Investigating Fertility

Fertility problems can affect both men and women and there are many possible causes of infertility. This can affect around 1 in 5 couples and can be a female or male partner problem.

How Common is Infertility?

It is estimated that one in five couples in the country trying for a child have difficulty conceiving. Around about 30% of infertility cases are attributed to female factors and 30% to male factors. 20% are due to combined male and female factors and 20% of cases remain unexplained.

Age and Fertility

One of the commonest reasons behind a difficulty in starting a family is advancing age. People still feel that they have not yet reached middle age when they, especially women, start to hit the fertility limitations sometimes described as the biological clock. Fertility drops significantly when a woman reaches her mid to late thirties. It is thought that, in evolutionary terms, this is to allow her to survive long enough to raise her family. Modern medicine, hygiene, nutrition and lifestyles have all extended our life expectancy but our fertile years have remained unchanged.

When to Consult a Fertility Specialist

If you have been trying long enough without success, if you have a known or suspected problem, or if you are older and are concerned that your probability of conceiving is reducing, you should have a consultation with a fertility specialist.

Unexplained fertility

A third of couples for which no clear explanation can be found despite investigations taking place and all the tests – for both male and female – show normal results. Couples who are said to have ‘unexplained infertility’ can still be treated successfully with the help of fertility treatment.
There are also a number of key factors which do affect fertility in both men and women:

  • Age – female and male fertility to a lesser extent does decline with age. This is particularly so for women whose fertility starts to decline after the age of 35.
  • Weight – being overweight or obese reduces your fertility. We recommend a BMI of under 30 to give you an optimal chance of success. We do however treat women with a BMI up to 35.
  • Smoking – can affect chances of conceiving in women and reduce semen quality in men. We recommend that you have given up smoking for at least three months before trying to conceive.
  • Alcohol – the safest approach for women is not to drink if planning to get pregnant and for men too much alcohol can affect sperm quality.
  • Stress – in severe cases can affect ovulation and sperm production. In lesser a loss of sex drive. We do however understand that infertility and undergoing fertility treatment can be a stressful time. Our monthly support group and counselling is available for all our patients.
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Some of the conditions that can cause infertility:

Fertility and age

The most common explanation for female infertility is simply ageing. There is evidence to show that fertility begins to decline after the age of 35 and by the age of 40 is in steep decline. The main explanation for age-related infertility is simply the approaching end of a woman’s reproductive life. This ‘ovarian reserve’ is a measure of female fertility and can be tested by completing some blood tests that measure the hormone levels.

Damage to the Fallopian tubes

IVF was originally developed to by-pass damage to the Fallopian tubes. Damage can be caused by a natural defect such as endometriosis, by infection following pelvic inflammatory disease or from pelvic surgery. Blockage in the Fallopian tubes can prevent a sperm from reaching an egg released from the ovary at ovulation or the fertilised egg reaching the uterus. Damage to the Fallopian tubes can be detected by an ultrasound scan and/or through a laparoscopy procedure.

Polycystic Ovarian Syndrome (PCOS)

Irregular or absent periods are common and are usually the sign of a hormonal problem. This can be associated with polycystic ovarian syndrome (PCOS), which usually means cysts can be seen on the ovaries or high levels of (male) hormones in the body.


Endometriosis is a condition in which tissue normally formed in the uterus develops elsewhere in the reproductive tract. This common condition can cause pain and disrupt pregnancy in both natural and assisted reproduction. Surgery may sometimes be necessary.


Miscarriage is one of the most common complications of pregnancy, with as many as 25-50% of women experiencing one or more early miscarriages. Recurrent miscarriage (in the UK) is defined as three or more consecutive pregnancy losses and can affect as many as 1% of all couples trying to have a baby. The risk increases with age.