Infertility

Infertility is the inability to conceive after a year of regular, unprotected sexual intercourse (or six months for women over 35). It can result from factors affecting either partner, or a combination of both, and many cases can be successfully treated once the cause is identified.

• The primary symptom is difficulty conceiving despite regular, unprotected intercourse over an extended period
• In women, irregular or absent menstrual periods can be a sign of an underlying cause affecting ovulation
• In men, there are often no specific symptoms, and infertility may only become apparent through the inability to conceive

• In women, common causes include irregular ovulation (such as with PCOS), tubal blockage (often related to past pelvic infection), and, less commonly, uterine abnormalities.
• In men, common causes include low sperm count or quality, problems with sperm delivery, and hormonal imbalances.
• In many couples, a combination of factors from both partners contributes, and in some cases, no specific cause is identified despite thorough evaluation.
• Age, particularly for women, is an important factor, as fertility naturally declines with increasing age.

• Evaluation typically involves both partners, since either or both may contribute to difficulty conceiving.
• For women, assessment includes a menstrual and reproductive history, blood tests to assess ovulation and hormone levels, and, where available, imaging to assess the uterus and fallopian tubes.
• For men, a semen analysis assesses sperm count, movement, and shape.
• Further specialised testing may be considered depending on initial findings.

Treatment is guided by the identified cause where possible — for example, medicines to induce ovulation for women with irregular ovulation, or treatment of an underlying hormonal or structural problem.

Lifestyle factors such as maintaining a healthy weight, reducing alcohol intake, and stopping smoking can improve fertility for both partners and are generally recommended as a first step.

For couples where standard treatment does not lead to conception, or where the cause involves significant tubal or sperm factors, referral to a specialist fertility service for further options may be appropriate, where available.

Emotional support is an important part of care, as infertility can be a significant source of distress for couples.

• Maintain a healthy body weight and avoid excessive alcohol intake.
• Avoid smoking, which can affect fertility in both men and women.
• Seek prompt treatment for pelvic infections and sexually transmitted infections, which can affect future fertility if untreated.
• Seek evaluation as a couple after a year of trying to conceive without success (or sooner for women over 35, or with known risk factors).