Fertility: the ins and outs

Fertility is a topic that many people only begin to consider when they’re planning a family. Understanding how fertility works, what might affect it, and what can be done when things don’t go to plan is important for anyone thinking about having children — now or in the future. In this article, a consultant obstetrician explains factors that affect fertility, and treatments that prospective parents may want to explore.

What is fertility?

Fertility refers to the ability to conceive and carry a pregnancy to term. For women, fertility typically peaks in their early to mid-20s. From around the age of 30, fertility begins to decline, and this decline becomes more significant after the age of 35. By 40, natural conception becomes more difficult and risky -- although not impossible.

In men, fertility also changes with age, but usually more gradually. Sperm quality can decline over time, especially from the age of 40 onwards.

It’s important to note that fertility varies widely from person to person. Some couples conceive quickly, while others may take longer or require help to conceive.

What factors can affect fertility?

There are many reasons why someone may experience difficulty conceiving. In women, common causes include ovulation disorders, polycystic ovary syndrome (PCOS), endometriosis, and damage to the fallopian tubes. Age is one of the most significant factors, but lifestyle choices such as smoking, excessive alcohol consumption, poor diet, and being significantly over- or underweight can also impact fertility.

In men, issues with sperm quality, motility, or count are often to blame. These can be caused by hormonal imbalances, infections, or underlying medical conditions such as varicoceles. Exposure to certain environmental toxins, heat, or tight clothing can also reduce sperm production.

In some cases, both partners may have factors contributing to infertility. Sometimes, no obvious cause is found, which is known as unexplained infertility.

Can infertility be treated?

Yes. Depending on the underlying cause, there are several medical and surgical treatments available to support conception. For many couples, the first step is a series of fertility tests, which may include hormone blood tests, semen analysis, and ultrasound scans.

Ovulation induction, using medications such as clomifene or letrozole, may be offered if a woman is not ovulating regularly. Intrauterine insemination (IUI) involves placing sperm directly into the uterus at the time of ovulation, increasing the chances of fertilisation.

In vitro fertilisation (IVF) is one of the most well-known treatments and is used in a range of circumstances, from blocked fallopian tubes to unexplained infertility. In IVF, eggs are fertilised with sperm outside the body and then transferred to the uterus.

Other options, such as intracytoplasmic sperm injection (ICSI) or egg/sperm donation, may be recommended depending on individual circumstances.

Patients need to have a thorough consultation to understand the options available, success rates, and any potential risks.

How can fertility be boosted naturally?

There are several lifestyle adjustments that can improve fertility. Maintaining a healthy weight is important for both men and women, as being underweight or overweight can interfere with hormonal balance and ovulation.

A balanced diet, rich in fruit, vegetables, whole grains, and healthy fats, supports general reproductive health. Regular exercise, without overexertion, also plays a role.

For men, reducing exposure to heat (such as hot baths or laptops on the lap) and limiting alcohol intake and smoking can help improve sperm quality. For women, tracking ovulation and having regular, unprotected intercourse during the fertile window can increase the chances of conception.

Managing stress levels is also important, as high stress can affect hormonal regulation in both partners.

When to seek help

If a couple has been trying to conceive for over a year without success (or six months if the woman is over 35), it is advisable to seek medical advice. Early assessment can help identify any treatable issues and avoid unnecessary delays.

Fertility challenges can be emotionally difficult, but support is available. With the right guidance, many couples go on to conceive successfully, whether naturally or with medical assistance.