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Subfertility

Subfertility describes difficulty becoming pregnant despite regular unprotected sex. Pregnancy may still occur naturally, but it can take longer than expected or require medical support. Factors affecting either partner may contribute. Assessment can help identify possible causes and guide treatment to improve the chances of achieving pregnancy.

Commonality

Subfertility is common and affects millions of couples worldwide.


Research suggests:


  • Around one third of cases are related to female factors

  • Around one third are related to male factors

  • The remaining cases involve combined or unexplained causes

Causes

Subfertility can result from a variety of female, male or combined factors.


Common female causes include:


  • Ovulatory disorders, including PMOS, thyroid disorders and hormonal imbalance

  • Endometriosis

  • Fallopian tube blockage, such as a tubal cyst, or damage

  • Fibroids

  • Uterine abnormalities

  • Cervical factors affecting sperm transport

  • Unexplained subfertility


Male factors may include:


  • Low sperm count

  • Reduced sperm motility

  • Abnormal sperm morphology

  • Varicocele (enlarged veins in the scrotum)

  • Hormonal imbalances

  • Previous infection, injury or medical treatments

Symptoms

Subfertility often causes no obvious symptoms apart from difficulty conceiving.


Some women may also experience symptoms related to underlying conditions, such as:


  • Irregular, painful or absent periods

  • Symptoms of endometriosis

  • Symptoms of PMOS

  • Symptoms of pelvic infections

  • Recurrent miscarriage

Effects on Fertility

Subfertility directly affects the ability to conceive and may prolong the time it takes to achieve pregnancy.


The impact on fertility depends on the underlying cause. Some couples conceive naturally after lifestyle changes or treatment, while others may benefit from fertility treatments such as ovulation induction, IUI or IVF.

Diagnosis

Assessment usually begins with a detailed review of medical history, menstrual cycles and previous investigations.


Investigations may include:


  • Pelvic ultrasound

  • Hormone blood tests

  • Ovulation assessment

  • Tubal patency testing to check whether the fallopian tubes are open

    • Usually using HyCoSy (ultrasound) or HSG (X-ray)

    • In some cases, a laparoscopy and dye test may be recommended, particularly if endometriosis, pelvic adhesions or another pelvic condition is suspected

  • Semen analysis


Hormone testing may include:


  • FSH

  • LH

  • Oestradiol

  • AMH

  • Thyroid hormones

  • Prolactin


These tests help identify factors affecting fertility and guide treatment planning.

Treatments

Treatment depends on the underlying cause and individual fertility goals.


Treatment options may include:


Lifestyle measures


  • Weight optimisation

  • Stopping smoking

  • Reducing alcohol intake

  • Dietary improvements

  • Stress management


Medical treatment


  • Ovulation induction medication such as letrozole or clomiphene

  • Treatment of hormonal imbalances


Surgical treatment



Laparoscopic surgery for:


Assisted conception


  • Intrauterine insemination (IUI)

  • In vitro fertilisation (IVF)

Ongoing Care

Living with the Condition

Subfertility can affect emotional wellbeing as well as physical health. Many individuals and couples experience stress, uncertainty, frustration and anxiety about future fertility


Supportive care, counselling and clear medical guidance can help people navigate fertility investigations and treatment with greater confidence. Identifying and treating underlying causes often improves the chances of a successful pregnancy.


Lifestyle measures that may support fertility include:


  • Maintaining a healthy weight

  • Stopping smoking

  • Reducing alcohol consumption

  • Eating a balanced diet

  • Managing stress

  • Timing intercourse around the fertile window

When to See a Specialist

You should consider specialist assessment if:


  • You have been trying to conceive for more than 12 months

  • You are over 35 and have been trying to conceive for more than 6 months

  • Your periods are irregular, painful or absent

  • You have endometriosis, PMOS or another known gynaecological condition

  • You have a history of pelvic infection or pelvic surgery

  • You have experienced recurrent miscarriage

  • You would like an early assessment of your fertility


Early evaluation can help identify treatable causes and improve the chances of successful conception.

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