Infertility Explained
Understanding Infertility, Common Causes, and the First Steps Towards Finding Answers
Hearing the word "infertility" can be frightening.
You may have been trying to conceive for months or years, wondering why it hasn't happened yet. You might be feeling confused, frustrated, hopeful, exhausted—or all of those emotions at once.
If that's where you are today, you're not alone.
Infertility affects millions of people around the world, and while every journey is different, one thing is true for everyone:
Infertility is a diagnosis that deserves investigation—not a reason to give up hope.
This guide explains what infertility means, some of the possible causes, and what usually happens next.
What is Infertility?
Infertility is generally defined as not becoming pregnant after:
12 months of regular unprotected sex if you're under 35 years old.
6 months if you're 35 or older, as fertility naturally declines with age.
Your healthcare professional may recommend earlier assessment if you have known risk factors such as absent periods, previous pelvic infections, endometriosis, chemotherapy, or previous surgery involving the reproductive organs.
Infertility is not a diagnosis in itself.
It simply means that pregnancy has not happened within the expected timeframe and that further assessment may be appropriate.
Is Infertility Common?
Yes.
Infertility is much more common than many people realise.
Many individuals and couples experience difficulties conceiving, although the reasons vary widely.
Some causes are straightforward to identify and treat.
Others take longer to uncover.
In some cases, no clear cause is ever found.
What Can Cause Infertility?
Pregnancy depends on many things happening at exactly the right time.
A problem affecting any stage of that process may make conception more difficult.
Possible causes include:
Problems with Ovulation
If an egg isn't released regularly, pregnancy cannot occur naturally.
Conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders may affect ovulation.
Fallopian Tube Problems
The Fallopian tubes allow the egg and sperm to meet.
Damage, scarring or blockages—including hydrosalpinx—can prevent this from happening.
Endometriosis
Endometriosis may affect fertility in several different ways, including inflammation, adhesions and damage to the reproductive organs.
Uterine Conditions
Fibroids, polyps, congenital uterine differences or other conditions may sometimes affect fertility or implantation.
Male Factor Infertility
Around half of infertility cases involve male factors either on their own or alongside female factors.
A semen analysis is therefore an important part of fertility investigations.
Age
Fertility naturally changes with age.
While many people conceive in their late thirties and forties, both egg quantity and egg quality tend to decline over time.
Lifestyle Factors
Smoking, excessive alcohol intake, obesity, being significantly underweight and some medical conditions may affect fertility.
Making healthy lifestyle changes can improve fertility for some people, although they are not a cure for every underlying condition.
Unexplained Infertility
Sometimes all investigations appear normal, yet pregnancy still doesn't occur.
This is known as unexplained infertility.
Receiving this diagnosis can be particularly difficult because there may not be a clear answer or treatment pathway.
What Investigations Might Be Offered?
Your healthcare professional may recommend investigations such as:
blood tests
ultrasound scans
HSG or HyCoSy
semen analysis
ovulation assessment
thyroid testing
further specialist investigations if required
These tests help build a picture of your reproductive health and identify any factors that may be affecting fertility.
What Happens After the Tests?
The next step depends on your results.
You may be:
reassured that everything appears normal
offered treatment for an underlying condition
referred to a fertility specialist
advised to continue trying naturally
offered assisted conception such as IVF or IUI
Every fertility journey is different.
Looking After Your Emotional Wellbeing
Infertility is more than a medical diagnosis.
Many people experience grief, frustration, anxiety, loneliness or guilt during their journey.
It's important to remember that needing fertility investigations or treatment says nothing about your worth, your strength or your ability to become a parent.
Seeking support—from loved ones, support groups or healthcare professionals—can make a real difference.
Questions You May Wish to Ask Your Doctor
What investigations do you recommend?
Have both partners been assessed?
What do my test results mean?
Are there any lifestyle changes that may help?
Should I be referred to a fertility specialist?
What are the next steps?
How long should I expect to wait?
Key Points
✔ Infertility means pregnancy has not occurred within the expected timeframe.
✔ It is a reason to investigate—not a diagnosis of the underlying cause.
✔ There are many possible causes, affecting both women and men.
✔ Fertility investigations help identify the most appropriate next steps.
✔ Many people go on to build their families through a variety of pathways, including natural conception, fertility treatment, donor conception or adoption.
Related Guides
Start Here – Your Fertility Roadmap
What Happens at Your First Fertility Appointment?
Blood Tests Explained
Ultrasound Explained
HSG Explained
Endometriosis Explained
Hydrosalpinx Explained
Waiting for Results
A Personal Note
For twenty years, I lived with what was called "unexplained infertility."
Eventually, I discovered there was an explanation after all: both of my Fallopian tubes had been damaged by undiagnosed endometriosis, resulting in bilateral hydrosalpinx.
I can't promise that every person searching for answers will receive a diagnosis as clear as mine. Fertility journeys are incredibly varied, and some people continue to have unexplained infertility despite thorough investigations.
What I can promise is this: understanding the process, knowing what questions to ask, and learning how the different pieces fit together can make the journey feel less overwhelming.
That is why I created this website. My hope is that it helps you feel informed, supported and empowered—wherever you are on your own path to parenthood.