Fertility problems

What causes fertility problems?

Around 1 in 7 couples in the UK may have fertility problems. Many go on to conceive, with or without treatment.

It can be difficult to understand what is causing fertility difficulties. For 25% of couples who are having trouble, no clear reason is found.

Problems with ovulation

Subfertility (low or reduced fertility) is most often caused by problems with ovulation - the stage when the body releases an egg. Usually, this happens once a month. But if there are issues, it might mean that eggs are being released less often, or not at all.

This can be because of:

• polycystic ovary syndrome (PCOS) where small growths or cysts can stop or slow the release of the egg

• endometriosis, where small pieces of womb lining start growing in other places such as on the ovaries

• thyroid problems, which can prevent ovulation

If you’ve just stopped using contraception, it can take time for some types, like the injection, to stop working and for your menstrual cycle to return to normal.

Problems with sperm count

Another common cause of fertility problems is poor-quality semen or a low sperm count. This means there’s not as much sperm as usual when you ejaculate (come). Up to 1 in 5 young men find they have a low sperm count. For up to 20% of couples who struggle to conceive, low sperm count is the cause of the problems.

Low sperm count could be caused by various factors, including:

• a hormone imbalance such as hypogonadism, where the testicles produce few or no hormones

• an inherited genetic problem

• undescended testicles

• a problem with the male genital tract – for example, the tubes that carry sperm can be damaged and blocked by illness or injury

• a genital infection or condition such as chlamydia, gonorrhoea, prostatitis or varicocele (dilated veins within the testicles)

As a couple

You could also experience fertility problems if one of you has had:

• surgery that may have scarred or affected your reproductive organs

• some medications and treatments, including testosterone replacement, steroids or chemotherapy

• complications in previous pregnancies or births

• a sexually transmitted infection (STI), such as chlamydia or gonorrhoea

• pelvic inflammatory disease (PID)

Your lifestyle can also affect your fertility. Smoking, drinking alcohol, being overweight and stress can all affect your chances of conceiving. Smoking can reduce sperm count, though it should increase again after quitting.

Getting tested

When you first seek advice from a fertility clinic or GP, the clinician may recommend you keep trying for a while if you’ve been having regular, unprotected sex for less than a year.

If you've been trying for more than a year, your clinician may recommend a range of tests to find out what's stopping you from conceiving. You may also be offered counselling.

A number of tests can be used to try and understand the cause of fertility problems:

• physical examination - a clinician will check the penis and testicles for anything unusual, including lumps and signs of infection

• hormone tests – a clinician will take a blood sample to check the hormones that affect ovulation

• checking your ovaries – this could be a blood test or an ultrasound scan to examine your ovaries for any problems

• semen analysis – this looks at a small sample of semen (ejaculate) and checks the sperm count and if the sperm are moving around correctly. You might be asked to stop having sex for a few days before the test to ensure you can produce enough semen.

• STI test – untreated chlamydia and gonorrhoea can cause problems with conceiving. If you have an infection, you’ll be prescribed antibiotics to treat it

• hysterosalpingogram (HSG) – this is an x-ray of the womb and fallopian tubes. A special dye is inserted before the x-ray is taken, to help show up any problems like a blockage of the fallopian tubes

• hysterosalpingo-contrast-ultrasonography (HyCoSy) – an ultrasound scan that uses a small amount of fluid to check if fallopian tubes are damaged or blocked

• laparoscopy – a clinician will make a small cut in your lower abdomen (tummy), then use a thin, tubular telescope to look at your womb, fallopian tubes and ovaries. This is usually carried out under general anaesthetic and is only used if there is a high chance that there is an internal problem