t is estimated that up to one in five couples of reproductive age may experience difficulties conceiving.
The causes of infertility can affect both women and men. In many cases, these are reversible factors that require proper diagnosis and targeted treatment. Early intervention and access to specialist help significantly increase the chances of successful therapy.
If you have been trying to conceive for a long time without success, don’t wait. Early diagnosis and appropriately chosen infertility treatment greatly improve the likelihood of pregnancy.
In our Polish practice in the UK, we offer comprehensive diagnostics, personalized care, and access to modern assisted reproductive techniques. We work interdisciplinary—with concern for your health, comfort, and emotional well-being.
Contact us to schedule a consultation with a gynecologist in London or Coventry. This is the first step toward parenthood.
This article presents the most common causes of infertility, discusses available diagnostic methods, and explores treatment options—from pharmacological therapy and surgical procedures to assisted reproductive technologies. The goal is to provide honest, understandable information about a topic that can evoke many emotions but primarily requires a calm, medically backed approach.
When is infertility diagnosed?
Infertility is diagnosed when a couple cannot conceive after regular sexual intercourse without contraception for at least 12 months. This criterion applies to couples of reproductive age and assumes cycles during which conception is physically possible.
In some cases—especially for women over 35—diagnostic procedures are recommended after 6 months of unsuccessful attempts. This is because ovarian reserve and egg quality decline with age, affecting pregnancy chances and treatment success.
There are two main types of infertility:
- Primary infertility – when the couple has never conceived before.
- Secondary infertility – when pregnancy was previously possible (including after miscarriage), but conception is now not occurring despite efforts.
Causes of infertility—women, men, and combined
Infertility can result from many different factors affecting both partners. Approximately 35–40% of cases involve women, 30–40% involve men, and in the remaining cases, causes are combined or unclear (so-called idiopathic infertility).
Causes of female infertility
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Ovulation disorders
This is one of the most common causes. Lack of ovulation or irregular ovulation can be caused by:- Polycystic ovary syndrome (PCOS)
- Hormonal disorders (e.g., hyperprolactinemia)
- Premature ovarian failure
- Thyroid diseases
- Stress, underweight, or overweight
-
Uterine and fallopian tube diseases
- Blockage of fallopian tubes (e.g., after infections, endometriosis)
- Intrauterine adhesions (e.g., after surgical procedures)
- Uterine fibroids that may interfere with embryo implantation
- Endometrial polyps
- Congenital uterine anomalies
Endometriosis
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus (endometrium) develops outside the uterine cavity, causing inflammation, adhesions, and pain. It can disrupt the function of the ovaries, fallopian tubes, and endometrium itself.
Causes of male infertility
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Abnormal semen parameters:
- Low sperm count (oligozoospermia)
- Poor motility (asthenozoospermia)
- Abnormal morphology (teratozoospermia)
- Complete absence of sperm in semen (azoospermia)
-
Hormonal and genetic disturbances:
- Testosterone deficiency and other hormonal imbalances within the hypothalamic-pituitary-gonadal axis
- Congenital conditions (e.g., Klinefelter syndrome)
- Congenital duct defects (e.g., absence of vas deferens)
-
External factors and lifestyle:
- Smoking, alcohol, drugs
- Stress, testicular overheating
- Certain medications and environmental toxins
- Trauma and surgeries to the testes or scrotum
- Varicocele (enlarged veins in the spermatic cord)
Causes that are combined or difficult to determine
-
Idiopathic infertility — about 10–20% of cases remain unexplained despite extensive testing. This does not mean treatment cannot be effective; often, empiric or supportive therapies help.
-
Environmental and lifestyle factors:
- Chronic stress
- Unhealthy diet and obesity
- Vitamin and mineral deficiencies
- Sleep disorders and lack of physical activity
-
Immunological factors:
Immune system disturbances can cause abnormal reactions against sperm or reproductive tissues, hindering fertilization or embryo implantation.
Infertility diagnostics
Early and thorough evaluation allows precise identification of causes and selection of effective treatments. Diagnostics should involve both partners, since issues may stem from either side or both.
