Fertility & infertility
INFERTILITY CAUSES, RISK FACTORS & SUPPORT
Here, we cover some of the most common risk factors associated with infertility and the available support, from tests to treatment.
Everyone’s fertility journey is different, so you may not have all of the risk factors and you may not have all of the tests and treatments offered to you, but your GP will explain your options.
Common causes of infertility include a lack of regular ovulation (the monthly release of an egg), poor quality semen, blocked or damaged fallopian tubes and endometriosis (where tissue that behaves like the lining of the womb - the endometrium - is found outside the womb).
CAUSES & RISK FACTORS
Fertility naturally starts to decrease with age. The number and quality of eggs decreases as women get older, this can vary from person to person, but fertility for someone with ovaries usually starts to decline from the age of 36.
Men may find their fertility declines around age 40 to 45 years. The decrease in fertility is caused by the decrease in the number and quality of the sperm they produce. Men can have fertility problems even if they can still have sex and have an ejaculation.
Women who are trying for a baby after the age of 36 years who may have concerns or questions should speak to their GP.
If you are femal and are trying to get pregnant, or plan to start trying, the closer you are to a healthy weight, the greater your chance of getting pregnant and having a healthy baby. The ideal weight for conception depends on how tall you are. Your body mass index (BMI) is a number based on your height and weight. The healthy BMI range is between 18.5kg/m2 and 24.9kg/m2. Adults with a BMI between 25kg/m2 and 29kg/m2 are considered overweight and a BMI over 30kg/m2 indicates obesity. Being overweight or underweight can affect can affect ovulation and impact your fertility. You can find out what your BMI is here. Everyone should aim to have a well balanced diet, drink plenty of water and exercise regularly.
There are several different sexually transmitted infections (STIs) which are common in the UK. Chlamydia and gonorrhoea are two of the most common. Most don’t pose any serious threat to your health as long as they’re diagnosed early and treated, but some can cause complications if they go untreated. In rare cases, an untreated STI can cause problems with your fertility.
Some STIs don’t cause any symptoms, which means it’s not always possible to know that you’re infected without a test. You can access testing services from your GP or local sexual health clinic. Alternatively, you can buy Sexual Health Home Test Kits†, for specific STIs, from Boots Online Doctor. If you test positive, you may be able to access treatment via a Boots Online Doctor Sexual Health Treatment Service.**
Smoking and passive smoking affects the chances of conceiving. Infertility rates in smokers are about double compared to non-smokers.***
Smoking can cause reduced fertility levels for women as smoking may negatively affect hormone production.
Erectile dysfunction may interfere with someone's chances of conceiving and smoking is a risk factor for increasing the chances of experiencing erectile dysfunction.
If you're a smoker, stopping smoking can make a positive difference to your health, as well as the health of your family. Stopping smoking can improve your chances of living longer. You should stop smoking if you are trying to conceive or are pregnant. If you are pregnant or breastfeeding, quitting smoking is really important, however, the Boots Online Doctor Stop Smoking Service isn't suitable for you, so you may find some useful information on quitting here. There is a range of stop smoking aids, such as gums, lozenges and inhalers, available to buy here. If you are trying to get pregnant or may be pregnant, you should speak to a pharmacy team member when selecting your stop smoking aid as some products are not suitable during pregnancy.
Consuming alcohol can affect fertility. Male fertility is impacted due to alcohol altering sperm count, shape, size and movement. Regular heavy drinking can reduce female fertilty as this can cause interruption to the menstrual cycle and ovulation. Consuming alcohol can also cause changes in hormone levels. The chief medical officers for the UK recommend adults should drink no more than 14 units of alcohol a week, which should be spread evenly over three days or more.
You should not drink alcohol if you're pregnant or trying to get pregnant. Alcohol can be passed to the unborn baby which can lead to long-term harm to the baby, and the more you drink, the greater the risk. Find out about alcohol and pregnancy, alcohol units and tips for cutting down from the NHS here.
Trying for a baby can be stressful, especially if you struggle to conceive, which can affect your relationship with your partner and cause a loss of sex drive. Whilst stress is unlikely to be a cause of infertility, in severe cases, stress may also affect ovulation and sperm production.
