What is subfertility?
Subfertility (infertility) is usually defined as not conceiving after 12 months of regular, unprotected intercourse. Most couples conceive within a year, but up to 1 in 6 experience difficulties. Fertility declines with age, particularly after 32, and causes are about equally split between female and male factors; sometimes both partners are affected or no cause is found.
When to consider a fertility check
- You’re under 35 and haven’t conceived after 12 months of trying
- You’re 35 or older and haven’t conceived after 6 months
- Your periods are very irregular, very infrequent or absent
- You have symptoms or history of endometriosis, pelvic inflammatory disease, fibroids or tubal surgery
- There’s a known male factor (e.g., testicular problems) or prior chemotherapy/radiation
- You’re planning pregnancy using donor sperm or assisted reproduction and want baseline testing
What happens at your GP fertility check
- History for both partners: previous pregnancies, time trying, intercourse timing, medicines and lifestyle (smoking, alcohol, drugs, caffeine, exercise).
- Female‑focused review: menstrual pattern, symptoms of endometriosis, contraception history (including depo‑provera), pelvic infections, fibroids, family history.
- Male‑focused review: erectile/ejaculatory issues, past STIs, testicular conditions (mumps, trauma, undescended testes, varicocele), surgery (hernia, vasectomy).
- Examination: BMI; targeted pelvic or scrotal exam only if indicated.
- Initial tests — women: preconception screen (blood group/antibodies, FBC, E/LFT, glucose/lipids, rubella/varicella immunity, HIV, hepatitis B/C, syphilis), urine MCS; STI screen if indicated; cervical screening if due;
- Ovulation confirmation: luteal‑phase progesterone (e.g., day‑21 in a 28‑day cycle, or 7 days before expected period).
- Hormones as needed: TSH; if irregular cycles consider prolactin and androgens (SHBG, testosterone, FAI ± DHEAS/androstenedione/17‑OHP).
- Pelvic ultrasound: to assess for PCOS, fibroids or other pelvic pathology (transvaginal preferred in the follicular phase).
- AMH blood test: may help estimate ovarian reserve; interpretation is nuanced and best discussed with your GP/specialist.
- Initial tests — men: semen analysis with repeat in 4–6 weeks if abnormal; STI testing if indicated; consider hormones (FSH, LH, prolactin, testosterone) and ultrasound based on findings.
Timing and simple steps to improve natural fertility
- Aim for sex every 2–3 days during the fertile window (the 5–6 days before and including ovulation). Sperm can live up to 5 days; the egg lasts 12–24 hours.
- Keep caffeine moderate; avoid smoking, recreational drugs and anabolic steroids; limit alcohol.
- Aim for a healthy BMI — high or very low BMI can reduce fertility. We can refer to a dietitian if helpful.
- Avoid sustained heat to the testes (saunas/hot tubs; very tight underwear).
- Consider prenatal vitamins; ensure rubella/varicella immunity and update vaccinations before trying to conceive.
- Ovulation kits and apps can assist with timing, but evidence for improving pregnancy rates is limited — use them only if they reduce stress.
Management and when we refer
- If anovulation related to PCOS: we manage lifestyle and medicines (e.g., metformin where appropriate) and, when indicated, refer for ovulation‑induction (letrozole or clomiphene) with a fertility specialist.
- If endometriosis or hydrosalpinx is suspected: we arrange gynaecology review.
- If semen analysis remains abnormal or azoospermia is found: we organise further testing and specialist referral; genetic tests may be recommended in some cases.
- We provide timely referrals for assisted reproduction (including IVF); referrals usually include both partners’ details (names and dates of birth).
- We can connect you with psychological support — fertility challenges can affect wellbeing.
Inclusive care
We welcome individuals and couples — including LGBTQIA+ people and single parents by choice — and can coordinate donor pathways with local fertility services.
