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Health condition · Clinically reviewed

Female infertility, causes, tests and modern UK treatment.

Around 1 in 7 UK couples struggle to conceive. A stepped assessment finds the cause and matches treatment - from lifestyle and ovulation induction to IVF and ICSI.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK-registered clinician with a fertility interest before publication.

  • 02

    Sourced from guidance

    Checked against NICE CG156, the HFEA and Royal College of Obstetricians and Gynaecologists guidance you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK fertility care - AMH testing, letrozole-first ovulation induction, tubal imaging and IVF/ICSI.

Key facts

Female infertility at a glance.

The essentials, in plain English - who it affects, what causes it, and how it is investigated and treated in the UK today.

  • What it is

    Failure to conceive after 12 months of regular unprotected intercourse, or 6 months when the woman is over 35.

  • How common

    Around 1 in 7 UK couples are affected at some point. About 40 per cent involve a female factor, 40 per cent a male factor and 20 per cent combined or unexplained.

  • Main female causes

    Ovulatory (about 25 per cent), tubal (about 20 per cent), uterine, cervical, endometriosis and age-related ovarian reserve decline.

  • Age matters

    Fertility falls gradually from age 30 and more sharply after 35. Ovarian reserve and egg quality are the biggest single drivers.

  • First-line workup

    Day 21 progesterone, day 2 to 5 FSH and LH, AMH, thyroid function, prolactin, tubal imaging and semen analysis for the partner.

  • Treatments

    Lifestyle, ovulation induction (letrozole or clomifene), tubal or uterine surgery, IUI and IVF/ICSI - stepped to the underlying cause.

Why this guide matters

A stepped assessment, not guesswork.

Fertility is a couple issue, and it is a time-sensitive one. The three points below shape everything else on this page.

  • Both partners are assessed together

    A male factor is present in roughly 40 per cent of couples - semen analysis and female workup happen in parallel, not in sequence.

  • Age changes the timeline

    Refer at 12 months if under 35, but at 6 months over 35 or with known risk factors. Waiting rarely helps and often costs cycles.

  • Treatment is matched to the cause

    Ovulation induction, tubal surgery, uterine surgery, IUI and IVF each work best when chosen against the identified problem.

How the diagnosis is made

From first consultation to a clear plan.

The steps a UK GP or fertility specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and lifestyle review

    Menstrual pattern, sexual, obstetric and medical history, medications, smoking, alcohol, BMI, occupational and family history.

  2. 02

    Assessing

    Examination and BMI

    General and pelvic examination, BMI, thyroid and signs of hyperandrogenism such as hirsutism or acne.

  3. 03

    Assessing

    Ovulation and hormone bloods

    Day 21 progesterone to confirm ovulation, day 2 to 5 FSH and LH, AMH for ovarian reserve, thyroid function and prolactin.

  4. 04

    Confirming

    Tubal patency imaging

    HSG (hysterosalpingogram) or HyCoSy (hystero-contrast sonography). Laparoscopy with dye is the gold standard where indicated.

  5. 05

    Confirming

    Uterine and pelvic imaging

    Transvaginal ultrasound, 3D scan or hysteroscopy for fibroids, polyps or septum. MRI adds detail for adenomyosis and complex anatomy.

  6. 06

    Confirming

    Partner semen analysis

    A concurrent semen analysis is essential - male factor is present in roughly 40 per cent of couples and often coexists.

  7. 07

    Planning

    Specialist fertility referral

    Reproductive medicine review, pre-conception bloods (rubella, haemoglobinopathies, STI and BBV screen) and a personalised plan.

Typical timeline: a full couple workup usually completes within one to three months.

Symptoms and clues

What female infertility can look like.

Infertility itself is the absence of pregnancy, but common patterns and coexisting features often point to the underlying cause.

  • Irregular or absent periods

    A common signal of ovulatory disorders such as PCOS, hypothalamic amenorrhoea or premature ovarian insufficiency.

