.png)
Fertility Health: When to Seek Help and What to Expect
Updated: 2 days ago
Trying to conceive can be an exciting time, but it can also become stressful and confusing when pregnancy does not happen as quickly as expected. Fertility is influenced by many different factors, and difficulty conceiving does not necessarily mean that pregnancy will not be possible.
Understanding what can affect fertility, when it is sensible to seek medical advice and what fertility investigations may involve can help you feel more informed and supported.
At HerCare, we understand that fertility concerns can feel deeply personal. A consultation with a specialist gynaecologist can provide an opportunity to discuss your individual circumstances, investigate potential causes and understand what options may be appropriate for you.
What affects fertility in women?
Female fertility is influenced by several factors, including age, ovulation, the health of the reproductive organs and general health.
Age
Age is one of the most important factors affecting female fertility. The number and quality of eggs naturally decline with age, and the decline in fertility becomes more significant from the mid-30s onwards.
This does not mean that pregnancy is impossible after 35. Many women conceive naturally in their late 30s and beyond. However, because fertility changes with age, it can be helpful to seek advice sooner rather than waiting if you have concerns.
Ovulation
Ovulation is the release of an egg from an ovary. For pregnancy to occur naturally, ovulation needs to take place regularly.
Irregular or absent periods can sometimes indicate that ovulation is not occurring consistently. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders and some other hormonal conditions can affect ovulation.
The fallopian tubes and womb
The fallopian tubes provide the pathway through which an egg and sperm meet. Problems affecting the tubes can make conception more difficult.
Previous pelvic infections, including pelvic inflammatory disease (PID), previous surgery and certain gynaecological conditions can cause damage or scarring to the fallopian tubes.
The womb can also play a role. Conditions such as fibroids and endometriosis may affect fertility in some women.
Lifestyle and general health
Fertility can also be influenced by general health and lifestyle factors. Smoking, alcohol consumption, some medical conditions and certain medicines may affect fertility.
Maintaining good general health is therefore an important part of preparing for pregnancy. If you take regular medication or have a long-term health condition, it is sensible to discuss your plans for pregnancy with your doctor so that any necessary adjustments can be considered.
Common causes of subfertility
The term "subfertility" is often used when conception is taking longer than expected, rather than meaning that pregnancy is impossible.
There can be a number of potential causes, including:
• Problems with ovulation
• PCOS and other hormonal conditions
• Endometriosis
• Fibroids or other problems affecting the womb
• Blocked or damaged fallopian tubes
• Previous pelvic inflammatory disease
• Previous pelvic or abdominal surgery
• Certain medical treatments, including some cancer treatments
• Age-related changes in egg number and quality
• Factors affecting sperm health
Importantly, fertility is not solely a female issue. Fertility difficulties can affect either partner, or both partners, and sometimes no clear cause can be identified even after investigation. The NHS estimates that around one in four couples experiencing infertility have no identifiable cause.
This is why fertility assessment is generally most useful when both partners are considered where applicable.
When should you seek help with fertility?
Knowing when to ask for help can be difficult. You do not necessarily need to wait a full year if there are already reasons to be concerned about your fertility.
For women under 36, NHS guidance generally recommends speaking to a GP if pregnancy has not occurred after 12 months of regular unprotected sex. More than eight out of ten couples where the woman is under 40 will conceive naturally within a year when having regular unprotected sex.
If you are aged 36 or over, it is advisable to seek medical advice sooner. NICE guidance recommends considering fertility assessment after six months of trying for women aged 36 and over because fertility declines with age and there may be less time available for intervention if a problem is identified.
You may also benefit from seeking advice earlier if you:
• Have very irregular or absent periods
• Have a known condition such as endometriosis or PCOS
• Have previously had pelvic inflammatory disease
• Have had pelvic or abdominal surgery
• Have previously received cancer treatment
• Have concerns about a previous sexually transmitted infection
• Have experienced recurrent pregnancy loss• Have another known or suspected fertility problem
You do not have to wait until you have been trying for a particular length of time if you already have a reason to be concerned. A medical assessment can help establish whether further investigation would be appropriate.
What happens during fertility testing?
Fertility assessment is not necessarily a single test. Your doctor will usually start by discussing your medical history, menstrual cycle, previous pregnancies, any symptoms you have and how long you have been trying to conceive.
Depending on your circumstances, investigations may include several different tests.
Blood tests
Blood tests can provide information about hormones and whether ovulation is taking place. The timing of some hormone tests depends on your menstrual cycle and whether your periods are regular.
