One in seven couples experiences difficulty conceiving. That number is high enough that if you find yourself in it, you are far from alone, and yet the emotional weight of the experience tends to be carried in silence. One of the most useful things you can do is understand what is actually meant by infertility, what the common causes are, and when to ask for help.
What Infertility Means Clinically
In medical terms, infertility refers to the inability to conceive after 12 months of regular unprotected intercourse, for women under 35. For women aged 35 and over, the timeframe shortens to six months. It also applies if there have been recurrent miscarriages or a known reason that pregnancy is unlikely without intervention.
Importantly, infertility is not a single diagnosis. It is an umbrella term covering a long list of possible underlying causes, some on the female side, some on the male side, and some unexplained even after thorough investigation. Roughly a third of cases involve a female factor, a third involve a male factor, and the rest are combined or unexplained.
Common Causes on the Female Side
Ovulation problems: These account for around 25 per cent of female infertility. The most common cause is PCOS, but thyroid dysfunction, hypothalamic amenorrhoea (often related to stress or undereating), and high prolactin can all stop or disrupt ovulation.
Tubal factors: Blocked or damaged fallopian tubes prevent egg and sperm from meeting. Pelvic inflammatory disease from a previous infection, including chlamydia, is a frequent cause. Endometriosis can also affect the tubes.
Endometriosis: Affecting around one in ten women, endometriosis can impact fertility through inflammation, scar tissue, and altered ovarian function, even when symptoms are mild.
Uterine factors: Fibroids, polyps, scar tissue, or congenital uterine differences can interfere with implantation.
Diminished ovarian reserve: Fewer eggs available, sometimes earlier than expected, including in cases of premature ovarian insufficiency.
Age-related egg quality: Particularly from the late 30s onward, the chromosomal health of eggs declines, which is one of the most common contributors to infertility and miscarriage.
Common Causes on the Male Side
Male factor infertility is involved in roughly 40 to 50 per cent of cases, and yet semen analysis is often the last test done rather than the first. Causes include low sperm count, poor sperm motility, abnormal sperm shape, and structural or hormonal issues. Lifestyle factors including smoking, alcohol, heat exposure and certain medications affect sperm quality, often within a three-month window since sperm takes around 90 days to mature.
If you are investigating fertility as a couple, a semen analysis should be one of the first steps. It is non-invasive, relatively quick, and avoids weeks of testing on the female partner only to find the contributing factor was elsewhere.
When to Seek Help
Under 35 and trying for 12 months without success
35 or older and trying for six months without success
Irregular or absent periods at any age
Known endometriosis, PCOS, fibroids, or pelvic infection history
Previous chemotherapy or pelvic surgery
Two or more miscarriages
Any concern, at any stage, that something is not adding up
You do not need to wait until you tick a clinical box to ask questions.
What Testing Usually Involves
Initial fertility investigation typically includes blood tests to check hormones (FSH, LH, oestradiol, prolactin, thyroid, AMH for ovarian reserve), a pelvic ultrasound to look at the ovaries and uterus, semen analysis for the male partner, and assessment of the fallopian tubes (often a hysterosalpingogram or HyCoSy). Additional testing depends on what the initial picture shows.
Treatment depends on the cause and can range from supporting ovulation with medication, to surgery for fibroids or endometriosis, to intrauterine insemination (IUI), to IVF with or without ICSI. Most fertility journeys involve more than one option and more than one decision.
On Carrying It Well
Fertility difficulty is one of the loneliest health experiences, partly because it sits at the intersection of medicine, identity and grief. The most useful starting point is information: knowing what the words mean, what the tests look at and what your options are. The second is community, even if quiet. Speaking to a fertility counsellor, a peer support group, or simply one other person who has been through it changes the experience of going through it.
Asking for help is not a failure because it is the part where care begins.