If you’re planning to have a baby, or are actively trying to conceive, seeing a health professional for support and guidance is a good idea.
If you’re experiencing difficulties conceiving, you may be understandably worried and wondering what steps you can take to boost fertility.
Help is available, and in this article, we explain more about fertility, what affects it and the treatments that exist to assist you on your journey to parenthood.
Our Fertility Specialist Nurse Carla Lang gives an overview of fertility.
What is fertility?
A person’s fertility describes their ability to either become pregnant or cause someone to become pregnant.
For a female, fertility begins to decline at around the age of 35. For men, their fertility also declines with age, but it tends to be at a much slower rate.
There are various statistics surrounding fertility that doctors use to encourage women and couples trying to become pregnant but who are concerned that they might not. These generally apply when a female is below 40 years of age:
- A male and female couple having regular, unprotected vaginal intercourse (every two to three days) have a chance of becoming pregnant
- 1 in 3 couples become pregnant within one month of regular, unprotected sex
- More than 8 in 10 couples will become pregnant within one year of regular, unprotected sex
- More than 9 in 10 couples will become pregnant within two years of regular, unprotected sex
- The chances of becoming pregnant fall to around 25% in a given year if a couple have been trying to conceive for three years or more
- Around 1 in 7 couples experience fertility problems
What can cause fertility problems?
Infertility in around a quarter of all couples trying to conceive cannot be given an exact cause, and is known as unexplained infertility. In other cases, the causes may be identified and can sometimes be treated, allowing couples to go on and conceive.
Problems conceiving can be caused by a number of different reasons, depending on your gender.
In women, the majority of fertility issues are caused by problems or interruptions in ovulation.
Ovulation is the process by which an egg is released on average every 28 days from an ovary. This occurs around the middle of your monthly cycle. It then travels down the fallopian tube to the womb, where it will settle if fertilisation has taken place in the fallopian tube. If an egg isn’t fertilised, it will leave the woman’s body during menstruation.
Problems with ovulation can be caused by lifestyle issues including being overweight or underweight. Polycystic ovary syndrome (PCOS) is a condition that interferes with how the ovaries work, causing irregular menstruation, and PCOS can also upset ovulation. Ovulation can also be negatively affected by having either an underactive or overactive thyroid gland.
Other causes of female fertility problems include:
- Endometriosis — a condition that causes the lining of the womb to migrate and begin to grow in other areas of the pelvic cavity. This can upset the egg meeting the sperm and it can also be associated with pelvic pain and painful intercourse
- Fibroids — non-cancerous growths that can grow into the lining of the womb
- Scarring of the ovaries, fallopian tubes or cervix from previous surgical procedures
- Certain Sexually Transmitted Infections (STIs) such as chlamydia, if left untreated (which can cause pelvic inflammatory disease) and can damage the tubes
- Certain medications such as chemotherapy or antipsychotic drugs, or long-term use of non-steroidal anti-inflammatory drugs (NSAIDs)
- Poor egg quality which can be age related
In men, the majority of fertility problems are caused by problems with the sperm or semen, (semen is the fluid that contains the sperm).
These problems include a low sperm count, problems with the mobility of the sperm or abnormally-shaped sperm. In most cases, the causes of these problems are unknown. However, damage, infection or surgery to the testicles can cause problems with the health of the sperm. Excessive drinking, smoking and weight issues can be a potential cause.
Testicles that are undescended (haven’t dropped into the scrotum), varicocele, past history of injury and having had testicular cancer can cause the same problems.
Certain medications including chemotherapy drugs, anabolic steroids and an anti-inflammatory drug called sulfasalazine used to manage chronic inflammatory conditions such as rheumatoid arthritis or Crohn’s disease, can also cause fertility problems in men.
As a couple, getting stressed about becoming pregnant, or when and how often you have sex can interfere with your chances of conceiving. If you’ve been trying to conceive for less than a year, it’s important not to stress and instead enjoy being a couple and having regular intercourse.
How can I increase my chances of conceiving?
Each person’s fertility is unique to them and will depend on their overall health, age and lifestyle. In general, a healthy adult woman has a higher chance of becoming pregnant the younger she is. More women over the age of 35 have difficulty conceiving than those under 35.