Ultrasound
A pelvic ultrasound can assess the womb and ovaries and may identify conditions such as fibroids or ovarian abnormalities.
A transvaginal ultrasound may also provide a more detailed assessment of the reproductive organs. In some circumstances, specialist ultrasound techniques can be used to assess the fallopian tubes.
Checking the fallopian tubes
If there is concern that a fallopian tube may be blocked, your doctor may recommend a specialist investigation to assess whether the tubes are open.
The appropriate test will depend on your circumstances and may include an ultrasound-based test or, in selected cases, an X-ray or laparoscopy.
Assessing sperm health
Where applicable, fertility assessment should also consider the male partner. A semen analysis can assess factors such as sperm count and movement.
Looking at both partners can help avoid unnecessary delays and provide a more complete picture of what may be affecting conception.
What happens after the tests?
The next steps depend entirely on what the assessment finds.
Some women may simply need reassurance and advice about timing and trying to conceive. If a specific problem is identified, treatment may be available.
Depending on the cause, treatment options can include medication to support ovulation, treatment for conditions affecting the reproductive organs, surgery in selected circumstances, or assisted conception such as intrauterine insemination (IUI) or IVF.
If no clear cause is identified, this is known as unexplained infertility. This can understandably be frustrating, but it does not mean that there are no options available.
Your doctor can discuss the most appropriate next steps based on your age, medical history and how long you have been trying to conceive.
The emotional impact of fertility problems
Fertility concerns are not simply a medical issue. The uncertainty of trying to conceive month after month can affect your mood, relationships, work and everyday life.
You may experience feelings such as frustration, sadness, anxiety, disappointment or guilt. It is also completely understandable to find pregnancy announcements, social occasions or conversations about babies difficult during this time.
There is no "right" way to feel.
It can help to talk openly with your partner, a trusted friend or family member, your GP or a healthcare professional involved in your care. Some people also find counselling or specialist fertility support helpful, particularly if fertility treatment becomes part of their journey.
It is important to remember that needing fertility support is not a personal failure. Fertility problems can have many different causes, and sometimes there is no identifiable explanation at all.
Taking the next step
If you have concerns about your fertility, you do not have to work everything out on your own.
A specialist gynaecology consultation can provide an opportunity to discuss your menstrual cycle, symptoms, medical history and fertility goals in a confidential setting.
Where appropriate, further investigations can then be recommended based on your individual circumstances.
The earlier a potential problem is identified; the sooner you can understand your options and make informed decisions about your care.
If you are concerned about your fertility or would like to discuss your reproductive health with a specialist, the team at Her
Care can help you understand what may be appropriate for your individual circumstances.
Frequently Asked Questions
How long should I try to conceive before seeking help?
If you are under 36, you would generally be advised to seek medical advice after 12 months of regular unprotected sex without conception. If you are 36 or over, it is advisable to seek advice sooner, with NICE recommending consideration of assessment after six months of trying.
Can I have fertility problems even if I have regular periods?
Yes. Regular periods can suggest that ovulation is occurring, but they do not provide information about every aspect of fertility. The fallopian tubes, womb, ovarian reserve and sperm health, for example, can also be relevant.
Does endometriosis affect fertility?
Endometriosis can affect fertility in some women. It may affect the ovaries, fallopian tubes or the pelvic environment and can sometimes make conception more difficult.
Is fertility testing painful?
Different investigations feel different for different people. Some, such as blood tests and ultrasound, are relatively straightforward. Other investigations may be more involved. Your doctor should explain what is recommended, why it is being offered and what you can expect before proceeding.
What if all my fertility tests are normal?
Sometimes no specific cause can be identified. This is referred to as unexplained infertility. Although this can be frustrating, there are still treatment and management options that can be discussed with a fertility specialist.
Should both partners be assessed?
Where applicable, yes. Fertility difficulties can affect either partner, and assessing both people can help identify potential factors and avoid unnecessary delays.
A final word from HerCare
Fertility is individual, and there is no single timeline or pathway that is right for everyone.
If you are concerned that conception is taking longer than expected, seeking advice does not mean that you will immediately need fertility treatment. It simply gives you an opportunity to understand your reproductive health and your options.
At HerCare, we believe that women deserve time to ask questions, understand their choices and receive personalised care throughout their reproductive health journey.
HerCare does not provide fertility treatment but offers general fertility advice, along with blood tests and scans where appropriate as part of an initial assessment.