  • Painful or heavy periods

    Can point to endometriosis, adenomyosis or fibroids affecting the uterine cavity or pelvic anatomy.

  • Pelvic pain or deep dyspareunia

    Deep pain with sex or between periods warrants review for endometriosis, adhesions or pelvic infection.

  • Recurrent pelvic infection

    A history of pelvic inflammatory disease or chlamydia increases the risk of tubal damage and hydrosalpinx.

  • Previous pelvic surgery

    Ectopic pregnancy, appendicitis or ovarian surgery can leave adhesions that affect tubal function.

  • Hormonal features

    Hirsutism, acne, weight change or galactorrhoea can point to PCOS, thyroid disease or hyperprolactinaemia.

  • Age over 35

    Fertility falls with age and earlier assessment is recommended once trying for six months rather than twelve.

  • Red flag - recurrent miscarriage

    Two or more losses, very short cycles or new pelvic pain deserve prompt specialist review rather than watchful waiting.

Treatment

How female infertility is treated in the UK.

Lifestyle and preconception first, then ovulation induction, tubal or uterine surgery where indicated, and assisted reproduction (IUI, IVF, ICSI) when needed.

  • Lifestyle and preconception

    BMI 20 to 30, smoking cessation, reduced alcohol, folic acid, rubella immunity check and regular intercourse every two to three days.

  • Ovulation induction

    Letrozole is preferred in PCOS, with clomifene or gonadotrophins as alternatives. Specialist monitoring reduces multiple pregnancy risk.

  • Metformin in PCOS

    Useful adjunct in women with PCOS and insulin resistance, particularly where BMI is raised.

  • Tubal surgery

    Laparoscopic adhesiolysis for adhesions and salpingectomy for hydrosalpinx before IVF, which improves implantation rates.

  • Uterine surgery

    Hysteroscopic myomectomy for submucosal fibroids, polypectomy, septum resection and treatment of Asherman syndrome.

  • Endometriosis surgery

    Specialist laparoscopic excision of deep or ovarian endometriosis where symptoms or anatomy suggest benefit.

  • IUI - intrauterine insemination

    Prepared sperm placed in the uterus around ovulation - used in unexplained infertility, mild male factor or same-sex and single-parent care.

  • IVF and ICSI

    Controlled ovarian stimulation, egg collection, fertilisation and embryo transfer. ICSI is added for severe male factor. NHS funding varies by region.

Assisted reproduction, in more depth

IUI

Prepared sperm placed in the uterus around ovulation. Suitable for unexplained infertility, mild male factor, same-sex couples and single parents by choice, with at least one open tube.

IVF and ICSI

Controlled ovarian stimulation, egg collection, laboratory fertilisation and embryo transfer. ICSI is added for severe male factor. NHS funding, cycles and age limits vary by ICB.

Donor gametes, PGT and preservation

Donor egg or sperm, surrogacy, elective oocyte freezing and preimplantation genetic testing (PGT-A and PGT-M) are offered through HFEA-licensed clinics with specialist counselling.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or fertility specialist knows your history and can tell you which parts apply to you. If in doubt, ask for a referral.

  • NICE. Fertility problems: assessment and treatment (CG156).

  • Human Fertilisation and Embryology Authority (HFEA). Patient information and treatment data.

  • Royal College of Obstetricians and Gynaecologists (RCOG). Green-top guidelines on tubal disease, endometriosis and recurrent miscarriage.

  • European Society of Human Reproduction and Embryology (ESHRE). Guidelines on unexplained infertility and PCOS.

Red flags

When to seek earlier specialist help.

Most couples fit the standard 12-month pathway. These are the features that mean earlier or urgent specialist review is warranted.

  • Age over 35 and trying for six months

    Earlier specialist referral is recommended - waiting a full year risks losing time when ovarian reserve is declining.

  • Very irregular or absent periods

    Suggests an ovulatory disorder that needs investigation and is unlikely to resolve without directed treatment.

