Fertility.

Fertility refers to the ability to conceive a pregnancy. Around 1 in 6 couples experience difficulties conceiving, and this can be an emotional and overwhelming journey. The good news is that many causes of subfertility are treatable, and early assessment offers the best chance of success.

What Is Infertility?

Infertility is defined as:

• Not achieving pregnancy after 12 months of regular unprotected intercourse (or 6 months if the woman is over 35 years).

• It may be female-factor, male-factor, or a combination, and in some cases no clear cause is found (unexplained infertility).

Causes of Infertility

Female Factors

• Ovulation problems (eg. polycystic ovary syndrome, thyroid disorders)

• Endometriosis

• Tubal blockage or damage (eg. previous pelvic infection, surgery, adhesions)

• Fibroids, particularly those affecting the uterine cavity

• Low ovarian reserve or age-related egg decline

• Uterine abnormalities such as polyps, septum, or scarring

Male Factors

• Low sperm count

• Poor sperm motility (movement)

• Abnormal sperm shape

• Blockages in the reproductive tract

• Lifestyle factors (smoking, heat exposure, excessive alcohol, certain medications)

Combined or Unexplained

In around 20–30% of couples, both partners have contributing factors.
Unexplained infertility is diagnosed when all investigations are normal but pregnancy is still not achieved.

Fertility Investigations and Assessment

A thorough assessment helps identify the cause and determine the best next steps.

Female Fertility Assessment

• Ovulation tracking: menstrual history, blood tests (AMH, day-2 FSH/LH/oestrogen, progesterone, prolactin, thyroid functions)

• Pelvic ultrasound: checks ovarian reserve (antral follicle count), uterus, endometrium, and detects conditions like fibroids or endometriosis

• Tubal assessment (tubal dye study)

• Cervical screening if due

• Additional hormonal tests (thyroid, prolactin) if indicated

Male Fertility Assessment

• Semen analysis to evaluate sperm count, motility, and morphology

• Repeat testing may be recommended if the first sample is abnormal

• In some cases, additional tests or referral to a male fertility specialist or urologist may be suggested

Surgical Procedures Used in Fertility Assessment and Management

Tubal Dye Study (HyCoSy, HSG or laparoscopy)

• A procedure that uses dye and ultrasound (HyCoSy) or X-ray (HSG) to check whether the fallopian tubes are open.

• Tubal dye study at the time of laparoscopy.

• Helpful for diagnosing blockages or tubal damage.

Hysteroscopy

• A small camera passed through the cervix to assess the uterine cavity.

• Can diagnose and treat polyps, septum, submucosal fibroids, and scarring, which may affect implantation.

• Often performed as a minor outpatient procedure.

Laparoscopy

• Keyhole surgery to assess the pelvis, treat endometriosis, release adhesions, or remove fibroids affecting fertility.

• Also used to confirm tubal patency by injecting dye during the procedure.

• Offers both diagnosis and treatment in one operation.

These procedures can improve natural fertility and optimise outcomes before assisted reproduction.

When Referral to a Fertility Specialist Is Recommended

You may benefit from referral to a fertility specialist if:

• You have been trying to conceive for 12 months (or 6 months if >35 years)

• There are known factors such as endometriosis, PCOS, fibroids, or tubal blockage

• Semen analysis is abnormal

• Your AMH is low or cycles are very irregular

• You require assisted reproductive technology (IUI, IVF, or ICSI)

Fertility specialists offer advanced care within a multidisciplinary team, including reproductive endocrinologists, andrologists, nurses, embryologists, counsellors, and genetic specialists.