Published by Bupa’s health information team, month year.
 
This factsheet is for women who are having trouble conceiving, or anyone who would like information about infertility.
 
Infertility is when a woman isn’t able to get pregnant after two years of having unprotected sex. There are a number of things that can affect fertility although often no cause can be found. This factsheet only considers infertility in women – for information about infertility in men, please see Related topics.
 

About female infertility
Symptoms of female infertility
Causes of female infertility
Diagnosis of female infertility
Treatment of female infertility
Living with female infertility

 

About female infertility

It’s thought that one in seven couples in the UK has trouble conceiving. However, it’s important to remember that over eight out of 10 couples will conceive within one year of having regular, unprotected sex, and more than nine out of 10 couples will do so within two years.
 
Infertility has been defined as not getting pregnant within two years of having frequent, unprotected sex. You may have primary infertility – this means you have never been pregnant – or secondary, which is when a couple has previously conceived.
 
It’s thought that in about four out of 10 couples who have fertility problems both partners have a condition that affects their ability to have a baby.
 

Symptoms of female infertility

There aren’t any specific symptoms of infertility, but if the problem is caused by a particular medical condition, you may have symptoms as a result of that.
 

Causes of female infertility

It may not be possible to find a cause for your infertility – this is true for about a third of couples who have problems conceiving.
 
There are various reasons why you may be having trouble getting pregnant. It’s important to bear in mind that your fertility decreases as you get older and this may make it more difficult. However, with regular unprotected sex more than nine out of 10 women aged 35 will conceive within three years of trying and nearly eight out of 10 women aged 38 will do so.
 
The most common reasons for infertility in women are:
 

  • your ovaries not producing eggs
  • damage to your fallopian tubes (the tubes that carry the eggs from your ovaries to your womb) as a result of a previous infection such as chlamydia
  • endometriosis – this is a condition in which tissue similar to the lining of the womb develops in other places as well, such as your fallopian tubes or ovaries

 
There are a number of reasons why you may not be producing eggs. Some of these are described here.
 

  • Polycystic ovary syndrome is a condition involving your hormones that can affect your menstrual cycle and how well your ovaries work. This is the most common cause for eggs not being produced regularly.
  • Premature ovarian failure is when your ovaries stop working properly and don’t regularly produce eggs. This can be temporary or permanent.
  • There are a number of disorders that can affect the glands in your body that produce hormones, such as the thyroid and pituitary glands. These can lead to problems with ovulation.
  • If you have a serious, long-term condition such as diabetes or cancer, this may mean you don’t have periods and your ovaries don’t work properly.

 
Things that can affect your fallopian tubes and lead to problems with fertility include:
 

  • infections, such as chlamydia, that damage the fallopian tubes and can lead to them becoming blocked
  • endometriosis
  • damage as a result of previous surgery to your fallopian tubes or ovaries
  • damage as a result of another condition, for example a burst appendix

 
It’s possible that your difficulty conceiving isn’t a result of a problem with your ovaries or fallopian tubes. Some of the other things that can affect your fertility are:
 

  • fibroids – these are non-cancerous growths on the wall of your womb
  • smoking – including being exposed to passive smoking or if your mother smoked during pregnancy
  • drinking more than the recommended limits of alcohol, or using illegal drugs such as marijuana or cocaine
  • being overweight – having a body mass index (BMI) of more than 29
  • being underweight – having a BMI of less than 19
  • taking certain medicines including non-steroidal anti-inflammatory drugs (NSAIDs) or antipsychotics to treat conditions such as schizophrenia
  • treatment for cancer or the human immunodeficiency virus (HIV)
  • certain jobs – for example if you’re exposed to some chemicals found in pesticides or solvents
  • stress

 

Diagnosis of female infertility

See your doctor if you’re concerned about your fertility. If possible, it’s a good idea for you and your partner to go together. Your doctor is likely to ask you for how long you have been trying to have a baby and whether you have had any problems having sex. He or she may ask you about your lifestyle and also about your medical history including:
 

  • whether or not you have been pregnant or had an abortion or a miscarriage in the past
  • questions about your menstrual cycle
  • whether you have ever had any sexually transmitted infections, serious long-term diseases or other conditions that can affect fertility
  • whether you’re taking any medicines

 
Your doctor may also need to examine you.
 
If you have not already been doing so, your doctor is likely to recommend that you have unprotected sex two to three times a week for a year before carrying out any tests. After this time, or sooner if your doctor thinks you or your partner may have a condition that means you’re less likely to conceive, there are a number of tests that he or she may do.
 
