Infertility

Also called Fertility problems, Subfertility

Affects around one couple in seven, and in roughly half of cases the male factor is involved. Access to NHS treatment depends on where you live.

What it is

Not conceiving after a year of regular unprotected sex, or six months if the woman is over 36.

It affects around one in seven couples. The causes are roughly evenly split: around a third female factors, around a third male factors, and the rest a combination or unexplained.

**Both partners should be investigated from the start.** A semen analysis is quick, cheap and non-invasive, and it is routinely done later than the female investigations, which is neither logical nor fair.

Female causes include ovulation problems such as polycystic ovary syndrome, tubal damage often from pelvic inflammatory disease, endometriosis, fibroids and thyroid problems. Male causes include low sperm count and quality, varicocele, previous infection, and genetic causes.

Age is the single largest factor and the one least often discussed early enough. Female fertility declines from the early thirties and more sharply after 35; male fertility declines more gradually but does decline.

NHS-funded IVF is subject to local eligibility criteria that vary substantially between areas, and knowing the local rules early matters because some criteria, including age and existing children, are absolute.

Signs you might notice

The absence of pregnancy after the periods above is the definition, but earlier assessment is warranted with:

Irregular or absent periods, which suggests ovulation is not happening.

Severe period pain or pain during sex, suggesting endometriosis.

Previous pelvic infection, surgery, or an ectopic pregnancy.

Previous chemotherapy or radiotherapy.

Undescended testicles, testicular surgery or injury, or a varicocele.

Erectile or ejaculatory difficulty.

Over 36, or a known cause: see someone at six months rather than waiting a year.

Recurrent miscarriage is investigated on a separate pathway; see antiphospholipid syndrome.

How it can affect day-to-day life

The emotional cost is severe and is consistently under-supported. Infertility is a grief that recurs monthly, and it strains relationships, friendships and family occasions.

Men are frequently left out of the emotional support entirely, even when the male factor is the identified cause, and male-factor infertility carries its own particular silence.

Treatment is medicalised, invasive and scheduled, which puts sex and intimacy under pressure in a way people rarely anticipate.

The postcode lottery for NHS funding is a genuine injustice and causes real distress; knowing the local criteria at the start prevents worse disappointment later.

Private treatment is expensive, and add-on treatments are widely sold with weak evidence. The regulator publishes a traffic-light rating of add-ons, which is worth consulting before paying.

Fertility preservation before cancer treatment is time-critical and is sometimes not raised. It should be.

Supporting someone well

Both partners should be investigated together, and semen analysis should be among the first tests, not the last.

See a GP at 12 months, or at six months if over 36 or if there is a known cause.

Ask about local NHS eligibility criteria early; they vary and some are absolute.

Optimise what is modifiable: stop smoking, reduce alcohol, address weight in either direction, and stop recreational drugs including anabolic steroids.

Take folic acid before conceiving, and check rubella immunity.

Have sex every two to three days throughout the cycle rather than timing to ovulation, which is less effective and more stressful.

Check the evidence rating before paying for any IVF add-on.

Ask about fertility preservation before any cancer treatment.

Ask for counselling; fertility clinics must offer it and many people decline it and later wish they had not.

Where to get help

A GP practice for initial investigation of both partners, and referral to a fertility service.

The Human Fertilisation and Embryology Authority for clinic performance data and the traffic-light ratings of treatment add-ons.

Fertility Network UK run a support line and are the main UK charity.

Tommy's midwives on 0800 014 7800 for pregnancy after fertility treatment.