find more information about IVF and learn what to expect in our guide.
Intrauterine insemination (IUI) involves separating higher-quality sperm from sperm that isn’t moving well. The higher-quality sperm is then placed directly into the womb, where it can meet the egg.
While this might seem like a treatment for low sperm count or lower-quality sperm, some research shows it doesn’t necessarily increase the chances of pregnancy for these issues. Because of this, it’s not usually offered on the NHS for low sperm count or sperm quality alone.
You might be offered IUI on the NHS for free if:
- You’re unable to have vaginal sex due to a physical disability or a psychosexual issue
- You have a condition that requires help to conceive, such as if one partner has HIV and it’s not safe to have unprotected sex
- You’re in a same-sex relationship and haven’t become pregnant after up to six cycles of IUI using donor sperm from a licensed fertility clinic
The waiting list for IUI treatment can be long in some areas, and the criteria for eligibility can vary, so it’s a good idea to check with your GP or local Integrated Care Systems (ICG) to find out the rules where you live.
If there’s an issue with your eggs or sperm, you might be able to use a donor to help you conceive. Treatment with donor eggs usually involves IVF.
If someone registered to donate eggs or sperm after April 1, 2005, they must provide information about their identity. This is because any child born as a result of donated eggs or sperm has the legal right to learn the identity of the donor when they turn 18.
Living with infertility
Dealing with infertility can be difficult. Even if you weren’t sure about starting a family before, many people assume that if they decide to have children, it will just happen. When things don’t go as planned, it can feel devastating. It’s natural to feel a mix of hope and sadness as you go through infertility treatments.
Acknowledge your feelings
It’s normal to feel a range of emotions like worry, sadness, anger and more. Recognising these feelings and understanding your fears is a big step in managing them. This can help you stay calm and refocus.
Communicate with your partner
Once you understand your feelings, it’s important to share them with your partner. Being open and honest helps you both support each other. Good communication can prevent misunderstandings and resentment, helping you face this challenge together.
Consider professional counselling
If you’re feeling overwhelmed or are feeling low, a fertility counsellor might be able to help. Counselling offers a safe space to express your feelings and can provide coping strategies during this challenging time.
Join a support group
Connecting with others who are going through the same thing can be incredibly comforting. Support groups, whether online or in person, give you a place to share your experiences and feel understood.
Understand your options
Infertility can make you feel like you’ve lost control. But knowing your options can help. A fertility specialist can evaluate you and your partner, recommend treatments and suggest lifestyle changes like diet and exercise. Having a plan can make you feel more positive about the future.
Practice self-care
Taking care of yourself is crucial when trying to conceive. This means eating well, getting enough sleep and exercising. Self-care can help you stay mentally and physically strong.
Avoid blame
Blaming yourself or your partner doesn’t help. Remember, you’re in this together. If blame starts to creep in, consider talking to a fertility counsellor to help work through these emotions.
Male fertility & infertility
For people with sperm, infertility might be about how healthy the sperm are or how their bodies make them. Things like genetics, hormones, or even how you live your life can affect fertility. This includes everyone with sperm, like transgender women or non-binary people who may have sperm.
Male infertility can happen for different reasons, and the most common one is when there aren't enough healthy sperm in the semen to successfully fertilise the egg.
Male infertility can be caused by many factors, including problems with the reproductive organs, medical conditions, and even lifestyle choices or age. So, even if you’re not trying to have a baby right now, the decisions you make can still impact your ability to have children in the future.
If you’ve been trying to have a baby for 12 months without success, it’s a good idea to see your doctor.
However, if you have any of the following issues, you should visit your doctor right away:
- Pain and/or swelling of your testicle(s)
- Abnormal discharge from the penis
- Rash or blisters on the penis
- Pain while weeing or ejaculating
- Injury or trauma to the testicles
- Testicles that haven’t descended properly
Your doctor will likely examine you and may arrange tests and/or may prescribe treatment if necessary (for example, for a sexually transmitted infection).
If needed, they may arrange for a semen analysis and might refer you to a fertility specialist for more tests. Together, you can then decide on the best treatment to help you conceive.
Causes of male infertility
Semen quality means the health and characteristics of sperm cells in the semen, including their count, shape and ability to move. One of the most common reasons men have trouble with fertility is due to lower-quality sperm and semen. This can happen for a few different reasons. Some men might have a low number of sperm in the semen or none at all.
Others may have sperm that don't move well, or that are shaped differently than usual. Even if sperm cells look normal, they might have damaged genetic material, which can make it harder to conceive.
Increased temperature in the testicles can affect sperm quality. If the scrotum (the skin that holds the testicles) gets too warm, sperm quality might decrease. Things like cycling, taking hot baths, working in hot environments or using a laptop on your lap can all make the scrotum warmer.
Wearing loose underwear can help keep things cooler. Varicocele (enlarged veins in the scrotum) can also increase the temperature in the testicles and affect sperm production. Problems present at birth, like undescended testicles (when the testicles stay in the abdomen instead of going down to the scrotum before or around birth) may also affect sperm quality due to higher temperatures in the abdomen.
Some men experience problems with ejaculation that can make it difficult to release semen during sex. This could be due to various reasons, including medical conditions, previous surgeries or psychological factors. Ejaculation disorders can significantly affect fertility because they can prevent sperm from reaching the egg.
Fertility & the menstrual cycle
The menstrual cycle is the time from the first day of your period to the day before your next period begins. While the average cycle lasts 28 days, it’s perfectly normal for it to be longer or shorter, ranging from 23 to 35 days.
