There are multiple causes of infertility affecting both women and men; you can find information on the most common ones here

Infertility is when a couple cannot get pregnant (conceive), despite having regular unprotected sex. According to the World Health Organisation infertility is assistance through grants and fundraisers.”

“a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”

Around one in six couples in the UK will experience difficulties conceiving. This equates to approximately 3.5 million people across the country and around 84% of those will successfully conceive after trying for 12 months. If you haven’t been successful after 12 months of trying you should consult your GP and if you are aged over 35 or know that you have a fertility problem, you should seek help earlier.

There are many potential causes of infertility, with fertility problems affecting the male as well as the female partner; often both partners are affected. However, sometimes it can be difficult to find the cause of fertility problems: this is known as unexplained infertility.

We have listed some of the conditions which can affect your fertility and provided additional information and links to other professional organisations. If you can’t find the information you are looking for, or would like to suggest we include information on a specific issue, please do contact us at info@bellafaithfulfoundation.org

Please see below for our Fertility Conditions factsheets.

Asherman’s Syndrome

Asherman’s syndrome is a condition where scar tissue affects the uterus and which can lead to problems with fertility. The International Asherman’s Association provides detailed advice on this condition, including the impact on fertility.
Visit the International Asherman’s Association for information and support for Asherman’s Syndrome, intrauterine adhesions/scarring, or related problems.

Cervical Mucus Problems

During ovulation, your cervical mucus becomes thinner so that the sperm can more easily pass through and reach and fertilise the egg. For more detailed information on this and other possible causes of infertility, visit NHS Choices.

Chlamydia

Chlamydia is one of the most common sexually transmitted infections (STIs), and can damage fertility. It affects men as well as women, but is avoided by consistently using condoms during sex. It is easily treated with antibiotics so if you suspect you may have contracted an STI, you should visit your GP or your local sexual health clinic for help and advice.
NHS Choices is the UK’s biggest health website.
FPA – the Sexual Health Charity’s vision is a society where everyone can make positive choices about their own sexual health and wellbeing.

Cystic Fibrosis

An extremely high percentage of men with cystic fibrosis (CF) have what is known as congenital bilateral absence of the vas deferens (CBAVD) which causes infertility. There are procedures now available which can help some men become biological fathers: you should initially speak to your GP and ask to be referred to a specialist who will carry out the appropriate tests to determine the best way to proceed.
The Cystic Fibrosis Trust has a huge amount of information on this condition, including a downloadable booklet on fertility issues for those with the condition.
NHS Choices is the UK’s biggest health website.
The Cystic Fibrosis Trust is the only UK-wide charity dedicated to fighting for a life unlimited by cystic fibrosis (CF) for everyone affected by the condition.

Ectopic Pregnancy

An ectopic pregnancy is one that implants outside the endometrial cavity of the uterus. Most commonly the pregnancy grows in the fallopian tube, but occasionally an embryo can implant on an ovary or elsewhere in the abdominal cavity. These pregnancies are not viable and need removing as a matter of urgency, as they present a considerable risk to the woman’s health. They are often difficult to diagnose, as signs and symptoms can mimic many other gynaecological problems such as intermittent lower abdominal pain and/or
abnormal vaginal bleeding.
Anyone who conceives an ectopic pregnancy can find the experience quite devastating as it often represents the loss of a much wanted baby, a fact that medical staff may be slow to appreciate as dealing with the medical emergency is their priority. Counselling and support may help you come to terms with feelings of sadness, anger and guilt which are common emotions in this situation. It is important to realise that grieving in itself is a vital part of the healing process and a normal reaction to such a loss.
The Ectopic Pregnancy Trust strives to provide information, education and support to those affected by early pregnancy complications and to the health professionals who care for them.
NHS Choices is the UK’s biggest health website

Endometriosis

Endometriosis is a condition where cells like the ones in the lining of the womb (the endometrium) are found elsewhere in the body including the abdomen, bladder, ovaries and fallopian tubes.

Whilst some women experience no symptoms at all, for others it is a chronic and debilitating condition which can cause painful or heavy periods, fatigue, bladder and bowel problems, and fertility problems. 

Treatment for fertility problems involves removal of the endometrial tissue using a laser or electric current during keyhole surgery. The charity Endometriosis UK provides support services, reliable information and a community for those affected by thecondition.

Endometriosis UK helps them take back control by providing vital support services, reliable information and a community for those affected by endometriosis.