Signs and symptoms of stress could include the following:
- Sadness that doesn’t go away
- High and low mood swings
- Withdrawing from the people and activities you enjoy
- Having low or no energy
- Feeling numb or like nothing matters
- Worries or fears that seem out of proportion
- Neglecting your appearance and hygiene
- Losing interest in sex
- Becoming disorganised or confused
- A change in your eating or sleeping habits
If you notice any of the above, you should talk to your GP, who can help you find the right support.
Everyday stress can impact all areas of your life, including your sex life, so it is important to find ways to manage and feel better. Being active is not only great for your physical health, but it can also improve your mental wellbeing. Just 30 minutes of walking everyday can help boost your mood and improve your health. Small amounts of exercise add up, so don’t be discouraged if you can’t do 30 minutes at one time.
Eating healthy, regular meals and staying hydrated can help you feel better. A balanced diet and plenty of water can improve your energy and focus throughout the day.
Sleep plays an essential role in mental health. To get enough high-quality sleep, try starting with these tips:
- Avoid caffeine drinks after 3 pm.
- Try to wake up and go to sleep at the same time everyday.
- Make your bedroom into a quiet, relaxing, clutter-free space.
- Try to relax before bedtime - this could be listening to music or taking a bath.
- Avoid looking at devices an hour or two before bed; try reading a book or magazine instead.
- Explore relaxation or wellness programmes or apps, which may incorporate meditation, muscle relaxation, or breathing exercises.
If you’re experiencing a mental health crisis or are at risk of harming yourself or others, please call 111, speak to the Samaritans on 116 123, text Shout on 85258 or speak to your GP.
Polycystic ovary syndrome (PCOS) is a condition that affects how a woman's ovaries work.
The symptoms of PCOS can vary, but the most common symptoms are:
- Irregular periods or no periods at all
- Difficulty getting pregnant
- Excessive hair growth, usually on the face, chest, back or buttocks
- Weight gain
- Thinning hair
- Hair loss from the head
- Oily skin
Many women with PCOS are found to have an imbalance in certain hormones, including:
- Raised levels of testosterone – a hormone often thought of as a male hormone, although all women usually produce small amounts of it
- Raised levels of luteinising hormone (LH) – this stimulates ovulation but may have an abnormal effect on the ovaries if levels are too high
- Low levels of sex hormone-binding globulin (SHBG)
- Raised levels of prolactin
PCOS is one of the most common causes of infertility in women†. During each menstrual cycle, the ovaries release an egg (ovum) into the uterus (womb). This process is called ovulation and usually occurs once a month. Women with PCOS do not ovulate or ovulate infrequently, which means they have irregular or absent periods and find it difficult to get pregnant. Many women discover they have PCOS when they're having difficulty getting pregnant. The exact cause of PCOS is unknown, but it's thought to be related to abnormal hormone levels.
Endometriosis is a condition where tissue, similar to the lining of the womb, grows in other places, such as the ovaries and fallopian tubes. Endometriosis is a long-term condition that can affect women of any age. Some women are badly affected, while others might not have any noticeable symptoms.
Symptoms can vary, but the most common are:
- Pain in your pelvis or lower tummy (which is usually worse during your period)
- Period pain that stops you from doing your normal activities
- Pain during or after sex
- Pain when peeing or pooing during your period
- Feeling sick
- Blood in your wee or poo during your period
- Difficulty getting pregnant
It's important to speak to your GP if you have symptoms of endometriosis.
Some women with endometriosis can sometimes experience a number of complications including fertility problems. This does not happen for all with endometriosis and it is not fully understood but is thought to be because of damage to the fallopian tubes or ovaries.
There is currently no cure for endometriosis and there are treatments can help ease symptoms, but won't improve the condition (or improve fertility if this is affected by endometriosis).
There are some drugs and medicines that can impact fertility, such as non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, neuroleptic medication and chemotherapy, and recreational drugs, such as cocaine, may also impact fertility. You can read more information on the causes of infertility, including medication on the NHS website here. If you are currently taking any medication or going through medical treatment, please consult your medical care team if you would like to start trying or are trying for a baby. Both the male and female taking medication should check with their GP before trying for a baby.
It's important to never stop taking a medicine that's been prescribed to keep you healthy without first checking with your doctor. Stopping taking your medicine could be harmful to both you and your baby.
If you're trying for a baby or are already pregnant, it's important to always:
- talk to your doctor immediately if you take regular medicine, ideally before you start trying for a baby or as soon as you find out you're pregnant.
- check with your doctor, midwife or pharmacist before taking any prescribed medicines or medicines that you have bought.