Your doctor may carry out blood tests to look at the levels of certain hormones. These can give information about how well your ovaries are working and whether they are producing eggs. Your doctor may also suggest a test to see whether you have been infected with chlamydia. If necessary, your doctor will refer you to a fertility specialist or a gynaecologist (a doctor who specialises in women’s reproductive health).
 
If you haven’t previously been diagnosed with a condition that can affect your fallopian tubes such as endometriosis, you may be referred for a test called hysterosalpingography. This can show if your fallopian tubes are blocked. Hysterosalpingography uses a type of X-ray procedure called fluoroscopy. This involves injecting a dye (contrast medium) that shows up on X-rays into your womb and fallopian tubes, and taking a series of X-rays that are displayed on a TV screen. If your tubes are clear, the dye will fill them and spill out.
 
An alternative to hysterosalpingography is hysterocontrastsonography. This uses an ultrasound scan instead of X-rays to check your fallopian tubes.
 
If you have a condition that affects your fertility, or your doctor thinks you may have, you may be offered a test called a laparoscopy and dye. This is a surgical procedure that can help your doctor see your fallopian tubes and other organs in this area. Laparoscopy and dye can usually give your doctor more information than hysterosalpingography.
 

Treatment of female infertility

If your infertility is caused by an underlying condition such as endometriosis, there may be specific treatments that can improve your chance of becoming pregnant. If your doctor can’t find a particular cause for your infertility, there are a number of options that he or she may suggest.
 

Self-help

Having sex two to three times a week is thought to maximise your chance of becoming pregnant. Your doctor may also suggest making certain lifestyle changes, for example, stopping smoking and not drinking more than one to two units of alcohol once or twice a week. You may also be advised to lose excess weight or put some on.
 
It’s a good idea to take a folic acid supplement if you’re trying to get pregnant. This can reduce the risk of your baby having certain developmental problems. Your doctor may recommend that you are vaccinated against rubella if you’re at risk. He or she is also likely to check that you have had a cervical smear test within the last three years.
 

Medicines

If your infertility is a result of a problem with ovulation, you may be prescribed a medicine such as clomiphene citrate. This is likely to stimulate your ovaries to produce eggs.
 

Surgery

You may be offered surgery if tests show that you have endometriosis or if your fallopian tubes are damaged. However, surgery won’t be suitable for everyone so it’s important to talk to your doctor about the best option for you.  
 
Surgery may also be an option if you have adhesions (fibrous scars) in your womb, or to remove fibroids, especially if they extend into the inner lining of your womb.
 

Assisted conception

There are several techniques that can be used to help you conceive. These aim to bring a sperm and an egg close together. The three main methods are:
 

  • intra-uterine insemination
  • in vitro fertilisation
  • intracytoplasmic sperm injection

 
For more information about these procedures, please see Related topics.
 

Living with female infertility

If you’re having trouble getting pregnant, it can have psychological and emotional effects. Feeling stressed, whether it’s caused by your problems conceiving, work or something else, may affect your relationship with your partner. This in turn may have an impact on your libido and how often you have sex, leading to further fertility problems.
 
You may find it helps to talk to other people – there are support groups where you can meet with couples who are also having treatment for infertility. Alternatively, you may find it helps to talk to someone who isn’t closely involved with your situation. Your doctor or clinic can give you details of a specialist fertility counsellor.

Can complementary therapy help infertility?
What causes premature menopause?
I’ve heard that a procedure called ovarian drilling can help you get pregnant – what is this?
 
 

Can complementary therapy help infertility?

Answer

It’s possible that if you’re having in vitro fertilisation, acupuncture may increase your chance of becoming pregnant.
 

Explanation

There is some evidence that acupuncture may increase the likelihood of you having a successful pregnancy if you’re already having in vitro fertilisation. Some research has looked into the effect of acupuncture when carried out immediately before or immediately after a fertilised egg is transferred to your womb. It’s possible that if you have acupuncture at these specific times, you may be more likely to become pregnant.
 
More research is needed before scientists can be sure whether or not acupuncture is effective. It’s also important to remember that the research that has been done so far only considered women who were having in vitro fertilisation. It’s also possible that acupuncture may be harmful if you have it during early pregnancy, so speak to your doctor first if you’re thinking about trying it.
 
There isn’t any evidence to show whether or not other complementary therapies can help infertility. However, you may find massage helps you to relax and feel less stressed – this may improve your libido.
 

Sources

  • Manheimer E, Zhang G, Udoff L, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ 2008; 336(7643):545–49. doi:10.1136/bmj.39471.430451.BE
  • Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted conception. Cochrane Database of Systematic Reviews 2008, Issue 4. doi:10.1002/14651858.CD006920.pub2

 

What causes premature menopause?