Fibroids

Fibroids are the most common non-cancerous tumour found in women of childbearing age.They develop in or around the womb, with around 1 in 3 women developing them at somepoint. They are most common in women aged 30-50: symptoms can include heavy or painful periods, lower back or abdominal pain, and pain or discomfort during sex.
Submucous fibroids can also reduce fertility, although it is unclear how. It is possible that a fibroid may prevent an embryo from implanting in the womb, but having fibroids does not mean you will have trouble conceiving. Fibroids that distort the uterine cavity by increasing the sheer bulk of the womb can contribute to early pregnancy loss. 

During pregnancy, such large fibroids can outgrow their blood supply and cause pain, as well as making the baby lie in an unusual way (malpresentation); this may make a caesarean section necessary.
NHS Choices is the UK’s biggest health website.

Male Factor Fertility Issues

In approximately half of couples experiencing difficulties conceiving, part of the problem lies with the male. Male infertility has a variety of causes. The most common cause is that the man’s semen has too few normal sperm to pass through the female tract and fertilise the gg.
If you have been trying unsuccessfully for a baby for 12 months, you should see your GP.
However if you have any of the following problems you should visit your GP straight away:
• undescended testicles
• injury or trauma to the testicles
• sexually transmitted infections
Your GP should examine you and arrange for you to have a semen analysis. If necessary your GP will then refer you to a fertility specialist who may arrange for further tests. You will then be able to decide on the best treatment to help you to conceive.
A man’s fertility reflects his general health. Following a healthy lifestyle may help improve sperm quality. Smoking, alcohol, use of steroids and recreational drugs, poor diet and stress can all affect not only your general health but also the health of your sperm.

Miscarriage

Miscarriage is the most common form of pregnancy loss, and affects around 1 in 4 pregnancies. For many women and their partners it is an extremely distressing experience. If you have been trying for a baby for a long time, or have had assisted reproductive treatment to help you conceive, having a miscarriage can be even more painful and difficult to cope with.

Recurrent miscarriage, where you experience three or more miscarriages in a row, is uncommon and if you have experienced recurrent miscarriage you should be referred for further investigation.

There are many reasons for miscarriage, but there is also support and information available from The Miscarriage Association, as well as through our online community at HealthUnlocked.
The Miscarriage Association offer support and information to anyone affected by the loss of a baby in pregnancy.
NHS Choices is the UK’s biggest health website.

Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome (OHSS) is a very rare complication of fertility treatment such as IVF. It occurs when too many eggs develop in the ovaries which then become swollen and painful. OHSS can be mild, moderate or severe. It generally develops in the week after egg collection and in rare cases can be extremely dangerous.
The symptoms of OHSS include pain and swelling in the lower abdomen, nausea and sickness. If you have any of these symptoms after any ovarian stimulation, you should contact your fertility clinic immediately. If your OHSS is severe, you may need to stay in hospital until your condition has been treated.
The British Fertility Society with associated Specialist Societies has produced a series of Quick Guides which you may find helpful.
NHS Choices are the UK’s biggest health website.

Ovulation Defects

There are only a few days in a woman’s menstrual cycle when pregnancy can occur. If you are trying to conceive it is therefore important to have regular intercourse especially around the time an egg is released from your ovaries (the process known as ovulation). You are most likely to get pregnant if you have intercourse in the couple of days leading up to ovulation or on the day of ovulation itself. Pinpointing this time can be difficult as ovulation takes place roughly 14 days before your period arrives, so it varies from woman to woman and from cycle to cycle.
It is estimated that problems with ovulation occur in 25% of infertile couples. This is an important problem to identify, as most of these patients can be treated successfully.
Ovulation problems can be treated with tablets, usually Clomifene (Clomid) or Tamoxifen, or with gonadotrophin drugs. It is important that you are carefully monitored when on any drugs to avoid over stimulation of the ovaries. If you produce multiple eggs, there is a much higher risk of a multiple pregnancy.

NHS Choices are the UK’s biggest health website.

Polycystic Ovary Syndrome

The polycystic ovary syndrome (PCOS) is the commonest hormonal disturbance to affect women.
The main problems that women with PCOS experience are menstrual cycle disturbances (irregular or absent periods), difficulty in controlling body weight and skin problems (acne and unwanted hair growth on the face or body). Not all women with PCOS experience all of the symptoms and a woman’s problems may change over time. In particular if an individual becomes overweight, then her problems are likely to worsen.
About 30% of women have polycystic ovaries, although a smaller proportion will have symptoms of the polycystic ovary syndrome – perhaps 15-20% of women. The problem therefore is extremely common, although many women have relatively mild symptoms.