When to begin diagnostic testing?
- After 12 months of regular trying if woman is under 35 years old.
- After 6 months if woman is 35 or older.
- Immediately if known risk factors are present, such as irregular cycles, gynecological diseases, prior surgeries, or low sperm count.
Basic female infertility tests:
- Monitoring the menstrual cycle (ovulation, phase lengths)
- Hormonal tests: FSH, LH, estradiol, progesterone, prolactin, TSH, AMH (ovarian reserve)
- Transvaginal ultrasound — assessment of ovaries, follicles, endometrium, uterus
- Tubal patency tests (hysterosalpingography or sono-hysterosalpingo-graphy)
- Immunological tests (if immune response issues are suspected)
- Laparoscopy (if endometriosis or adhesions are suspected)
Key male infertility tests:
- Semen analysis: sperm count, motility, morphology
- Hormonal tests: testosterone, FSH, LH, prolactin
- Scrotal and testicular ultrasound (structure, varicocele)
- Genetic testing — especially in cases of very low sperm count or azoospermia
- Immunological and infectious tests, if uro-genital infections are suspected
Joint evaluation of the couple:
- Medical history and lifestyle: chronic illnesses, habits, stress, diet, medications
- Assessment of sexual activity — frequency, possible dysfunctions
- Psychological or sexological consultation if needed
This comprehensive approach helps identify the root causes of infertility and guides appropriate treatment options.
Infertility Treatment
The treatment of infertility should always be tailored to the underlying cause, the couple’s age, duration of trying to conceive, and overall health. The therapeutic plan may include medical, surgical, and assisted reproductive techniques. Often, treatment effectiveness is enhanced when lifestyle modifications and psychological support are implemented simultaneously.
Basic approaches include:
-
Treating ovulation disorders:
Hormonal induction of ovulation — stimulating the ovaries to produce mature eggs. This therapy can be conducted cyclically and monitored with hormone levels and ultrasound scans.
For men, hormonal treatment may help in cases of testicular dysfunction or low testosterone levels. -
Surgical interventions:
Recommended for blocked fallopian tubes, ovarian cysts, fibroids, or endometriosis. Procedures are often minimally invasive, such as laparoscopy or hysteroscopy, enabling quicker recovery. -
Assisted reproductive technologies (ART):
When causal treatments are ineffective or factors are complex, ART procedures are considered, including intrauterine insemination (IUI) and in vitro fertilization (IVF). Advanced techniques like ICSI (intracytoplasmic sperm injection), preimplantation genetic testing (PGT), and cryopreservation of eggs or embryos are also available. -
Supportive lifestyle measures:
Modifying diet, maintaining a healthy weight, reducing stress, eliminating substances like nicotine and alcohol, and increasing physical activity can significantly improve fertility, both naturally and with ART. -
Psychological support:
Long-term infertility treatment can be emotionally taxing, so many clinics offer psychological counseling as part of comprehensive care.
Importance of Early Diagnosis and Treatment
Time is a critical factor, especially in women, as ovarian reserve diminishes with age. The earlier a couple consults a specialist, the higher the chances of effective treatment and the less likely they will need invasive ART procedures.
Early diagnosis allows for quick identification of treatable issues such as hormonal imbalances, which may restore natural conception. For more complex cases like endometriosis or advanced male factor problems, earlier intervention provides more time to prepare for procedures like IVF.
Avoid delaying diagnostics out of fear of results. Access to modern infertility treatments has greatly expanded over recent years, and prospects for conception are realistic even in challenging cases.
Summary: Causes, Diagnosis, and Treatment of Infertility
Infertility is a serious but increasingly well-understood medical condition affecting many couples. Thanks to advances in diagnostics and therapies, many couples can successfully realize their parenthood plans. Early intervention, thorough diagnostics, and personalized treatment—including medication, surgery, and ART—are key.
Simultaneously, maintaining a healthy lifestyle and emotional well-being improves the chances of success and helps cope with the emotional challenges of infertility treatment. This holistic approach increases the likelihood of achieving pregnancy and supports better mental resilience during the process.