You can read more about the NHS guidance on taking medicines during pregnancy here.
Everyone should aim to eat a balanced diet and drink plenty of water, exercise regularly and take time to relax but it is especially important when trying to conceive. If you're unsure where to start, speak with your GP or pharmacist. Your pharmacist can also talk to you about which food supplements are recommended when trying for a baby and when pregnant.
The NHS recommend that you should take a 400 microgram supplement of folic acid every day before you get pregnant, and every day afterwards, up until you're 12 weeks pregnant. Do not worry if you get pregnant unexpectedly and were not taking a folic acid supplement at the time. Start taking them as soon as you find out until you've reached the 12th week of pregnancy . Folic acid reduces the risk of your baby having a neural tube defect, such as spina bifida.
You can buy folic acid supplements from Boots in the form of tablets, gummies or liquids. Browse the full range here.
You might be advised by your GP or midwife to take a higher dose supplement of 5 milligrams (5mg) every day if you have certain risk factors, such as diabetes or a family history of neural tube defects. If you need to take a high dose of folic acid, this will be prescribed for you by your GP.
In the winter, adults should consider taking a daily vitamin D supplement containing 10 micrograms of vitamin D supplement throughout the year. It's particularly important for pregnant or breastfeeding women. If you're pregnant or breastfeeding a baby, you should make sure you take a daily vitamin D supplement. The NHS advise pregnant women to take 10 micrograms of vitamin D a day. Check the labels on your daily vitamin supplement to find out what level of vitamin D it provides.
If you're pregnant or trying to conceive, you should avoid taking supplements that contain vitamin A. Large amounts of vitamin A can harm your unborn baby. Speak to your GP or midwife if you would like more information. If you would like to read more about what vitamins to take and which should be avoided when trying to conceive, read our guide here.
A common cause of infertility in men is poor-quality sperm, that is ejaculated in semen during sex.
For some men, their sperm quality may be an issue for reasons such as:
- A very low sperm count or no sperm at all.
- Sperm that doesn't move properly, making it hard to swim to the egg and fertilise it.
- Abnormally shaped sperm, making it harder for them to move and fertilise an egg
You can buy SpermCheck Fertility Home Test Kit online or in selected stores, which is a test can help you take a proactive step in the fertility journey. If SpermCheck identifies you have a low sperm count, we recommend you visit your doctor to find out more about having a fully comprehensive fertility examination.
If you have been having unprotected sex for over a year and trying for a baby but been unable to conceive, the NHS recommend you speak to your GP to get further support.
If you are female, blood tests can be used to measure a variety of hormones that all play a part in fertility. Levels of progesterone can be checked to see if you are ovulating, and gonadotropins, hormones that stimulate the ovaries to produce eggs, can be measured if your periods are irregular. Speak to your GP to understand your testing options.
An ultrasound can be used to scan your reproductive organs and look for any conditions that may be contributing to your infertility, such as endometriosis or fibroids, as well as any blockages that could be affecting ovulation. You should speak to your GP if you have any questions or concerns about your fertility, who will then be able to discuss what investigative options are available for you.
An x-ray of the womb and fallopian tubes, called a hysterosalpingogram, can be used to find and diagnose any blockages that could be affecting ovulation. A special dye is injected before the scan to highlight anything that could be stopping eggs from travelling down into the uterus. You should speak to your GP if you have any questions or concerns about your fertility, who will then be able to discuss what investigative options are available for you.
A laparoscopy can be used to find any blockages. A small key-hole incision is made into the lower part of the tummy and a thin camera is inserted to examine the uterus, fallopian tubes, and ovaries. You should speak to your GP if you have any questions or concerns about your fertility, who will then be able to discuss what investigative options are available for you.
A sperm sample can be taken and analysed to examine sperm count and the quality of sperm which can contribute to infertility. You should speak to your GP if you have any questions or concerns about your fertility, who will then be able to discuss what investigative options are available for you.
Medical professionals can prescribe several different fertility medicines, including gonadotrophins, to encourage ovulation. Gonadotrophins have also been shown to improve fertility in men.
IUI is a type of artificial insemination where sperm is collected and washed in a special fluid to separate the highest quality sperm from the rest. The selected sperm is then directly inserted into the womb. You should speak to your GP if you have any questions or concerns about your fertility, who will then be able to discuss what support options are available for you.
