Why can’t I conceive?

Around 1 in 6 couples around the world seek advice at some time in their lives about difficulties in getting pregnant.

The time it takes to conceive naturally varies and age can be an important factor, both women’s and (to a lesser extent) men’s fertility gradually declines as they get older.

A woman may have fertility problems for a variety of reasons, it could be due to PCOS (polycystic ovary syndrome), endometriosis, her fallopian tubes are damaged or blocked, these are just a few of the possible causes.

In men, a fertility problem is usually because of low quantity, morphology or poor quality sperm.

For up to a quarter of people, no reason can be found for their fertility problems. This is known as unexplained infertility.

We have listed below some of the most common causes of infertility and urge you to download the pre treatment checklist, as a first step, to take to your doctor or consultant to discuss investigative tests before embarking on IVF. Recurrent miscarriages, emotional upset and just so much invaluable time and money can be lost due to a wrong diagnosis.

Damaged Fallopian tubes

Blocked or damaged tubes causes infertility because they stop fertilised eggs reaching the uterus. Surgery to remove adhesions or unblock the tubes may be available through the NHS or through your insurance, so talk to your doctor. If the problem cannot be solved with tubal surgery, IVF may be the only possible treatment.

Abnormal or low sperm count

Male infertility can often be treated. The sperm may still be capable of fertilising an egg even if the sperm count is low or the quality is poor. Intracytoplasmic sperm injection (ICSI) involves ‘washing’ sperm and injecting the highest quality sperm available into the egg. The fertilised egg (embryo) is then transferred to the woman’s womb. Some men have very low levels of hormones that stimulate the production of sperm and drugs can be used to improve fertility. If you have zero sperm count, you may want to consider donor sperm insemination (DI).

Difficulty ovulating

If the eggs are not being released so they can reach the sperm, drugs can be used to stimulate hormones and cause the egg to move naturally. The success rate is high, there’s about a 90 per cent chance that your ovaries will work properly after taking the correct hormonal drug. Treatment may be available on the NHS or through insurance, so ask your doctor

Polycystic ovary syndrome (PCOS) is a disorder where the edge of the ovary is covered in multiple cysts which interfere with ovulation. If medication to stimulate ovulation doesn’t work, surgery may be needed. With treatment, most women with PCOS are able to get pregnant.

Having many eggs helps to increase the chances of getting pregnant with IVF. Egg production slows with age and women older than mid-30s may have a reduced chance of getting pregnant with IVF. If the eggs are poor quality or not enough eggs are produced, then IVF with a donor egg from another woman may be the best alternative.

Uterine polyps and fibroids

These may sometimes present no symptoms at all and yet can increase the chances of miscarriage or in some cases prevent implantation dependent on their location. Both polyps and fibroids in the uterine cavity can cause occasional cramping and several types of abnormal uterine bleeding, including: heavy menstrual bleeding, spotting between periods, or bleeding after intercourse. They are almost always benign but may need to be removed to render implantation. A simple scan can detect polyps and fibroids.

Pain and infertility from endometriosis

Endometriosis is a disease where cells from the womb lining move to other parts of the body and cause bleeding and sometimes severe pain. Fallopian tubes or ovaries can be damaged. There’s sadly no cure, but it may be treated with surgery or hormone treatments. If pregnancy doesn’t happen after treatment, IVF may be the best option. Find out more here about endometriosis.

Scarring of the cervix or vagina

If the cervix or vagina have been scarred (usually after surgery), this may increase the risk of infertility or miscarriage. The cervix is like a tunnel from the vagina to the uterus. Because it is so narrow, even the slightest scarring can obstruct the tunnel. IVF can be helpful because embryos are placed directly into the uterus and avoid the cervix area.

Thyroid issues

Infertility can also be caused by either an under or over active thyroid issue. If the thyroid is under (or over) active, it can stop you ovulating, lead to miscarriages and prevent the reproductive system working properly and so it’s so important to get this checked out. Find out more information here.

Multiple factors causing infertility

A couple can sometimes have many reasons for their infertility and IVF can often be the best treatment. For example, there could be a minor sperm problem and scarring of the fallopian tube. In this case, IVF could greatly increase the chances of fertilisation and pregnancy.

Couple at risk of having genetic abnormalities being transferred to their baby

If there’s a risk of a disease such as cystic fibrosis or muscular dystrophy passing on to the child, embryos can be screened to detect one that is free of defects and then transferred to the uterus. The same treatment can be used for women who have abnormal chromosomes that cause miscarriages.

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