Fertility challenges - starting a family
14 September 2022
Being able to conceive a child naturally is not a given. In fact, more than 3.5 million people in the UK encounter difficulties trying to start a family1. The reasons why are numerous and varied. Sometimes, a few lifestyle changes are all that is needed. However, in other cases, surgical treatment is required, and for some people there is no way to have a biological child. But whatever your fertility problems, the sooner you get help the better your chances of becoming a parent. So, if you know conceiving naturally is not an option, or if having regular, unprotected sex doesn’t seem to be working, it's probably a good idea to get in touch with your GP.
Did you know?
About 84% of heterosexual couples will conceive naturally within a year if they have unprotected sex every 2-3 days2.
What is infertility?
Infertility is when a heterosexual couple are having regular sex without using contraception, but the woman does not become pregnant. It can affect both men and women of all ages; even parents who have previously had healthy children can experience infertility when they try to conceive again.
Some fertility problems are easy to treat; others are more complicated. However, the good news is there is help available, both on the NHS and privately, including counselling for those whose mental health is affected by infertility.
When and how can I get help with fertility?
Fertility specialists usually recommend a couple actively try to conceive, i.e. have unprotected sex every 2-3 days, for 12 months before contacting their GP.
But because fertility decreases with age, if you are a woman over the age of 36, or either of you are aware of a potential fertility problem, you should make an appointment sooner.
Your GP will ask about your medical background and your lifestyle and will also conduct a physical examination and tests to try to establish the cause of the infertility.
Know your numbers
Around one in seven couples may have difficulty conceiving. For couples who have been trying to conceive for more than three years without success, the likelihood of getting pregnant naturally within the next year is one in four, or less3.
What lifestyle factors can cause fertility issues?
Lifestyle factors that can cause infertility include:
- Age - women are born with all the eggs they will ever have. By their late 30s, this usually means most of their eggs have already been released. Sperm quality also decreases with age.
- Body Mass Index (BMI) - being overweight (30+ BMI) or - in women - severely underweight can affect fertility.
- Smoking, Drugs, Alcohol – these are known to affect fertility, so it's best to avoid them when trying to conceive.
- Pharmaceuticals – medical treatments such as chemotherapy can affect fertility, sometimes permanently.
- Sexually Transmitted Infections (STIs) – STIs such as Chlamydia pose a threat to fertility.
- Environmental Factors – exposure to certain pesticides, solvents, and metals can affect fertility, particularly in men.
- Stress – can cause infertility in both men and women.
Infertility in men
The key to fertility for men is to produce lots of good quality sperm. Issues that can arise with this include:
- Semen and sperm production - when you have a very low/zero sperm count or produce "lazy" sperm that has difficulty moving towards the egg.
- Testicular damage - when your testicles are damaged due to injury, infection, cancer, surgery, or a birth defect, this could impact your fertility.
- Ejaculation disorders – when you find it hard to ejaculate and release semen during sex.
Infertility in women
A fertile woman's body usually releases an egg from the ovaries once a month. This then travels down the fallopian tubes to the womb where it can be fertilised by a sperm.
But numerous issues can arise with this process, including:
- Lack of regular ovulation - often due to Polycystic Ovary Syndrome (PCOS), thyroid problems or ovarian failure.
- Damaged fallopian tubes - for example due to Endometriosis or Pelvic Inflammatory Disease (PID).
- Cervical problems – for example due to Endometriosis or Pelvic Inflammatory Disease (PID).
Did you know?
One in four couples never find out the cause of their infertility4.
Treatments
If you have received an infertility diagnosis, the next step is to see a specialist who will generally suggest one of the following:
- Medical Treatment - some medications can encourage the ovaries to produce eggs.
- Surgery - if a physical problem such as fibroids is stopping the sperm and egg meeting, then a surgical procedure may be able to help.
- Artificial insemination – or intrauterine insemination (IUI) involves collecting sperm and inserting the best specimens into the cervix to increase the chances of one fertilising an egg.
- In vitro fertilisation (IVF) - when eggs are fertilised with sperm in a laboratory and one - or more - of the fertilised eggs (embryos) is implanted into the cervix to grow.
- Egg or sperm donation – the only option for some couples; any resulting children are legally entitled to find out who their donor parent is when they reach 18.
Know your numbers
The chance of having a baby after one IVF attempt is around 30% for women under 35, but only about 10% for women aged 40-44, reducing to 4% after this age5.
Is IVF available on the NHS?
IVF can be physically and mentally demanding, but it is also one of the most successful treatments available - and can often be done on the NHS6.
The National Institute of Clinical Excellence recommends that it is offered to women aged under 43 who have been having regular, unprotected sex for 2 years, or who have tried 12 cycles of artificial insemination with at least 6 being IUI.
However, decisions about IVF treatment are made locally by Integrated Care Boards, so ask your GP for more information about what's available where you live. IVF is also available privately in the UK. An average cycle costs £5,000, although prices vary widely between different centres.
Choose a clinic that is regulated by the Human Fertilisation and Embryology Authority7. If you are considering a clinic abroad, check their success rate statistics and whether they are regulated in their home country first.
Same sex fertility treatment
While same sex couples cannot conceive a child naturally, there are lots of ways they can become parents. The main options available to LGBT+ couples are:
- IUI - for female couples, IUI using donor sperm - either from a fertility clinic or from a friend or family member - is a common route to parenthood.
- Surrogacy - a popular choice among male couples, usually using one partner's sperm. It can be done using the surrogate's own eggs (via IUI) or using donated eggs (via IVF).
- IVF – combined with donor sperm, donor eggs or a donor embryo, IVF offers a solution for female couples with fertility problems. It's also an option for single people keen to have a child, regardless of their sexual orientation.