Fertility: your questions answered
Are you trying for a baby? Or maybe you plan to someday. You might have questions about fertility. This might be the best time to conceive, how to preserve your fertility or how to get help if you’re struggling to conceive naturally. In this article, I answer some common questions about fertility to help you understand fertility and fertility treatments.
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When are you most fertile?
If you’re trying to conceive via sexual intercourse with a partner, your best chance is to have sex every two to three days throughout your cycle. If you’re having artificial insemination (when sperm is inserted into the womb) to conceive, this should be timed around when you’re ovulating.
What is ovulation?
Ovulation is when an egg is released from one of your ovaries, usually around 10 to 16 days before the start of your next period.
You can get to know when you're ovulating by keeping track of changes to your cervical mucus (discharge). Or you can use an ovulation predictor kit or monitoring device. But there’s no problem if you don’t do this – trying to time this exactly might make you feel stressed.
What are causes of infertility?
Eighty percent of women under the age of 40 will get pregnant (conceive) within the first year of trying. If after a year you still haven’t been able to conceive, you may have infertility.
Infertility can be due to a range of factors and affects both men and women. Fertility also naturally decreases with age. Here are some of the causes of infertility.
- Sperm disorders- this includes low sperm count, low sperm motility and ejaculation problems.
- Ovulatory disorder- this can lead you to have no ovulation so you don’t release an egg every month. Polycystic ovary syndrome for example is a condition that causes problems with ovulation.
- Tubal disorders- problems with your fallopian tubes where they can be blocked.
- Uterine or peritoneal disorders- changes or damage in the structure of your womb make it difficult to get pregnant. This might be due to conditions such as fibroids and endometriosis. Sometimes infertility is unexplained.
Can you increase fertility?
There are some lifestyle changes you can make to reduce the risk of infertility.
- If you smoke, it’s best to stop. Smoking can affect sperm quality. It can also reduce fertility in women. Your GP can help you to stop smoking.
- If you drink heavily this could affect sperm quality. So try to keep to recommended limits.
- Try to keep to a healthy weight. Being overweight can affect fertility in both men and women. Being underweight can affect your hormone balance and ovulation.
- Eat a balanced and varied diet to help you get all the nutrients your body needs. If you’re planning to get pregnant you should also take folic acid and vitamin D supplements.
- Manage stress. Being stressed may affect your sex drive or your relationship, meaning you have sex less often. If you’re feeling extremely stressed, anxious or low, speak to your GP. They may refer you for counselling (talking therapy) to discuss your thoughts and feelings.
What fertility treatments are there?
There are a few different fertility treatments options, which depend on the cause of infertility. You can have medication, assisted conception, or surgery. There is also fertility preservation.
1. Medication for fertility
Medication such as Clomifene citrate, and gonadotrophins, can stimulate your ovaries to produce eggs (ovulation). Metformin is another type of medication that is used as treatment for polycystic ovary syndrome. It helps your hormones and make your periods more regular.
2. Assisted conception
The main types of assisted conception are explained below.
- Intra-uterine insemination (IUI). This is when a sample of your partner’s sperm or donor sperm is placed inside the womb close to the time of ovulation.
- In-vitro fertilisation (IVF). You have medicines to stimulate your ovaries to produce several eggs at once. One or more of these eggs is collected and mixed with sperm in a laboratory. Hopefully this results in embryos. One or more embryos are then placed in the womb.
- Intracytoplasmic sperm injection (ICSI). A single sperm is injected directly into an egg in a laboratory. The resulting embryo is placed in the womb.
- Donor conception. You can have fertility treatment with eggs, sperm or embryos from a donor. This is an option if you can’t use your own eggs, sperm or embryos, if you’re in a same sex couple or if you’re single.
3. Surgery to treat fertility
You can have surgery to treat fertility, such as:
- tubal surgery to repair blocked fallopian tubes
- surgery to treat conditions such as endometriosis or fibroids
- surgery to treat sperm disorders caused by blockage
What is fertility preservation?
You can have your eggs, sperm or embryos frozen and then have them thawed once you’re ready to have children. You may want to freeze your eggs, sperms or embryos if you are:
- not ready to have a family but wish to in the future
- undergoing cancer treatment
- undergoing gender transition
When you have frozen eggs, sperm or embryos, you will need to have fertility treatment such as IVF, ICSI or IUI when you want to use them.
How can I find a fertility clinic?
Fertility treatments are done at a fertility clinic. You can find an accredited clinic via the Human Fertilisation and Embryology Authority (HFEA) website. You might be able to get treatment on the NHS if you’re eligible, and criteria can depend on where you live. Otherwise you will need to pay for treatment.
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Sources Sources
- Infertility. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2023
- Fertility problems: assessment and treatment. Clinical guideline [CG156]. National Institute for Health and Care Excellence (NICE). nice.org.uk, last updated September 2017
- Ovulation and fertility. Tommy’s. tommys.org, reviewed March 2024
- Pre-conception - advice and management. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2023
- Walker MH, Tobler KJ. Female Infertility. StatPearls [Internet]. Last updated December 2022
- Polycystic ovary syndrome. British National Formulary. bnf.nice.org.uk, accessed August 2024
- Benefits of taking folic acid and vitamin D before pregnancy. Tommy’s. tommys.org, reviewed August 2023
- Clomifene citrate. British National Formulary. bnf.nice.org.uk, accessed July 2024
- Polycystic ovary syndrome. Patient. patient.info, last updated March 2021
- PCOS and fertility: everything you need to know. Tommy’s. tommys.org, reviewed June 2024
- Using donated eggs, sperm or embryos in treatment. hfea.gov.uk, accessed August 2024
- Fertility preservation. Human Fertilisation and Embryology Authority. hfea.gov.uk, published December 2023
- Egg freezing. Human Fertilisation and Embryology Authority. hfea.gov.uk, accessed August 2024
- Sperm freezing. Human Fertilisation and Embryology Authority. hfea.gov.uk, accessed August 2024
- NHS-funded in vitro fertilisation (IVF) in England. Department of Health & Social Care. gov.uk, last updated February 2024
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