  • Suspected premature ovarian insufficiency

    Menopause-type symptoms or a family history under 40 need urgent hormonal assessment and specialist care.

  • Severe pelvic pain or deep dyspareunia

    A pattern that points to endometriosis or pelvic pathology - specialist gynaecology review is warranted.

  • Recurrent miscarriage

    Two or more early pregnancy losses warrant specialist workup for anatomical, hormonal and immunological causes.

  • Previous ectopic or tubal surgery

    Increases the chance of tubal factor infertility - imaging or laparoscopy is often needed before conservative attempts.

  • Chemotherapy or pelvic radiotherapy

    Fertility preservation counselling should ideally happen before treatment - discuss urgently with reproductive medicine.

  • Suspected uterine anomaly

    A septate, bicornuate or double uterus can affect implantation and pregnancy - MRI and hysteroscopy help clarify anatomy.

  • Untreated thyroid disease or hyperprolactinaemia

    Both are readily treatable causes of subfertility - correct before or alongside other fertility treatment.

Living with it

A common experience, with real options.

Four things that make the biggest difference day to day - sensible timing, small lifestyle changes, good support and knowing when to step up.

A quiet reminder

Fertility care is a marathon, not a sprint.

Progress is measured in cycles and months. Look after your relationship and your mental health alongside your treatment plan.

  1. 01 Timing

    Regular intercourse works

    Aim for every two to three days across the cycle rather than chasing ovulation apps - it maintains sperm quality and covers the fertile window.

  2. 02 Lifestyle

    Small changes, real gains

    BMI in the 20 to 30 range, stopping smoking, reducing alcohol and starting folic acid before conceiving all move the needle.

  3. 03 Support

    You are not alone

    Around 1 in 7 UK couples experience fertility difficulty. Fertility Network UK, specialist counsellors and peer groups help.

  4. 04 Escalate

    Don’t wait if time is short

    Over 35, irregular cycles, pelvic pain or a known male factor - ask for early referral rather than another six months of trying.

Frequently asked

Everything we get asked about female infertility.

Quick answers on when to seek help, what tests are done, and how treatment steps up from lifestyle to IVF.

  • When should I seek help for fertility?

    After 12 months of regular unprotected intercourse, or after 6 months if the woman is over 35 or there is a known risk factor such as irregular periods, previous pelvic surgery, endometriosis or a suspected male factor. Earlier referral is reasonable when time matters.

  • What are the main causes of female infertility?

    Ovulatory disorders (around 25 per cent) including PCOS, hypothalamic amenorrhoea, thyroid disease, hyperprolactinaemia and premature ovarian insufficiency; tubal disease from previous infection, endometriosis or surgery; uterine causes such as fibroids, polyps and adhesions; cervical factors; unexplained infertility; and a coexisting male factor in a significant minority.

  • What tests will I need?

    Day 21 progesterone to confirm ovulation, day 2 to 5 FSH and LH, AMH for ovarian reserve, thyroid function and prolactin, tubal imaging with HSG or HyCoSy, transvaginal ultrasound and a semen analysis for your partner. Pre-conception bloods include rubella immunity, haemoglobinopathies and an STI and blood-borne virus screen.

  • Does age really make that much difference?

    Yes. Female fertility declines gradually from age 30 and more sharply after 35, mainly because both the number and quality of eggs fall. This is why earlier referral is offered from 35 onwards and why AMH and antral follicle counts are useful.

  • What is the difference between IUI and IVF?

    IUI places prepared sperm directly into the uterus around the time of ovulation and needs at least one open tube. IVF collects eggs after stimulation, fertilises them in the laboratory and transfers an embryo back to the uterus. ICSI is IVF with a single sperm injected into each egg, used for severe male factor.

  • Can lifestyle changes really help?

    Yes. Bringing BMI into the 20 to 30 range, stopping smoking, reducing alcohol, taking folic acid, addressing untreated thyroid disease and reducing stress all improve natural conception rates and IVF outcomes. They rarely replace medical treatment, but they meaningfully add to it.

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