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Waiting for a positive pregnancy test month after month can feel isolating. But infertility is far more common than most people realise: roughly one in six couples worldwide faces it at some point. In many cases a cause can be found and treated. Our post on fertility after 35 and egg health looks at age. This guide explains when to seek help and what an evaluation
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What is infertility?
Infertility is usually defined as not achieving pregnancy after 12 months of regular, unprotected intercourse. For women aged 35 and over, evaluation is usually recommended after six months. If you have irregular periods, known endometriosis, previous pelvic infection or a known male factor, seek advice sooner.
Infertility is a shared issue. Roughly a third of cases involve the female partner, a third the male partner, and the rest both partners or no clear cause
How conception works
Each month a woman releases an egg (ovulation). Sperm must travel through the cervix and uterus to meet the egg in a fallopian tube. The fertilised egg then moves to the uterus and implants. A problem at any step in either partner can delay pregnancy.
Common causes in women
- Ovulation disorders, including PCOS and thyroid problems
- Blocked or damaged fallopian tubes
- Endometriosis. Read our post on endometriosis symptoms and diagnosis
- Uterine problems such as fibroids, polyps or scarring
- Reduced ovarian reserve, mostly related to age
- Lifestyle factors, such as smoking, very high or low body weight and heavy caffeine intake
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Common causes in men
Low sperm count, poor sperm movement or shape, blockages, hormonal problems, varicocele, infections, certain medicines and lifestyle factors can reduce male fertility. See our guide on male fertility problems.
What does an evaluation involve?
- History and examination: menstrual cycles, past pregnancies, surgeries, medicines and lifestyle
- Blood tests: ovulation, ovarian reserve (such as AMH), thyroid and other hormones
- Pelvic ultrasound: to examine the uterus and ovaries
- Tube and uterus assessment: such as a dye X-ray or saline ultrasound where needed
- Semen analysis for the male partner
- Further tests, including genetic tests, where indicated
Most of the work-up can be completed within a few weeks, and both partners are encouraged to attend together.
Treatment options
Treatment depends on the cause, your age and how long you have been trying:
- Timing and lifestyle advice: tracking ovulation, healthy weight, stopping smoking
- Ovulation induction: tablets or injections to help the ovaries release eggs
- Treating underlying conditions: thyroid disease, PCOS, endometriosis, fibroids
- Assisted options: such as intrauterine insemination, and referral for IVF where appropriate
Success rates vary with age and diagnosis, and your doctor will give you realistic expectations.
Supporting your fertility naturally
- Aim for a healthy weight and balanced diet
- Stay active but avoid extreme exercise
- Stop smoking and limit alcohol and caffeine
- Start folic acid before conception
- Manage stress and prioritise sleep
- Do not delay evaluation if you are over 35
Emotional support matters
Fertility challenges can strain mood and relationships. Talk openly with your partner, lean on trusted support, and speak with your doctor if you feel overwhelmed. You do not need to go through it alone.
