The British Fertility Society defines infertility as ‘a disease of the reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sex (without contraception) between a man and a woman”
Infertility can be further classified into primary or secondary:
- Primary infertility: when a couple has never been able to conceive
- Secondary infertility: when a couple cannot get pregnant again, despite previously having been able to without any difficulty
In the UK, it is thought that 1 in 7 couples will struggle to conceive. According to NICE, over 80% of couples will conceive within 1 year if:
- The woman is aged under 40 years and
- They do not use contraception and have regular sexual intercourse (every 2-3 days)
Of those couples that do not conceive within the first year, around 50% will go on to conceive in the second year.
General causes of infertility
- Male infertility (30%)
- Ovulatory disorders (25%)
- Tubal damage (20%)
- Uterine or peritoneal disorders (10%)
- No identifiable cause (25%)
In 40% of infertile couples, both male and female causes are apparent.
Investigations will often begin in primary care and involve performing tests on both the male (e.g. semen analysis) and female (e.g. female hormonal testing). Referrals for specialist clinical assessment should be considered in couples who, despite having normal examination/investigation findings, are still unable to conceive after 1 year.
Earlier referral may be considered for women aged 36 years or over (refer after 6 months), or if there is a suspected underlying cause for infertility as suggested by history/examination e.g. previous pelvic inflammatory disease.. For further information regarding investigations please see our sections on male factor infertility and female factor infertility.
General advice to couples who are trying to conceive
- Regular (every 2-3 days) sexual intercourse throughout the woman’s cycle
- Preparation for pregnancy e.g. taking preconceptual folic acid (400mcg daily)
- Smoking cessation advice to both men and women that smoke
- Avoidance of drinking alcohol excessively
- Note: The Department of Health recommend that women should avoid alcohol altogether whilst trying to conceive
- Women should aim for a BMI of 19-25 kg/m2
General management for infertility
There are 3 main types of fertility treatment
- Medical treatment e.g. drugs to induce ovulation such as Clomifene
- Surgical treatment e.g. tubal microsurgery in women with tubal damage
- Assisted conception e.g. intrauterine insemination, in vitro fertilisation (IVF)
It is important to note the psychological impact infertility may have on individuals/couples. NICE recommends that patients who experience fertility problems should be offered counselling before, during and after investigation and treatment – irrespective of the outcome.