When to seek help for infertility

Getting pregnant isn't always easy. About a quarter of couples experience a period of infertility lasting more than a year, and some continue to experience difficulties for longer. At least one in six couples consults an infertility specialist, and about one is 80 babies in the UK is born as the result of in vitro fertilisation (IVF) treatment.

Infertility may be a result of factors affecting the fertility of either partner. In some instances, despite investigation, the cause is never identified. This is called unexplained infertility.

How long does it take to get pregnant?

If you make love two or three times a week, you have about a 20 to 30 per cent chance of conceiving in any month. The average couple, where the woman is under 35, takes four to six months to achieve pregnancy. It's not unusual, however, for a couple to take up to two years to conceive, as the following statistics from the Human Fertilisation & Embryology Authority (HFEA) show.

• 30 per cent of couples conceive within a month of starting to try for a baby.
• 75 per cent conceive within six months.
• 90 per cent conceive within a year.
• 95 per cent conceive within two years.

Time it right

For fertilisation to occur, the man's sperm needs to meet the woman's egg at about the time of ovulation (when the egg is released from the ovaries). Ovulation normally occurs 14 days before a period. So, if the woman has a menstrual cycle of 28 days, ovulation will be on or around day 14. If the menstrual cycle is longer or shorter, count 14 days back from when the next period is due.

When to seek help

Many experts suggest seeing a doctor if no pregnancy occurs after two years of regular, unprotected sex.

If you're a woman, seek help if you:

• Are 35 or over and haven't conceived a year after stopping contraception. At 38, don't delay - fertility declines significantly between 38 and 40.
• Have been diagnosed with pelvic inflammatory disease.
• Have irregular periods or have been diagnosed with polycystic ovary syndrome (PCOS).
• Have had a previous ectopic pregnancy that resulted in one of your fallopian tubes being removed.
• Have had severe appendicitis or abdominal surgery, which can cause scarring and blocked fallopian tubes.
• Have had a positive test for chlamydia or gonorrhoea, both of which can block the fallopian tubes.
• Have been diagnosed with endometriosis.
• Have symptoms which may reflect hormonal deficiencies after a head or brain injury.

If you're a man, seek help if you:

• Have had an infection affecting your testicles - for example, as a result of mumps.
• Have had surgery for undescended testicles.
• Have been treated for an STI such as gonorrhoea, which can block the tubes that carry sperm.
• Have problems such as premature ejaculation or difficulty getting or keeping an erection.
• Have a job that involves radiation or contact with industrial chemicals.
• Have symptoms which may reflect hormonal deficiencies after a head or brain injury.

Special circumstances

There are certain situations in which it may be preferable or necessary to have a baby using fertility treatment rather than conceiving in the conventional way. These include:

• Previous cancer treatment resulting in either partner becoming infertile.
• Couples where one partner has HIV or has hepatitis B or C. In such cases, IVF can help avoid transmission of the virus to the uninfected partner.
• Couples where there's a high risk of passing on a serious, incurable inherited disease such as muscular dystrophy, cystic fibrosis or haemophilia, caused by a single faulty gene. Embryos created by IVF can be screened by pre-implantation genetic diagnosis (PGD) before being placed in the womb.

Seeing your GP

The GP will start by asking about aspects of your lifestyle, general health and medical history. This initial assessment will be followed by a few simple tests, such as:

• Ovulation (egg release) test for women.
• Blood tests to check for hormonal problems such as PCOS and premature menopause for women.
• Screening for rubella (German measles) for women.
• Sperm count test for men.
• Chlamydia test.

Where to go from here

If the results of these initial tests are normal, you're young and healthy, and have been trying for a baby for less than 18 months, your GP may suggest you carry on trying for a little while longer before referring you to a specialist.

If the tests suggest a specific reason for your difficulty in conceiving, or if you're older and have been trying for two years, your GP may refer you to a specialist at a local hospital, reproductive medical centre or assisted conception unit.

Referral to a fertility specialist

For women, your GP should refer you without delay if:

• You're 35 or over. Fertility investigations and treatments can take time to complete and NHS upper age limit for treatment is 39 years.
• Your menstrual cycle is less than 21 days or longer than 35 days, which suggests there may be an underlying hormonal problem that needs investigating.
• An ovulation test suggests you're not ovulating.
• You've had a previous ectopic pregnancy, pelvic infection or endometriosis, all of which may be linked to blocked fallopian tubes.
• There are any abnormalities in the anatomy or structure of your reproductive organs.

For men, your GP should refer you without delay if tests suggest you have a low sperm count or poor sperm motility.