Problems related to ovulation are the most common reason for ‘female’ infertility and may be caused by hormonal imbalances, Polycystic Ovary Syndrome (PCOS), thyroid problems, diabetes, being over or underweight, exercising too much, and certain medications.
Problems with eggs may be due to age (over 35 years the quality and number of eggs drops) or, more rarely, Premature Ovarian Insufficiency (POI) occurring spontaneously or after medical treatment such as removal of the ovaries or chemotherapy.
Uterine (fallopian) tubes may be blocked or damaged due to disease (e.g., endometriosis or Pelvic Inflammatory Disease caused by untreated gonorrhea or chlamydia), ectopic pregnancy, or pelvic or abdominal surgery.
Problems in the pelvis that may prevent eggs from implanting include endometriosis, uterine fibroids or polyps, an unusually shaped uterus, scarring in the uterus because of previous surgery or infection, and an endometrium that is not the right size (too thin or too thick).
Some people themselves do not have fertility problems but need donor sperm because they are single, their male partner has fertility problems, or their partner is a woman or trans or gender diverse person presumed female at birth.
Lifestyle factors that affect fertility include smoking, alcohol consumption, substance misuse, exposure to environmental toxins (e.g., lead, pesticides), over-exercising, and stress.
A diagnosis of ‘unexplained infertility’ is usually given after testing does not reveal any clear explanation for fertility problems. Sometimes this is a temporary diagnosis, and further tests or fertility treatment experience can help identify the problem.
Finally, many people experience more than one fertility issue, and in many couple relationships (heterosexual or same-sex) both partners can have fertility problems.
1 Trans and gender diverse people presumed female at birth may experience the fertility problems discussed on this page as well, but if they have decided to undergo medical treatment (hormone therapy and/or surgery) to affirm their gender and wish to leave open the possibility of becoming a parent they will have specific needs. To learn more, please see Options for transgender and gender diverse people (VARTA) or Gender diversity and fertility (Your Fertility).
The people we talked with experienced a wide range of fertility problems. The first film covers fertility problems related to endometriosis, PCOS, and low ovarian reserve. In the second film, age-related infertility, unexplained infertility and infertility following medical treatment are covered.
To learn more about other fertility problems people experienced, please visit People’s Profiles. As well as further examples of the conditions covered in the films below, you can also learn about people’s experiences of fertility problems related to autoimmune conditions, premature menopause, cancer, an abnormally shaped uterus, ovarian cysts, and more. You can also visit the Donor Conception and Surrogacy Talking Point to hear more about people whose fertility problems were related to male partner infertility, being single or in a relationship with a woman or a trans or gender diverse person presumed female at birth.
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During fertility testing, Megan learned she had endometriosis. While finding an explanation for her painful periods was a relief, the uncertainty about what this meant for her fertility was ‘hard’.
So we went and saw a doctor, a fertility specialist, at the start of 2016, and he ran a more extended battery of blood tests on both myself and my husband. We both also had a couple of other tests as well; checked sperm samples, all that sort of stuff. When everything came back normal, the fact that I was having quite heavy, painful periods still, meant that we then went on to have a laparoscopy. So in March 2016, I went in for my lap, which at that stage was just meant to be exploratory, but while they were there they found stage three endometriosis. So they were able to excise that, which was great; and from that point on, it was sort of treated as, “You had endometriosis, and that’s dealt with now, so everything should be fine.”
It was never really talked about as, “This is a condition that will affect the rest of your life. It may have long-term impacts on your fertility. It doesn’t ever completely go away.” In hindsight, it would have been great to have a follow-up to talk about what this would mean for my life as a woman, moving forward; but it was perhaps… Because in the context of what we were doing, it was resolved; it was a problem that was resolved, and so we moved on. But at a personal level and at a health level, as a woman, I think it would have been great to take stock or have some resources given to me that would help me process what I had discovered about my body.
So I think in hindsight, perhaps before starting anymore of the fertility treatments, it might have been good to be able to have more time to process, or be supported in processing what that had actually meant; because it definitely had a big effect on how I viewed my body and fertility, and the next steps, I think.
We had a follow-up a month after the surgery, to discuss what had been found, and what the next steps were; but in hindsight, it would have been helpful to me to be given resources to help me better understand what it was, and what it would mean. I had to do a lot of research myself. I didn’t know what support networks were available to me, I didn’t… I didn’t know anybody else who had this condition, and so it was hard to know what this would mean for my life, moving forward. While a lot of women… Surgery is successful, and they don’t necessarily see a recurrence, I knew that it was possible, and I didn’t know when or if it would come back. I think that uncertainty was really hard.
Diagnosed with PCOS in her 20s, Skye was advised to take the contraceptive pill to manage her periods until she wanted to have a baby. As her previous attempts to conceive were unsuccessful, she is now contemplating IVF.
Skye: I think I was 24 when I found out I had PCOS. The gynaecologist’s words exactly were, he said, “Your ovaries look like a rat’s been at them”. That’s how I knew that I had – and I didn’t know what PCOS was. He said to go and Google it and do some research. So that’s how I found out what it was.