Premature Ovarian Insufficiency

Premature ovarian insufficiency (POI), or a premature menopause occurs when a woman’s periods stop well before the natural age of menopause. There is often some warning, just as there is at the time of the natural menopause (around the age of 50 for most women) with periods becoming irregular and more widely spaced. Sometimes, however, periods cease
suddenly. The ovaries stop producing the hormone oestrogen and so symptoms of oestrogen deficiency can occur, including hot flushes, mood changes and vaginal dryness.
The ovaries also stop producing eggs and so conception is extremely unlikely.
IVF treatment with donor eggs may be an option if you have POI and want to conceive. The donor eggs can be fertilised with sperm from the male partner, or with donated sperm by IVF or ICSI treatment and the developing embryos transferred to your uterus.
The Daisy Network is dedicated to providing information and support to women diagnosed with Premature Ovarian Insufficiency, also known as Premature Menopause.
The British Fertility Society with associated Specialist Societies has produced a series of
Quick Guides which you may find helpful.
NHS Choices is the UK’s biggest health website 

Secondary Infertility

Fertility problems affect approximately 15% of the population, while secondary infertility affects approximately 5%. Secondary infertility is where a person has had one or more pregnancies in the past but is having difficulty conceiving again.
Secondary infertility can be just as devastating as primary infertility, and it is important to recognise that it is important for people not only to have a family, but to have the size of family they want.
Treatment of secondary infertility is generally the same as for primary infertility. It can include ovulation induction or IVF or ICSI treatment.
As fertility declines with age, the length of time to achieve pregnancy increase. It is important therefore to reach a diagnosis quickly. Couples with secondary infertility, because they have already achieved a pregnancy together, are more likely to achieve a second pregnancy even with fertility treatment.
The British Fertility Society with associated Specialist Societies has produced a series of Quick Guides which you may find helpful.
NHS Choices is the UK’s biggest health website.

Tubal Damage

A woman’s fallopian tubes carry the eggs from the ovary to the womb, with the egg being fertilised as it travels down the fallopian tubes. When the fertilised egg reaches the womb, it implants into the womb’s lining, where it continues to develop and grow.
If the womb or the fallopian tubes are damaged, it may be difficult to conceive naturally.
Tubes can become damaged or scarred following pelvic surgery, or if there has been any pelvic inflammatory disease. This can occur as the result of a sexually transmitted infection (STI).
Treatment options include surgery to repair the tubal damage, or you can be referred for IVF or ICSI treatment. IVF or ICSI treatment means that the eggs are removed and fertilised with sperm in the laboratory and do not have to pass down the damaged tubes.
The British Fertility Society with associated Specialist Societies has produced a series of Quick Guides which you may find helpful.
NHS Choices is the UK’s biggest health website.

Unexplained Infertility

It can feel very unsatisfactory to be given a diagnosis of unexplained infertility, and couples often wonder whether more detailed tests might produce some kind of answer. The reality is that some people who have no apparent medical problems still do not get pregnant. Studies have shown that even in this group, over a period of seven years, 36% will eventually conceive, and over the same period, in a similar group who cannot conceive again after having one or more children, 79% will eventually conceive. Some fertility problems just reflect this inefficient human reproduction.

One study of unexplained infertility of less than two years duration showed that 50% of these couples would conceive over the next two years, and suggested that the right treatment was to do nothing.

What is unexplained infertility?

One study of unexplained infertility of less than two years duration showed that 50% of these couples would conceive over the next two years, and suggested that the right treatment was to do nothing. Infertility may be said to be “unexplained” if the woman is ovulating regularly, has open fallopian tubes with no adhesions, fibrous growths or endometriosis and if the man has normal sperm. Intercourse must take place frequently, at least twice a week, particularly around the time of ovulation, and the couple must have been trying to conceive for the previous two years at least. Using these criteria, about 10% of all infertile couples have unexplained infertility according to the most often quoted figures. However, it is thought this figure could be lower if thorough screening is carried out. Some studies show around 28% of patients experiencing unexplained infertility, so a great deal has to do with how thoroughly diagnostic tests are performed.

Possible causes of unexplained infertility?

