Fertility Overview

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Fertility Overview

Fertility

What does fertility mean to you?

By definition, fertility is the “capacity to establish a clinical pregnancy”.¹But what does that mean for the estimated 1 in 6 couples of reproductive age who struggle to conceive?^2,3

We are taught as teenagers that having unprotected sexual intercourse only once will likely result in a pregnancy. This statement is neither true nor untrue. Rather, it does not reflect the intricacies of fertility and conception, yet a large proportion of both men and women continue into adulthood with a lack of fertility knowledge that could support them on their road to parenthood.^3,4

Getting pregnant

Approximately 80% of couples under 40 years conceive within 12 months of regular, unprotected intercourse.⁵

While many couples believe they are having regular, unprotected intercourse when trying to conceive, the actual frequency varies widely. Among couples actively trying to conceive, studies report an average of approximately six sexual acts per month.⁶

Regular, unprotected sexual intercourse usually means every 2–3 days without contraception, which helps ensure sperm are present during the fertile window, the five days before ovulation and the day of ovulation itself, when pregnancy is most likely.⁷

Approximately 41% of women actively trying to conceive cannot correctly identify their fertile window during their menstrual cycle, and 1 In 10 do not know their cycle length.⁸ It is crucial to know the different phases within your cycle, to help facilitate conception, and to also identify when something may not be right and when to seek help. Closing the fertility knowledge gap could help couples on their road to parenthood.

Factors affecting fertility

Over half of women feel more pressure on them than their partner during the conception process.⁹ It is a disproportionate burden as fertility can be affected by multiple factors, in both men and women.¹⁰ Infertility and reduced fertility may be caused by a range of abnormalities of the ovaries, uterus, and fallopian tubes, as well as some endocrine disorders, such as polycystic ovary syndrome (PCOS), endometriosis, thyroid dysfunction, hyperprolactinemia, and premature ovarian insufficiency (POI).¹¹ Some modifiable lifestyle factors can also affect fertility. These can be influenced by:

Age

Fertility has been shown to decline with advancing age, starting as early as 35 years in both men and women.¹⁰ Increasing age may result in poor quality sperm in men, and a reduction in number and quality of eggs in women and birthing people.¹⁰

Weight

Having a Body Mass Index (BMI) of ≥25 kg/m² (overweight and obese) is associated with higher incidences of irregular menstrual cycles and ovulation failure in women and birthing people.¹² Obesity in men can impact testosterone production, sperm quality, and may also lead to erectile dysfunction.¹³

Smoking

Smoking, including passive smoking, can affect sperm concentration and quality in men.¹⁰ In women, it is associated with thickening of the membrane surrounding the egg, which makes it more difficult for sperm to penetrate.¹⁰ Smoking in women is also associated with altering the hormone levels needed to support the luteal phase, which may disrupt developing egg follicles.¹⁰

Alcohol

It is widely recommended that people reduce and restrict their alcohol intake when trying to conceive as it has been shown to decrease fertility potential.¹⁰ Excessive alcohol consumption can decrease sperm quality, and have harmful effects on testosterone, follicle-stimulating hormones (FSH), and luteinising hormone (LH), all needed to support fertility and conception.¹⁰

Sexually transmitted infections (STIs)

Common STIs, such as, Chlamydia trachomatis and Neisseria gonorrhoeae have been shown to negatively impact both male and female fertility. Both infections can result in tubal factor infertility and pelvic inflammatory disease in women, as the inflammation damages the fallopian tubes and pelvic tissue that facilitate egg release and supports conception.¹⁴ In men, it is not fully understood how these infections affect fertility, but it is thought they can impact semen quantity and quality.¹⁵

Stress and depression

In men, stress and anxiety can decrease testosterone levels which negatively affects sperm production.¹⁰ In some women, anxiety and depression may affect hormonal balance, which can lead to irregular or absent periods. Increased stress hormones can inhibit the luteinizing hormones and ovarian oestrogen and progesterone secretion that govern the normal functioning of the menstrual cycle.¹⁰

Sometimes there is no known cause of infertility. This is referred to as unexplained infertility. This can be frustrating, but if you have been trying to conceive naturally for at least 12 months, you could be offered further testing and reproductive help through IVF (In Vitro Fertilisation).⁷ You should seek further information from your healthcare provider.

The mental impact of infertility

Data from available literature demonstrates that nearly a third of couples experiencing infertility can report feelings of significant anxiety. Major depression is also very common, occurring in up to 54% of couples seeking treatment for infertility.¹⁶

The Infertility Awareness Report surveyed 429 participants across the UK who are currently experiencing or have experienced fertility struggles found:⁹

3 in 4 people have feelings of failure when experiencing infertility.

Half of people struggling to conceive have felt dismissed by a medical professional and over a quarter have felt overlooked when seeking fertility treatments.

Nearly a third of people feel more resilient for having experienced infertility.

Major barriers for seeking infertility treatment include fear of treatment failure and the daily injection schedule, as well as how it will impact work, family and social activities.¹⁷

It is important to discuss these concerns with your healthcare provider, as well as your partner, family or friends so that you can feel supported throughout your fertility journey.

In a survey distributed across 4 countries (France, Germany, Italy and Spain) involving 445 women who had received fertility treatment within the past 2 years, or were having trouble conceiving but had not received treatment, results indicated:¹⁷

Women who received treatment felt more hopeful

Women, who were in treatment, felt closer to their partner than those not in treatment

When to seek support

If you and your partner have been struggling to get pregnant for a while, don't worry. There is support there for you. Usually, both partners will be offered fertility tests.

For men, this involves checking how much sperm they make, and sperm quality.

For women having trouble getting pregnant, doctors usually start with blood tests to check hormone levels and see if ovulation is happening properly. Ultrasounds or special X-rays may be done to look at the uterus and fallopian tubes. In some cases, a small camera may be used to check the inside of the uterus or pelvis. Other tests, like genetic checks or infection screening, might be suggested depending on individual circumstances.¹⁸

Healthcare specialists can offer a range of fertility support. Depending on the outcome of your tests, you may be offered:¹⁸

Medication that helps you ovulate
Fertility treatments, such as IVF (In Vitro Fertilisation), or ICSI (Intracytoplasmic sperm injection), a technique where a single sperm is injected directly into an egg
- It is important to note that assisted reproductive technology (ART) does not include assisted insemination using sperm from either a woman’s partner or a sperm donor.¹

It can feel overwhelming talking about your fertility. However, opening up about your experience and learning about the path from conception through to birth will help empower you to tackle the emotional and mental challenges that fertility issues may bring.

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