Interviewer: So can you maybe describe a little bit about, like, what it was actually – what having your period was like?
Skye: So if I wasn’t on the pill it would normally last for, say, anywhere between 10 and 14 days and it would be very heavy and I would have maybe five or six of them days where it was extremely heavy and very clotty and just the cramps were – that’s what kept me from going to work was the cramping. There was just really no way I could – it didn’t really matter what pills I took to stop the pain, it just never really – it might take the edge off but it was still enough that I didn’t feel I could go out in public.
I would always be sort of hunched over and I would have to sort of lay in bed all day with a hot water bottle and things like that. So even off the – even when I was on the pill the periods were still like that however they didn’t go for as long. They’d maybe be eight or nine days, but they would still be still quite painful and still very very heavy. So that was what the main issue was, is just the heaviness and I think it would then make me – I’d be so – and I don’t know; I never got tested when I was younger. If I had, like, an iron deficiency or something. But I think just the amount of bleeding and stuff like that just made me so lethargic. Then for the week after my period I would be really quite lethargic and tired and I just – I’d turn into this, like, you know, PMS monster sort of thing so… [laughter]
So I think, yeah, and I think – then when I went and seen the gynaecologist for the first time and he sort of said – I was, like, “What can I do to get them regular and to help with the pain?” and all of that sort of thing. When he said, you know, “Go and come back when you want a baby,” I kind of thought, ‘Well, if a gynaecologist is telling you this, obviously there’s, you know, the problem – the fix is a bandaid-ish problem. You just took the pill and that’s your fix, you know.’ So I didn’t really – that’s – and that’s all I’ve ever done now is just been on the pill to keep that regular and for them not to be as long, pretty much.
Interviewer: So during that time that you were getting your periods regular and trying [to conceive] with your previous partner, did the doctor kind of – what was their explanation for why it wasn’t happening?
Skye: From what – to be honest the explanation; I never really got a proper one. My understanding was that the eggs were not growing to the right size, so then when they were releasing they weren’t going to be fertilised. That’s what I kind of understood. But at the same time it was never really explained to me why it wasn’t happening. It was just, it’s not happening. So now I’m older and a bit wiser I probably would ask a lot more questions.
Aisha, then 28, was ‘shocked’ when her body initially didn’t respond to her first IVF cycle. Further testing revealed she had a low ovarian reserve for her age.
So my period came quite regularly and I wasn’t getting pregnant. I had read a little bit about online and I started looked at some forums about getting pregnant and I saw that if you didn’t get pregnant in a year and you were under 35 it was time to go to a GP. So we waited and finally when it had been a year I went to my GP and I asked her to refer me to a fertility specialist. She had done all the checks for my husband and myself and we were all healthy. So we went to see a fertility specialist. He reviewed all our test results and he didn’t find anything wrong either.
So we did timed intercourse for about three months and again, even with timed intercourse and having blood tests very often, nothing happened.
So after about three months he asked if we would like to try IUI but by that time we just said we just wanted a baby and if it meant going to IVF we just wanted to go straight there. Since I was quite young; I think I was about 28 years old at the time, the doctor started off giving me a dose of GONAL-F [follitropin alfa], which is one of the hormones that was suitable for a person my age.
And I basically, to my great surprise, had absolutely no response to the drugs whatsoever. I went for my first scan on day eight and basically nothing was happening at all. I was not growing any more eggs than what I normally grow so I think after one or two scans the cycle was cancelled, much to my surprise, and I was quite shocked because it had never occurred to me that IVF might not work; that I might not respond to the drugs. I didn’t even know that that was an option.
I did a lot of research online. Again, because I’m quite a scientific person. I went through a lot of forums and I found that this could happen where people don’t respond to the drugs and that there was a test called AMH [Anti-Mullerian Hormone] test that you could ask for where that result would then give you an indication of what your ovarian reserve was like. So I asked my doctor for that test and it came back at a very, very low result; only about 1.1 which is extremely low for my age at the time. At that time my husband and I were just going to just keep going and keep trying IVF until, over and over again. We weren’t willing to give up.
So the doctor doubled the dose of GONAL-F and we tried again. And much to our amazement, I managed to get five eggs on the second try and one of those eggs was put back in and became my beautiful little boy, who we’re very very blessed to have. After we had him, I knew how lucky we were.
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Kim shares her experience of deciding to try to have a baby as a single person in her early 40s, and how awareness of the impact of age on fertility influenced her decision-making.
So, yes, I had a first initial meeting with my specialist. She sent me away to do some tests like blood tests and then ultrasound just to check hormone levels and physically that there was nothing immediately wrong. That seemed to all come back fine. It was just mainly my age really because I was 41, 42 at that stage so obviously getting on a bit already. So I went back to her after my test results came back and she basically said, “If you’re thinking about this you should start straight away because of your age and go straight to IVF. There’s no point doing IUI.”
