Subfertility
Subfertility describes a reduced ability to conceive despite regular unprotected intercourse. Pregnancy may still occur naturally, but it may take longer than expected or require medical support. Subfertility can affect both women and men, and identifying any underlying causes can help improve the chances of conception.
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 PCOS, thyroid disorders and hormonal imbalance]
Fallopian tube blockage or damage
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 PCOS
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 (HyCoSy or HSG) to check whether the fallopian tubes are open
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:
Structural abnormalities of the uterus
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, PCOS 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.