Female infertility

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.