So, yes, then I enrolled with the clinic, started going through that process, doing all the counselling sessions and everything to get onboard and that process takes quite a long time anyway. I also started to research I suppose, do my own research.
I think during that time I kind of came to the conclusion that I wanted to change specialists because I didn’t necessarily gel very well with the one that I’d been referred to. You didn’t get a choice of people to be referred to. I suppose if I had done some research beforehand I could have said, “I want to go to this person,” but I kind of just got allocated to whoever my GP thought was the best person. So, yes, I suppose that thought that I wanted to make informed decisions I suppose all the way along made me really start researching properly.
So I ended up just reading a lot on forums and listening to podcasts and basically decided that because I wasn’t 100 per cent with the specialist I’d been sent to and because of my age I basically have sort of one shot to get this right. I don’t have the luxury of time. So I decided to pick a specialist with the CREI [Certificate in Reproductive Endocrinology and Infertility] speciality and one of the major clinics because I also knew that I would have to use donor sperm. So not all clinics have a sperm donor bank or have many options to choose from so that kind of narrowed down my choices anyway.
In terms of a treatment plan I probably decided that I had more money than time and because of age I was also quite worried about the risks of miscarriage and genetic abnormalities as well. So I kind of decided to go through with genetic screening as part of the process so I got myself fully screened and in my first round of ICSI I also got the embryo screened as well.
When Jacinta was 25, she and her husband began trying to conceive but were unable to. Although eventually they had their first child through IVF and conceived twice on their own after that, they have never had an explanation for their fertility problems.
Jacinta: In 2014 I got married and my husband and I decided that we would start trying for a baby straight away and after about 12 months there was still nothing happening. By this point my periods were extremely painful so I was taking days off work every month because of dealing with the pain. I’d gone off contraception obviously by that point so I wasn’t managing it through the pill or anything.
So I went to a female GP and she was absolutely incredible and straight away she said to me, “I think you might – I don’t know a huge amount about this but it sounds like endometriosis to me and I want to get you checked out immediately.”
So she referred me on to a wonderful obstetrician/gynaecologist here and she was brilliant.
She immediately booked me in for a laparoscopy just to investigate and see if there was any endo there and I got into that in about five weeks or something afterwards. It was a really quick process which was amazing. So she found a little bit of endo, not too much that she could see that it would cause any hindrance to getting pregnant. So, yes, did a laparoscopy. I think she did a hysteroscopy, flushed the tubes, did all of that kind of stuff that they would do in those initial investigations. Then we tried for a little bit longer just on my own and nothing was working still.
Interviewer: So the verdict was there was some endometriosis but not that much.
Jacinta: Yes. It was mainly – so the endo’s in the Pouch of Douglas which [laughter] was a body part that I did not even know existed but kind of the location of the endo. So they were able to laser what they could find off but where it was located it sort of wasn’t deemed that it would cause enough trouble to actually inhibit me getting pregnant. It was just something that was there. It could have been causing painful periods, possibly not. [laughter] It was just there. There was just a little bit there.
Interviewer: So what was your specialist giving you in terms of some sort of explanation as to why you weren’t getting pregnant?
Jacinta: So we’ve never known. We’ve always just – I guess the official diagnosis was unexplained infertility. There was no really obvious reason as to why it wasn’t working everything was working fine. I was ovulating really fine. I was producing really great quality follicles. Everything was working fine. The sperm analysis came back fine. It just wasn’t ever sticking.
A BRCA 1 genetic mutation carrier, Elena had to go through fertility preservation and IVF to have her baby because she’d had her uterine (fallopian) tubes removed to reduce her risk of ovarian cancer.
I carry a BRCA1 genetic mutation and my mother passed away when she was quite young as have most of the women in my family that have this genetic mutation. So I made a decision many years ago that I would undergo pre-implantation genetic testing before I had a family, or as part of my process for having a family. That meant undertaking IVF and testing the embryos before they were implanted back into me and selecting an embryo that didn’t have my BRCA1 genetic mutation.
As part of my being a carrier for this, I also needed to have my ovaries removed to reduce my own risk of ovarian cancer and doctors wanted to do that by the age of 35. I hadn’t had a family, but by the age of 38 I decided I would undergo fertility preservation, have my eggs harvested and frozen which I did. Then I decided to have my fallopian [uterine] tubes removed to reduce my risk of ovarian cancer, but it would also end my ability to fall pregnant naturally, so lock me into IVF as well.
The plan was to leave those eggs, find a partner and come back and have a family, but the doctors were advising me to get my ovaries removed by the age of 40. The more research I did the more I saw that it can take a lot of eggs and a lot of embryos to actually have a successful pregnancy. I knew that a lot of those eggs could be carriers for my BRCA gene so I didn’t know how many I needed would be enough to get enough embryos or any embryos. Would all the embryos die, would they be carriers, blah, blah, blah.
So then I made the decision that I would progress to have those eggs fertilised with a view to having a child on my own, to be a solo mum by choice.