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Fertility Problems: Top Causes Of Infertility And What To Do Next

Fertility Problems

Infertility can be a confusing and heartbreaking condition for couples who are trying to conceive. There are a few key factors that can cause fertility problems in both women and men.

Here we will explain the most common causes for infertility and discuss when you should look for medical advice. 

How Do We Know If There's A Fertility Problem?

If time just seems to be passing you by without any signs of being pregnant then it could indicate that there are fertility problems.

Most importantly, try not to be anxious. The time it takes to conceive varies enormously. Even if everything is absolutely fine, you still have only a 20 per cent to 25 per cent chance of getting pregnant each month.

Although your age can, and does, make a difference. If you and your partner are in your early 20s, you should expect success within a few months. But the older you are, the longer the wait is likely to be. If you're over 35 and have been trying for six months without conceiving, you should consider seeing your GP.

Getting pregnant isn't completely down to good luck. Try to have intercourse every two or three days and learn to spot the signs that you're in your fertile window.

If you feel you've already taken all the advice and waited the recommended time, go to see your doctor. Infertility affects as many as 15 per cent of couples at some stage. But even if you turn out to be one of these couples, it doesn't mean you'll never have a baby. You may just need more time or some medical help to conceive.

Why Am I infertile?

Once you've set your heart on having a baby, not getting pregnant can be hard to come to terms with.

It's perfectly normal to believe that there must be "something wrong" with you or your partner. Because infertility is a shared experience, it won't really be helpful to see it that way. Fertility problems affect men and women roughly equally.

There may be health issues affecting one of you that are interfering with getting pregnant. The two key factors affecting female fertility are hormone problems or problems with the fallopian tubes and uterus. 

We will go through these step by step.

Is It A Problem With Your Hormones That Is Causing Infertility?

1. Anovulation

Production of an egg (ovulation) Is triggered by your fertility hormones. If these levels are interrupted or being affected by something else then ovulation may not take place. This is called Anovulation. 

Anovulatory cycles occasionally are fairly common but this is one of the first factors to look out for. You can either monitor ovulation using OPKs (Ovulation Predictor Kits) or by visiting your GP for blood tests. This is the only way to confirm ovulation has actually taken place. 

2. PCOS - Polycycstic Ovarian Syndome

PCOS is the term for a condition often caused by hormone imbalance. There are a number of different signs which would indicate PCOS:

  • Weight gain
  • Excessive Facial/body hair
  • Irregular or no periods

Approximately one out of 5 women in the UK will have polycystic ovaries. Many will not know they have it.

3. Short Luteal Phase

The Luteal Phase is the time following ovulation and before your period starts. Occasionally if this time is too short then the fertilised egg will be flushed out of the system before implantation is able to take place.

This can be treated so if you are concerned that you have a very short Luteal Phase then do seek medical advice. 

4. Early Menopause

During the perimenopause (the period before the menopause) It is very difficult to get pregnant. If you are able to find out of your mother had an early menopause then this will be a good indicator if this is likely to be the same for you.

Fertility Problems Caused By Uterus Or Fallopian Tube Problems

If you understand that the egg is carried by the Fallopian tube to the uterus then you will be able to understand tha any blockages in this tube can be the reason the sperm isn't able to get to the egg. 

Likewise if there are any growths in the uterus then this can affect implantation. 

Here we will look at the possible reasons for these to occur. 

1. Chlamydia 

Did you know that if Chlamydia is left untreated then it can cause the Fallopian tube to become blocked?

Chlamydia is one of the more common infections transmitted through unprotected sex and it can be completely lacking in symptoms. You could go years without realising that you have it so it is best to get checked. If detected then Chlamydia can be treated with a course of medication. 

2. Fibroids

Fibroids are growths that can develop in the tissue of the uterus and they can affect implantation or blockages in the fallopian tubes.

This will be something your GP will need to look into further and referring you to a specialist. 

3. Endometriosis

Endometriosis is a condition that causes the uterus lining to grow outside the uterus. This can obstruct the Fallopian tubes which in turn will stop fertilisation. Heavy or painful periods can be a sign of Endometriosis.

There Are A Number Of Treatment Options Which Your Doctor Will Be Able To Talk You Through. 

Even with one of these conditions, you'll probably still be one of the 85 per cent of couples who conceives within 12 months. If you're not, there's still a very good chance you'll get pregnant the following year without needing medical help.

If you have had three or more miscarriages, you may want to talk to your doctor about trying for another baby.

Also see your doctor if you take medication that affects fertility. Some anti-inflammatories and antidepressants can compromise your fertility. Most GP surgeries offer a check-up before conception, and this is exactly the sort of thing you can discuss then.

Apart from current or previous medical conditions, what you eat and your overall lifestyle may have some effect.

Male Fertility

Why Is My Partner Infertile?

When it comes to male fertility there are three main areas to look at with fertility. Sperm quality, sperm count and erectile dysfunction.

1. Sperm Count

If a man has a sperm count lower than 15 million per millimetre then this is considered a low count. There are some things that can be done to boost a mans sperm count or at least to contribute towards it. 

One factor believed to affect sperm count is overheating. If the testicles get too hot by wearing tight underwear then this can effect sperm count. 

2. Sperm Quality 

As with Sperm count, the quality of sperm can be greatly affected by overheating the testicles so advice is to wear loose fitting underwear. 

There is a simple test which can be done at the doctors which can asses the sperm count and the quality. 

3. Erectile Dysfunction

Maintaining an erection or becoming aroused to begin will contribute to difficulties during sex. These problems can be caused by either psychological reasons or physical reasons. 

It would be advised in this case to visit the GP who will be able to offer advice. 

If any of the following apply to him, do advise him to see his GP:

  • STD, such as chlamydia or gonorrhoea.
  • A lifelong illness such as diabetes, thyroid disease or heart disease.
  • Infection with the mumps after puberty.
  • Testicular tumours, cysts or cancer.
  • Surgery in his groin or injury to his testicles.
  • Problems with ejaculating.
  • Undescended testicles.

Your partner should also see his doctor if he takes medication such as antihistamines, androgens or beta blockers.

Just as with women, lifestyle can affect a man's fertility. These are:

  • Working in a hot environment or spending long periods sitting down. Either could result in your partner's testes overheating.
  • Working with chemicals or radiation.
  • Being overweight with a body mass index (BMI) of more than 29.
  • Being a heavy smoker.

What Should We Do If We Think There's A Problem?

The best person to see first is your GP. Ideally, you and your partner should go together, as he is just as likely as you to need help. Feel free to talk to your GP about your concerns or fears, no matter how long you've been trying to get pregnant.

He or she should be able to answer any of your questions, arrange for some initial tests and then, if necessary, refer you to an infertility specialist.

Article By

Dr Beverley (MBChB, MRCGP) is a qualified GP. She works in a GP practice in Manchester and also helps in the out of hours GP service. She has experience in both obstetrics & gynaecology and paediatrics and has three children of her own.

to read more articles by Dr Beverley Sanders

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