The menstrual cycle is controlled by hormones. During the first part of the cycle, levels of a hormone called oestrogen rise, which causes the ovary to develop and release an egg—this process is called ovulation. At the same time, the lining of the womb begins to thicken, preparing for a possible pregnancy.
In the second half of the cycle, another hormone, progesterone, helps the womb get ready for a fertilised egg to implant. The egg then travels down to the womb through the fallopian tubes that connect the ovaries to the womb.
If the egg is fertilised by sperm, it gets implanted in the lining of the womb and pregnancy can begin. If the egg is not fertilised, the levels of oestrogen and progesterone then drop, and the thickened womb lining breaks down and leaves the body as a period.
Ovulation is the release of egg cell(s) from the ovaries. Women are born with all the eggs they will ever have. After puberty, one egg is usually released during each menstrual cycle. Pregnancy can occur if sperm meets and fertilises this egg. Sperm can survive in the fallopian tubes for up to seven days after sex.
Sometimes, more than one egg is released during ovulation, and if both eggs are fertilised, it can result in twins or other multiple births. If ovulation doesn’t occur, pregnancy cannot happen. Some hormonal contraceptives, like the combined pill, patch or injection, work by preventing ovulation.
The time when you’re most likely to get pregnant is around ovulation. Although it’s hard to pinpoint the exact day ovulation happens, it usually occurs about 10 to 16 days before the start of the next period.
If you have a 28 day cycle, ovulation likely happens around day 14. However, this can vary if your cycle is shorter or longer. It’s also possible, though less likely, to get pregnant soon after your period ends, especially if you ovulate early or have a shorter cycle.
One way to track your ovulation is by monitoring your basal (resting) body temperature. There’s a small rise in your body’s basal temperature just after you release an egg (ovulation) and it can help you understand your cycle better.
To do this, you’ll need either a digital thermometer or one designed specifically for natural family planning (you can find these at pharmacies).
It’s important to know that ear or forehead thermometers won’t give you accurate readings for this purpose. To check your basal temperature:
- Take it first thing in the morning before getting out of bed
- Do it before you eat, drink or smoke (if you smoke)
- Try to take it at the same time every morning
You’ll know you’ve ovulated when your basal temperature is higher for 3 days in a row than it was during the previous 6 days. The increase is small, usually around 0.2°C and it likely means you’re no longer in your fertile window.
As this increase in basal body temperature happens just after the ovulation, recording it daily for a few cycles can give you a better understanding of when you are likely to be most fertile.
We’ve put together our guide of advice for if you’re trying to conceive and vitamins that could help support your journey.
Considering starting a family?
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Frequently Asked Questions
Women are born with a certain number of eggs in their ovaries, and this number decreases as they grow older. At birth, a baby has about 2 million eggs. By the time they become a teenager, this drops to around 400,000. By age 37, about 25,000 eggs remain. Each month, 1 egg matures and is released during ovulation, while the others are reabsorbed by the body.
As women age, both the number and quality of their eggs can decrease, which can affect their ability to get pregnant.
For men, sperm is produced daily rather than being present from birth. However, around age 40 to 45, the quality and number of sperm can start to decline, which might impact fertility.
If you’re concerned about how age affects fertility, there are tests available at pharmacies, online and at fertility clinics. It's also helpful to talk to a doctor if you have any questions or worries about fertility.
You can check your fertility in a few different ways, and it’s a good idea to start by talking to your doctor if you have concerns.
For women, doctors might suggest blood tests to check hormone levels, an ultrasound to look at the ovaries and uterus, or tracking your ovulation at home. There are also home ovulation tests that can help you know when you’re most likely to get pregnant.
For men, a semen analysis is often done to check the number and quality of sperm. Some home tests can give you an idea about sperm count, but seeing a doctor will give you a more complete picture.
If you’re worried about your fertility, your doctor can guide you through the best steps and answer any questions you have.
There are several lifestyle changes you can make to help improve your fertility:
- Eat a balanced diet
- Exercise regularly – regular physical activity helps maintain a healthy weight, which is important for fertility. Just be careful not to overdo it, as too much intense exercise can sometimes have the opposite effect
- Quit smoking
- Limit alcohol and avoid recreational drugs
- Manage everyday stress
- Get enough sleep
Making these changes can help you feel healthier and improve your chances of getting pregnant. If you’re unsure where to start, your doctor can give you personalised advice.
If you've been trying to get pregnant for a year without success, or for 6 months if you're over 36, it's a good idea to talk to your GP or a specialist. You should also speak to a doctor if you’re worried about your fertility, for example, if you’ve had cancer treatment or you might have had a sexually transmitted infection (STI).
They can help figure out if there's anything affecting your fertility and guide you on what steps to take next.
You are most likely to get pregnant around the time of ovulation, which usually happens about 10 to 16 days before your next period. If your cycle is regular, you can track this time to know when you're most fertile.
Another way to help track ovulation is by checking your basal (resting) body temperature. After ovulation, your basal body temperature rises slightly, about 0.2°C. By taking your temperature each morning before getting out of bed, you can spot the small increase and better understand your fertile window.
Infertility can be caused by various factors, such as problems with ovulation (the ovaries releasing egg(s), blocked fallopian tubes (tubes connecting the ovaries with the womb), low sperm count or health conditions like polycystic ovary syndrome (PCOS). Sometimes, the cause is unknown. If you're concerned about infertility, a doctor can help identify the reason and suggest possible treatments.
We’ve explored this more in the ‘Causes of infertility’ section of the page.
1Subject to availability. Eligibility criteria may apply. Charges may apply.
2Access to prescription-only treatment is subject to an online consultation with a clinician to assess suitability. Subject to availability. Charges apply.
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