1.Anatomical abnormalities
It used to be thought that a retroverted uterus (or a tilted womb) was a cause of infertility, but this is no longer taken to be the case. The position of the cervix is unlikely to be so abnormal that sperm are unable to reach it. It is possible that there may be failures in the mechanism in the mouth of the fallopian tubes which allows them to pick up the egg. Abnormal levels of hormones called prostaglandins, which are responsible for making the muscles contract, may interfere with the passage of the egg in the tube. High prostaglandin levels, however, are usually associated with endometriosis, and this condition is likely to be detected. Scar tissue, often associated with inflammation of the womb lining, or large multiple fibroids can interfere with the process of reproduction by making the womb unreceptive to a fertilised egg. Scar tissue can also result in damage to the fallopian tubes. To aid accurate diagnosis of the cause of infertility, investigations should include vaginal ultrasound scans and hysteroscopy. Vaginal ultrasound will pick up abnormalities within the womb and abnormalities with the ovaries, which would otherwise be missed by a laparoscopy. If vaginal ultrasound is not available, a hysteroscopy should be performed at the same time as a laparoscopy so that any problems within the womb, which could cause infertility, may be excluded. 
2. Abnormal development of the follicle and of ovulation
It used to be thought that a retroverted uterus (or a tilted womb) was a cause of infertility, but this is no longer taken to be the case. The position of the cervix is unlikely to be so abnormal that sperm are unable to reach it. It is possible that there may be failures in the mechanism in the mouth of the fallopian tubes which allows them to pick up the egg. Abnormal levels of hormones called prostaglandins, which are responsible for making the muscles contract, may interfere with the passage of the egg in the tube. High prostaglandin levels, however, are usually associated with endometriosis, and this condition is likely to be detected. Scar tissue, often associated with inflammation of the womb lining, or large multiple fibroids can interfere with the process of reproduction by making the womb unreceptive to a fertilised egg. Scar tissue can also result in damage to the fallopian tubes. To aid accurate diagnosis of the cause of infertility, investigations should include vaginal ultrasound scans and hysteroscopy. Vaginal ultrasound will pick up abnormalities within the womb and abnormalities with the ovaries, which would otherwise be missed by a laparoscopy. If vaginal ultrasound is not available, a hysteroscopy should be performed at the same time as a laparoscopy so that any problems within the womb, which could cause infertility, may be excluded. 
3. Abnormal eggs
It would appear that a very small number of cases of unexplained infertility are due to the persistent production of abnormal eggs. These may have a deformed structure or chromosomal abnormalities
4. Trapped eggs
In some cases it would appear that eggs are produced, and mature correctly within the follicle. This goes on to become a “corpus luteum” (the next stage of development) but without first bursting to releasing the egg. The egg is therefore effectively “trapped” inside the unbroken “corpus luteum”.
5. Luteal phase abnormalities
This is perhaps the most important of all causes of “unexplained” infertility. This is where the part of the cycle that follows after the egg has been released from the ovary, is abnormal in some way. After releasing the egg, the folicle which contained it in the ovary goes on to become the “corpus luteum” (this translates from the Latin as “yellow body”). The corpus luteum produces the hormone called progesterone. Progesterone is essential for preparing the lining of the womb to receive the fertilised egg, and for sustaining the embryo in its first seven weeks of life.
Several things can go wrong with progesterone production: the rise in output can be too slow, the level can be too low, or the length of time over which it is produced can be too short. Problems during this phase of the cycle are known as “luteal phase defects”, and can be investigated either by carefully examining samples from the lining of the womb (endometrial biopsy) or by monitoring the progesterone output by taking a number of blood samples on different days after ovulation so that the progesterone level in them can be measured. Problems in the luteal phase may also occur as a result of abnormal levels of the hormone prolactin.
Treatment
Problems in the luteal phase seem to relate to levels of the hormone follicle stimulating hormone (FSH) and luteinising hormone (LH). If the levels of FSH are not right this can be responsible for lower levels of progesterone being produced by the corpus luteum. Low LH levels can also be responsible for failure to develop an adequate secretion of progesterone. The ratio between LH and FSH appears to be critical to progesterone production.
For these reasons treatment with the drug, clomiphene may be useful in helping to restore adequate secretion of FSH and LH. Luteal phase abnormalities, abnormalities in the development of the follicle and in the timing of ovulation can thus be helped.
Direct treatment with progesterone can also help luteal phase abnormalities. The progesterone can be given either as injections or vaginal suppositories. Synthetic “progestin” should not be used as they have an anti-progesterone activity, and furthermore, they become broken down into male hormones within the body; this could adversely affect the developing embryo.
Of the other possible causes of “unexplained” infertility, not all are treatable with our current state of knowledge.
Undoubtedly as our knowledge increases and our techniques and treatments improve the diagnosis, “unexplained infertility” will become less and less frequent. No-one should expect that all these factors will automatically be taken into account when they are told that the reasons for their infertility are inexplicable, and a little gentle prodding or some pertinent questions may be helpful.

The information contained in our factsheets is for general information purposes only, and not intended to constitute legal, medical or other professional advice. Our factsheets should not be relied on or treated as a substitute for specific advice relevant to any individual’s particular circumstances.
 
October 2016

NHS CHOICES

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FACTORS AFFECTING FERTILITY

Click here to read more about the lifestyle factors that can affect female fertility.