Infertility
Infertility affects around 15% of couples and can arise from a wide range of factors involving either partner or remain unexplained. In medical terms, it refers to difficulty conceiving after a year of regular, unprotected sex. Causes may include hormonal imbalance, ovulation issues, sperm quality, or lifestyle factors. Assisted Reproductive Treatments such as IVF or ICSI can help many couples achieve pregnancy, but the process can also be emotionally and physically demanding. Understanding the underlying causes is the first step toward the right support and treatment.
10/5/20253 min read
The information on this page is for general educational purposes only and is not a substitute for professional medical advice.
Understanding Fertility Challenges
Infertility: the inability to conceive naturally.
Subfertility: difficulty conceiving that requires medical or assisted support.
Primary infertility: when a couple has not conceived after one year of regular, unprotected intercourse.
Secondary infertility: when a couple experiences difficulty conceiving or carrying another pregnancy to term after previously having one or more children.
Infertility Overview
Fertility issues affect around 15% of couples in the UK. According to the National Institute for Health and Care Excellence (NICE), couples who have not conceived after two years of regular, unprotected sex are considered to have a fertility problem. However, most doctors recommend starting basic investigations after one year.
A healthy couple in their mid-twenties, having regular intercourse, has approximately:
a 30% chance of conceiving in the first month, and
a 90% chance within one year, if conception is possible naturally.
Around 10–15% of couples will still not conceive within 12 months and may be offered basic fertility tests through the NHS to identify any underlying cause.
Unexplained Infertility
Even after thorough investigations, about 20% of couples are diagnosed with unexplained infertility — meaning that no specific cause can be identified.
Male Infertility
In roughly 30% of cases, fertility difficulties are linked to the male partner.
Modern sperm analysis helps identify specific issues that may affect conception.
Common findings include:
Low sperm count: fewer than 20 million sperm per millilitre is considered below the normal range.
No sperm (azoospermia): may result from a childhood infection or a blockage between the testicles and urethra.
Poor sperm motility: less than 50% of sperm moving effectively reduces the likelihood of reaching the egg.
Abnormal sperm morphology: irregularly shaped sperm may not penetrate the egg or may carry genetic abnormalities.
Retrograde ejaculation: semen flows backward into the bladder instead of exiting through the penis.
Erectile dysfunction: difficulty maintaining an erection can prevent sperm delivery.
Currently, there are no reliable medications to increase sperm count or improve morphology.
When male factors are present, assisted reproductive techniques such as Intrauterine Insemination (IUI) or Intracytoplasmic Sperm Injection (ICSI) are often recommended.
Assisted Reproductive Treatments (ART)
ART includes a range of medical approaches designed to support conception — from hormone stimulation and ovulation tracking to advanced laboratory-assisted procedures.
Common ART methods include:
Ovulation Induction: Hormonal stimulation of the ovaries, often used when ovulation is irregular or absent (as in PCOS).
Intrauterine Insemination (IUI): A prepared sperm sample is placed directly into the uterus during ovulation, sometimes alongside mild ovarian stimulation.
In Vitro Fertilisation (IVF): Eggs are collected from the ovaries, fertilised in the laboratory, and then transferred to the uterus. Any additional good-quality embryos can be frozen for future use.
Gamete Intrafallopian Transfer (GIFT): Eggs and sperm are placed together in the fallopian tube. This method is now rarely used in the UK.
Intracytoplasmic Sperm Injection (ICSI): A single sperm is injected directly into an egg, and resulting embryos are transferred to the uterus. This method is particularly helpful when sperm quality or motility is low.
IVF Success Rates in the UK (Fresh Eggs)
28.2% – Women under 35
23.6% – Ages 35–37
18.3% – Ages 38–39
10.6% – Ages 40–42
There are no official UK government statistics for IVF above age 42, but estimates suggest a success rate of 1–4%.
Risks and Considerations
Fertility drugs used to stimulate the ovaries can occasionally cause unwanted side effects.
In women with polycystic ovaries, stimulation may lead to the formation of additional cysts or to Ovarian Hyperstimulation Syndrome (OHSS) — a condition where the ovaries become swollen and painful.
Symptoms range from mild abdominal discomfort to, in rare cases, more serious complications such as fluid retention, blood clots, or kidney issues.
While Assisted Reproductive Treatments have helped many couples, no treatment guarantees pregnancy.
Success rates remain below 50%, and the emotional journey can be challenging. Many individuals and couples experience significant stress as they move through treatment cycles and face the uncertainty that accompanies each stage.