IVF is a common fertility treatment where medication is given to increase the number of eggs released by the ovaries. The eggs are then collected and fertilised outside of the womb using either patient or donor sperm before being implanted in the lining of the uterus. You should speak to your GP if you have any questions or concerns about your fertility, who will then be able to discuss what support options are available for you.
In ICSI, eggs are extracted from a patient and a single sperm is injected into the centre of an egg. The fertilised egg is then implanted in the lining of the uterus. This form of fertility treatment is especially helpful for those who have a low sperm count, poor motility or a higher number of abnormally shaped sperm. You should speak to your GP if you have any questions or concerns about your fertility, who will then be able to discuss what support options are available for you.
If you or your partner have fertility issues, or you are unable to conceive naturally, you may be able to use donated eggs or sperm. This can be an option for same-sex couples or for people who are single.
Egg and sperm donation is typically used as part of the IVF (in vitro fertilisation) process, but donated sperm can also be used in IUI (intrauterine insemination).
You should speak to your GP if you have any questions or concerns about your fertility who will then be able to discuss what support options are available for you.
Fertility issues can take a toll on the mental health of both you and your partner. The NHS offers counselling for anyone going on their fertility journey and can direct you towards other useful support systems, including fertility support groups and forums. Speak to your GP if you would like some further support.
LEARN MORE ABOUT FERTILITY
FREQUENTLY ASKED QUESTIONS
Women are born with a fixed number of immature eggs in their ovaries (about two million). Every menstrual cycle, one of these immature eggs will mature and be released during ovulation. At the age of 37, there are about 25,000 eggs remaining. Not only do the number of eggs decrease with age, but the quality of the eggs gets poorer, meaning that the decline in fertility occurs when reaching the mid-30s.
Men aren’t born with sperm; it’s produced daily. However, fertility starts to decline around 40 to 45 years old. This is caused by the decrease in the number and quality of the sperm produced.
A fertility test will help you understand your fertility status and enable you to make informed decisions, whatever situation you’re in.
It’s recommended that you see your GP if you:
- haven’t conceived after a year of trying (both partners should visit the GP as fertility problems can affect either or both partners)
- are female and are aged 36 or over and would like to try for a baby
- have any other reason to be concerned about your fertility, for example, if you've had treatment for cancer or you think you might have had, or have, a sexually transmitted infection (STI)
Your GP will be able to do an initial assessment, ask questions about your medical and sexual history and advise you on what to do next. They may carry out a physical examination too, after which you might be referred to a specialist infertility team at a hospital or fertility clinic for further tests if needed.
Men can also check their sperm count in the privacy of their own home with a SpermCheck Fertility Test.
Several lifestyle factors can affect your fertility, so your GP may recommend making small changes to increase your chances of conceiving, such as:
- Stopping smoking
- Maintaining a healthy weight
- Cutting down on or stopping drinking alcohol
- Finding ways to reduce everyday stress, for example, exercising or meditation
If you’re, a woman who is worried about your fertility and you’ve not conceived after a year of trying, and are aged 36 or over, or you’re already aware that you may have fertility problems, you should see your GP.
They can check for common causes of fertility problems and provide support as needed.
There is a specific time in each menstrual cycle when it’s possible to conceive. This ‘fertile window’ is once a month, generally close to when the woman in the partnership ovulates and releases an egg, approximately two weeks before the next period is due.
To increase your chances of getting pregnant, it’s recommended that you have unprotected intercourse every two to three days and try to have sex around ovulation.
Men don’t have a ‘fertile window’ as sperm is continually formed and stored in the testicles.
Some couples will conceive quickly, but for others it can take longer. It’s important that both partners support each other as much as possible during this time as it can be an emotional process.
If you’re concerned about your fertility, it’s a good idea to see your GP for advice.
There are many possible causes of infertility, but sometimes it can be tricky to identify the cause.
Common causes include:
- Lack of regular ovulation (the monthly release of an egg)
- Blocked or damaged fallopian tubes
- Endometriosis (where tissue that behaves like the lining of the womb is found outside the womb)
- Poor quality semen
You can read the NHS information on infertility here.
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**Access to test kits and treatment is subject to an online consultation with a clinician to assess suitability. Subject to availability. Charges apply.
- Fact Sheet from ReproductiveFacts.org
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Boots is the place to go for healthcare advice. You can find the fertility tips, advice and information you might need to try and get pregnant, as well as tips for conceiving.