Infertility About a quarter of couples have problems trying to conceive and as many as one in seven need medical help. Why does this happen and what treatments are on offer?

In this article

What are the causes? What will your GP do?

What can specialists do? IVF and ICSI

Further information

After a year of trying to get pregnant, around one in seven couples won't have conceived.

In about 30 per cent of cases, the woman has a problem with ovulation, or releasing eggs. In another 20 per cent, there are other problems in the woman, such as endometriosis, previous pelvic infection or fibroids. These problems can block the passage of the egg or sperm through the fallopian tubes or prevent the fertilised egg implanting in the lining of the womb.

In about 20 per cent of cases, the problem is found to lie with the man. Most often this is a very low sperm count.

In the remaining 30 per cent, no cause can be identified.

Miscarriage is common, even among fertile women. A considerable number of women who think they're infertile do manage to conceive but miscarry before they know they're pregnant.

Your doctor will want to know about your development as a teenager and your periods. They'll ask when they started, how regular they are, whether you've ever been pregnant before or whether you've ever had a pelvic infection or sexually transmitted infection.

It's also important to mention any other illnesses you've had and any medication you may be taking.

Your doctor will examine you, including an internal examination, and send you for blood tests to check your blood count and hormone levels.

Your doctor may ask your partner about his development too, check his medical history for problems such as mumps, examine him and give him instructions to collect a semen sample for testing.

They may then refer you to a specialist clinic for further tests and advice. This is usually done once you've been trying to get pregnant for at least 18 months, but may be sooner if you're in your mid-30s or older.

Once referred to a fertility specialist (a reproductive medicine specialist), the cause of your infertility will be investigated.

The treatment will depend on the cause. It can range from hormone treatments and the use of donor sperm, to assisted conception techniques such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

IVF involves removing eggs from the woman's ovaries and mixing them with either her partner's or a donor's sperm in a laboratory. If the eggs are fertilised successfully, they may then be placed back in the womb.

This is a demanding treatment for the couple and only about one in three women will become pregnant. Some of these pregnancies will be lost in the early stages. Many cycles may be required.

ICSI is sometimes recommended to couples who've had no success with IVF. It involves injecting a single sperm into the egg. If a healthy embryo develops, it's then placed back in the womb as in IVF.

Access to IVF is limited on the NHS

Access to IVF is limited on the NHS. Guidelines from the National Institute for Health & Clinical Excellence (NICE) say women aged 23 to 39 who have an identified cause of infertility or have had unexplained infertility for at least three years should be entitled to three cycles of IVF.

The Government has suggested that each primary care trust starts by offering couples one cycle, working up to three when possible. A cycle of IVF at a private clinic costs around £3,000.

For more detailed information on fertility and other aspects of reproductive medicine, see ReproMED from the Centre for Reproductive Medicine

For a more in-depth look at IVF and other fertility treatments, see our Fertility section.

This article was last medically reviewed by Dr Trisha Macnair in August 2007.