Answer

There are a number of things that may mean you go through the menopause early. It may be the result of a medical condition or it can be caused by certain medical treatments, such as for cancer. It’s possible that a genetic reason may be behind premature menopause. If your mother or grandmother had a premature menopause, you may be slightly more at risk of it.
 
However, for most women it isn’t possible to find a cause.
 

Explanation

Premature menopause is defined as going through the menopause before the age of 45. It means that your ovaries no longer produce any eggs and you don’t have periods.
 
It’s likely that it won’t be possible to find a reason why you have a premature menopause – this is the case for most women. You may find this more difficult to come to terms with than being diagnosed with a specific condition.
 
Premature ovarian failure is often the cause of premature menopause. This affects about one woman in 100 under the age of 40 and one in 1,000 women under the age of 30. Premature ovarian failure is when your ovaries don’t work properly and you may not produce an egg every month. This doesn’t always mean that your ovaries will never produce eggs again – between five and 15 in 100 women with premature ovarian failure find that their ovaries produce eggs from time to time and some may even become pregnant. However, your doctor won’t be able to say if this will be the case for you.
 
There are a number of causes for premature ovarian failure, including:
 

  • an autoimmune disease where your body’s immune system attacks your own healthy body tissue – it may attack your ovaries and damage them so they can’t produce eggs properly
  • radiotherapy to your pelvic region – this can damage your ovaries and may mean they no longer produce eggs
  • chemotherapy – this can affect your ovaries even if the treatment wasn’t for cancer of the ovaries or womb
  • surgery to remove your ovaries, for example to treat cancer
  • an infection such as mumps or tuberculosis – this is very rare and generally your ovaries will start working again once the infection has cleared up

 

Further information

The Daisy Network
www.daisynetwork.org.uk
 
The British Menopause Society
01628 890199
www.thebms.org.uk
 

Sources

  • Menopause – background information. Clinical Knowledge Summaries. www.cks.nhs.uk, January 2008
  • What are the causes of menopause? The Daisy Network. www.daisynetwork.org.uk, 2007
  • POF FAQ. The International Premature Ovarian Failure Association. www.pofsupport.org, August 2004
  • Premature menopause. The British Menopause Society. www.thebms.org.uk, January 2008

 

I’ve heard that a procedure called ovarian drilling can help you get pregnant – what is this?

Answer

Laparoscopic ovarian drilling may help improve your chances of getting pregnant if your fertility problems are caused by polycystic ovary syndrome (PCOS).
 

Explanation

If you have PCOS, you’re likely to have irregular periods, higher than usual levels of the hormone testosterone and cysts on your ovaries. If you have PCOS, you probably won’t be ovulating regularly or at all.
 
You may be offered laparoscopic ovarian drilling, also known as ovarian diathermy, if taking medicines to trigger ovulation hasn’t worked. Ovarian drilling is done under general anaesthetic. Your surgeon will make small cuts in your abdomen (tummy) and insert a narrow, flexible, tube-like telescopic camera so he or she can see your ovaries. Your surgeon will then use an electrical current to heat up tiny areas on your ovaries and destroy some of the extra tissue.
 
This treatment aims to reduce the amount of testosterone that your body produces and so bring about ovulation.
 

Sources

  • Fertility – assessment and treatment for people with fertility problems. National Institute for Health and Clinical Excellence, February 2004. www.nice.org.uk
  • Medical terms explained. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, accessed 8 February 2010

Related topics

Acupuncture
Assisted conception
Male infertility
Polycystic ovary syndrome (PCOS)
 

Related topics

Assisted conception
Endometriosis
Gynaecological laparoscopy
Male infertility
Polycystic ovary syndrome (PCOS)
 

Further information

Human Fertilisation and Embryology Authority
020 7291 8200
www.hfea.gov.uk
 
British Infertility Counselling Association
01372 451626
www.bica.net
 
Infertility Network UK
0800 008 7464
www.infertilitynetworkuk.com
 

Sources

  • For patients and their supporters. Human Fertilisation and Embryology Authority. www.hfea.gov.uk, accessed 29 December 2009
  • Fertility – assessment and treatment for people with fertility problems. National Institute for Health and Clinical Excellence, February 2004. www.nice.org.uk
  • Infertility – background information. Clinical Knowledge Summaries. www.cks.nhs.uk, October 2007
  • What is menopause? The Daisy Network. www.daisynetwork.org.uk, 2007
  • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010
  • Hysterosalpingography. RadiologyInfo. www.radiologyinfo.org, 21 June 2009
  • Laparoscopy and dye insufflation. Infertility Guidance Service. www.infertility-guidance.co.uk, March 2009
  • NHS cervical screening programme. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, accessed 5 January 2010

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