Everything you need to know about female fertility

Trying to conceive? Here's everything you need to know about female fertility, from ovulation and conception tips to understanding your cycle.

Navigating the world of fertility can be an incredibly daunting, overwhelming and emotional experience. It’s important to remember that everyone’s fertility journey is unique and not to overly compare yourself to friends and family around you. Trying to conceive can take a long time, so it’s always beneficial to properly understand your options and the information available. 

What is fertility? 

Female fertility concerns a woman’s ability to get pregnant. A woman is usually most fertile one to two days before ovulation. As such, if you have a regular 28 day cycle, you will be most fertile 14 days from when you expect your next period to start. 

Whilst it is generally estimated that about 84% of couples will conceive naturally within a year, if they have regular unprotected sex (regular is usually considered to be every 2 or 3 days). Around 1 in 7 couples are likely to have some experience with infertility, encountering difficulties when trying to conceive. 

When should I start to question my fertility? 

Trying to conceive can be an incredibly difficult and stressful time in your life - it’s easy to jump to conclusions and assume the worst about your fertility levels early on. That’s why it’s important to remember that getting pregnant can take a long time and will always vary according to the individuals. Even if you haven’t conceived in your first year of trying, there’s no need to panic - studies have found that of those who fail to conceive in the first year, about half will conceive in the second year.

However, if you are struggling to conceive it’s important that you do consider seeking medical advice and take the necessary steps to ensure you are prepared and have multiple options available. It’s generally advised that you should first reach out to your GP if you and your partner have been trying to get pregnant with frequent, unprotected sex, for a year or more. 

You may want to speak to a GP sooner if you’re over 36 and have known fertility issues such as endometriosis or polycystic ovary syndrome, if your partner has known fertility issues, or you’re concerned that you or your partner may have a medical issue that would affect your ability to get pregnant. 

What can cause infertility? 

There are many causes of infertility, affecting either partner. In most cases, fertility levels are caused by factors out of your control. For women, the factors below can often be causing fertility problems: 

Problems with ovulation

This could be the result of polycystic ovary syndrome (PCOS), or a thyroid problem (either an overactive thyroid gland or an underactive thyroid gland). 

Uterine or cervical abnormalities

Issues such as polyps or fibroids in the uterus can cause infertility. In some cases, fibroids can block a fallopian tube, or prevent a fertilised egg attaching itself in the womb. 

Endometriosis

This is also a common cause, where the tissues that normally line the inside of the uterus grow instead on the outside of the uterus

Primary ovarian insufficiency (early menopause)

Another potential cause, occurring when the ovaries stop working and menstruation ends before you have reached the age of 40 

Pelvic inflammatory disease (PID)

This is an infection of the upper female genital tract. PID can damage and scar the fallopian tubes, making it virtually impossible for an egg to travel down into the womb 

Age

Unfortunately, a woman's age can also be a significant factor. As you get older, the quantity and quality of your eggs is likely to decline, making it harder to conceive 

Whilst in most cases fertility problems can be easily explained and linked to one of the above causes, according to NHS statistics, 1 in 4 fertility cases in the UK will have no clear identification of the cause. 

How can I improve my fertility? 

Whilst most forms of female infertility cannot be predicted or prevented, there are a number of factors within your control (usually relating to your lifestyle choices) that could either be contributing to infertility, or, could be adapted in order to improve your fertility levels, such as: 

Ensure you are maintaining a health weight

It has been found that being overweight or significantly underweight can inhibit normal ovulation 

Prevent sexually transmitted infections

Infections such as chlamydia and gonorrhea are a leading cause of infertility for women. If you’re having sex, make sure to always use the necessary protection and regularly test for STI’s (especially if you have a new partner). 

Smoking

Smoking has been found to age your ovaries and deplete your eggs prematurely. If you are looking to get pregnant, quitting smoking could definitely help. 

Limit alcohol consumption

It has been found that excessive drinking increases the risk of ovulation disorders. A safe level of fetal alcohol consumption has yet to be established so general advice remains to cut alcohol out completely if you are pregnant, or trying to conceive. 

How can infertility be treated? 

It’s likely that your GP will carry out a number of tests to determine what could be causing fertility problems. This includes blood tests (to check for a hormone called progesterone which determines ovulation levels) and STI tests. An ultrasound may also be taken to check your ovaries, womb and fallopian tubes, as well as a hysterosalpingogram (an X-Ray of your womb and fallopian tubes). If your GP thinks it’s likely that you have a fertility problem, they may also advise that you get a Laparoscopy. 

Once the cause of infertility is verified, your GP will be able to provide you with potential fertility treatments. This will differ depending on the cause of the problem, as well as what is available from your local clinical commissioning group. Common treatments can include:

Medicines

Common fertility medicines include: clomifene, tamoxifen, metformin (particularly beneficial for women with PCOS) and gonadotrophins

Surgical procedures

This can include, fallopian tube surgery, laparoscopic surgery (often used to treat endometriosis and remove submucosal fibroids), epididymal blockage correction or surgical sperm extraction

Assisted conception

This can include Intrauterine Insemination (IUI), In Vitro Fertilisation (IVF) or an egg and sperm donation

You can find further information on your fertility treatment options from the Human Fertilisation and Embryology Authority (HFEA) website


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