But there are some general steps that both females and males can take that can help to increase their fertility. These generally involve living as healthy a lifestyle as possible:
- Maintain a healthy weight and BMI — being overweight or obese can reduce fertility and cause ovulation problems in women
- Take steps to increase your weight if you’re very underweight, especially as a female as having too little body fat can lead to irregular menstruation
- Eat a balanced diet, rich in fresh fruits and vegetables, lean protein and whole grains, that is also low in saturated fat, salt and sugar
- Remain active, aiming to be active in some way on most days
- Get tested, and treated if necessary, for STIs
- If you smoke, take steps to quit
- Reduce your consumption of alcohol to less than the safe guidelines of 14 units or fewer in a week, or stop drinking completely and avoid binge drinking
- Avoid all illegal drugs and legal highs
- Talk to your GP about the effect on your fertility of any prescribed medications you may be taking
- Consider limiting your caffeine intake to one or two cups of tea or coffee a day
- Have regular romantic evenings
In men, keeping the testicles cool and unrestricted by wearing loose fitting underpants and clothing made from natural, breathable fibres will help to keep the sperm at a healthy temperature.
If you have a medical condition, such as epilepsy, sickle cell disease, high blood pressure or diabetes, you may benefit from preconception care to help to maximise your health and chances of becoming pregnant. Speak to your GP or specialist about preconception care.
What is infertility?
Infertility describes the various reasons and causes that mean that someone or a couple will have problems conceiving. If a person or a couple have been trying to conceive for more than a year, then a doctor will usually diagnose infertility.
However, this doesn’t necessarily mean that this person or couple will never become pregnant. It means that they may continue to struggle and may need medical help becoming pregnant.
There are two different types of infertility — primary and secondary infertility.
Primary infertility is used to describe a situation where someone who has never been pregnant before is experiencing difficulty becoming pregnant.
Secondary infertility is used to describe a situation where someone who has been pregnant one or more times in the past is experiencing difficulty becoming pregnant again.
Steps, therapies and treatments for infertility
Infertility is a very emotive subject, and you may find yourself getting upset and emotional, which is understandable and completely normal.
If you’re concerned about your fertility and chances of becoming pregnant, speak to your GP. They will usually then take steps to help you if you’ve been actively trying to conceive for a year.
See your GP if you haven’t conceived after a year of trying, if:
- You’re female and in your mid 30s or older
- If either partner has a medical condition that you know may affect your fertility
Your GP will carry out some tests to try to discover the cause of your fertility problem (in both female and male partners) or refer you to a specialist if you require treatment for a condition that may be affecting your fertility.
Treatments for infertility vary — what might be recommended for one couple, may be very different from the recommendations for another couple. In all cases, your doctor will discuss your best course of action with you.
Fertility treatments are divided into three main types:
- Fertility drugs — these are usually prescribed to help regulate ovulation in women with ovulation problems and include clomiphene. Stimulating the ovaries using drugs can cause side effects including nausea and headaches. These need to be carefully monitored as there is a risk of multiple pregnancies.
- Surgery — in women, surgery can help to treat conditions such as PCOS, endometriosis and fibroids. Although surgery is now used less often. After you’ve recovered from surgery, your chances of conceiving may be significantly increased. In men, surgery can be used to help treat a varicocele that may be present in the tubes that carry the sperm.
- Assisted conception, of which there are three main types:
- In vitro fertilisation (IVF) where the female partner uses drugs to stimulate her ovaries to grow more than one egg. These eggs are then removed during a surgical procedure and fertilised in a laboratory using her partner’s If after a few days, embryos are formed, these will be transplanted back into the woman’s body. If the sperm count is low then a treatment called Intracytoplasmic Sperm Injection (ICSI) is used to inject the sperm into the egg.
- Intrauterine insemination (IUI) or artificial insemination where a female’s partner’s sperm is injected into the cervix using a long, thin tube.
- Egg or sperm donation using donated eggs and an IVF procedure or donated sperm and an IUI or IVF procedure.
The National Institute for Health and Care Excellence (NICE) guidance recommends that a woman aged 40 or below who has unexplained infertility after two years of actively trying to conceive, should be offered assisted conception treatments.
However, different Clinical Commissioning Groups (CCGs), that make decisions on the treatments, services and medications offered in their local areas, have different guidelines on these various treatments. You may find that what’s offered in your area differs to other areas, or that no assisted conception is offered on the NHS in your CCG.
Further advice and resources can be found on the Human Fertilisation and Embryology Authority (HFEA), and Fertility Network UK websites.
- Making an appointment to see your GP is a good first step in discussing any fertility concerns you may have. If you don’t have access to a GP, you can make an appointment with one of our same day private GPs.
- The Poundbury Fertility Centre here at King Edward VII’s Hospital, is dedicated to investigating potential causes of infertility and to doing all we can to help couples conceive.