If you don’t get pregnant straight away, it doesn’t mean you have a problem. In fact, research has shown that 1 in 2 couples could simply be trying at the wrong time of the month1. Most healthy couples will conceive within one year2 of trying for a baby. So if it takes a while, there’s generally nothing to worry about. If you’ve been trying for more than a year without success, it is recommended that you seek medical opinion.
If think you might have a fertility problem, the best thing to do is to make an appointment with a doctor. For more information, we have outlined some of the more common fertility problems that can affect men and women.
The majority of women’s fertility difficulties are caused by a problem with ovulation (usually that eggs are not being released), a blockage in the Fallopian tubes (so the sperm can’t get to the egg) or endometriosis (which can affect both ovulation and the egg travelling down the fallopian tube).
Problems with ovulation
Your ovulation is controlled by your hormones. So if for any reason your hormone levels are disturbed, your ovulation can be affected. A sign of possible ovulation problems is irregular periods. You may find that you are ovulating, but not every cycle.
Hormonal disturbance that can affect ovulation can be caused by many factors. These include dramatic changes in weight, emotional problems, stress, strenuous exercise and illness.
Polycystic Ovarian Syndrome (PCOS) can be another cause of ovulation problems. This is when you have hormone imbalances and lots of small cysts on your ovaries. Your doctor will be able to diagnose PCOS through a blood test.
There are treatments that your doctor can explain to you to ‘kick-start’ ovulation, but the treatment depends on your unique situation.
Problems with fallopian tubes
A blockage in your Fallopian tubes can prevent the sperm getting to the egg and the egg from travelling to the uterus where if fertilised, it would implant. The most common cause of blocked Fallopian tubes is a chlamydia infection that has been left untreated. Many women in this situation are completely unaware that they ever had a chlamydia infection, because very often the infection doesn’t have any symptoms.
Your doctor will recommend the best course of action for you.
Endometriosis is when tissue that lines the womb can also grow outside the womb. This can obstruct the movement of the egg down the Fallopian tubes, and may also prevent fertilisation in other ways. Women with endometriosis often have heavy and/or very painful periods.
Endometriosis can be treated by medication or by removing the extra tissue. Your doctor will be able to tell you more about the treatments available.
Other factors that affect women’s fertility
Fibroids are abnormal growths of muscular tissue in the womb that can block the fallopian tubes or hinder a fertilised egg implanting in the lining of the womb. If you have fibroids, your doctor can tell you about the different treatments available for removing them.
Your fertility is affected by your age. In women, there is a store of around 300, 000.eggs at puberty and this number gradually reduces with age. However, after 38-40 years of age, the rate of loss is much more rapid. Also, the quality of the remaining eggs diminishes, and both these factors result in a more rapid decline in fertility after the age of 40. In men, fertility also declines with age.
Low sperm count or poor sperm quality
The main cause of male fertility problems is a low sperm count or poor sperm quality. This means that there are not as many sperm as there could be, so the chances of a sperm fertilising an egg are reduced. Or the sperm are unable to reach the egg and break through the egg membrane to fertilise the egg. Heat is a factor that can lead to low sperm count, because it reduces sperm production. Your partner can make sure his testicles don’t get too hot by, for example, avoiding soaking in hot baths or wearing tight underwear.
Other causes of infertility (less common than a low sperm count) include a blockage in the tube that carries sperm from the testicles, a genetic cause, or a hormone problem.
If the man has trouble getting or maintaining an erection, for physical or psychological reasons, this will reduce his ability to have sex.
This is defined as infertility without a known cause, when tests are normal and a couple has been trying for a pregnancy for more than two years. Although everything seems to be in perfect working order with a couple, the woman is not able to get pregnant. This can be very frustrating and upsetting for a couple, because there is nothing to focus on that can be rectified or treated.
It is estimated that in around one third of couples with unexplained infertility the woman will get pregnant without intervention within 3 years, although some couples do eventually try assisted reproduction treatment, such as in-vitro fertilisation (IVF).
Alcohol: both you and your partner should avoid excessive consumption. Alcohol may reduce female fertility and affect sperm quality. It also may increase the risk of miscarriage. Following the government’s “sensible drinking” guideline of a maximum of 1-2 units per day for women and 3-4 units per day for men, is recommended by health care professionals. Pregnant women are advised to drink less than this or no alcohol at all.
Smoking: both you and your partner should stop smoking if you’re trying to conceive. Compared to non-smokers, men who smoke often have lower sperm counts or a greater proportion of abnormal sperm. In women, smoking is associated with early menopause and infertility. It can also increase the risk of miscarriage and early onset of labour3.
Weight: Both you and your partner’s weight should ideally be in the normal range for your height. For women, both being underweight or overweight can cause disturbances in the menstrual cycle and reduce the chances of conception. Overweight men can have lower sperm counts and poorer sperm quality.
Medication: If you or your partner are taking any medication, it’s important to check with your doctor that it won’t reduce your fertility or your partner’s sperm production. There may be more appropriate alternatives available if you are trying to conceive.
1GfK Roper Study 2005 2National Institute for Clinical Excellence, 2004 3The HFEA guide to infertility 2007/08