Definition
Subfertility means difficulty getting pregnant after 12 months of regular, unprotected sex.
It may be due to problems with ovulation, sperm, fallopian tubes, uterus, or may be unexplained.
If the woman is 36 years or older, earlier assessment (after 6 months) is advised.
(Source: NICE CG156, RCOG, WHO)
Prevalence / How Common
| Region | Estimated Prevalence | Key Notes / Sources |
| Worldwide | ~1 in 6 people (≈17.5%) | WHO 2023 |
| United Kingdom | ~1 in 7 couples (≈14%) | NICE / RCOG |
| United States | ~6–9% of women (12-month definition) | CDC, NIH |
| Europe | ~10–17% | ESHRE |
| Asia & Africa | ~10–20% (under-reported) | WHO regional data |
Common Causes
• Female: ovulation disorders (e.g. PCOS), endometriosis, tubal blockage, uterine problems.
• Male: low sperm count or poor sperm quality.
• Both / unexplained: in up to 25% of couples.
• Lifestyle: smoking, obesity, alcohol, stress.
Possible Clues / Symptoms
• No pregnancy after 12 months.
• Irregular or absent periods.
• Pelvic pain or history of infections.
• Abnormal sperm test results.
• Painful sex or known gynaecological problems.
Investigations
Both partners should be assessed together.
Women:
• Menstrual & medical history.
• Blood tests (FSH, LH, prolactin, TSH, progesterone, AMH).
• Pelvic ultrasound.
• Tubal patency test (HSG / HyCoSy).
Men:
• Semen analysis (count, motility, shape).
Both:
• Infection screening (e.g. chlamydia).
• BMI, smoking, alcohol, and general health review.
Treatment Options
Lifestyle:
• Stop smoking, reduce alcohol, maintain healthy weight, regular sex (every 2–3 days).
Medical:
• Ovulation induction: Letrozole (first-line), Clomifene, or Gonadotrophins.
• Metformin: if insulin resistance.
• Treat underlying conditions: thyroid disease, PCOS, endometriosis.
Surgical:
• Laparoscopy for endometriosis or tubal repair if indicated.
Assisted Reproductive Techniques (ART):
• IUI – insemination of prepared sperm into uterus.
• IVF – fertilisation in lab then embryo transfer.
• ICSI – sperm injected into egg (male factor infertility).
• Donor gametes / surrogacy – for severe or untreatable causes.
Support:
• Counselling and emotional support (infertility can cause stress, depression).
• Genetic or endocrine referral if indicated.
Long-Term Consequences
• Psychological distress, relationship strain, stigma.
• Delayed parenthood → increased pregnancy risks.
• May uncover chronic diseases (PCOS, endometriosis).
• Financial and social burden from prolonged treatment.
Key Takeaways
• Very common (≈1 in 7 couples) — affects both genders equally.
• Early referral (after 12 mo, or 6 mo if age > 36 yrs) improves outcomes.
• Many causes are treatable.
• Lifestyle, medical, and ART options offer high success rates when managed early.
Remember, ALWAYS consult with your GP and/or your gynecologist for your specific treatment options. Every woman is different!
Leave a Reply