Although many couples believe that becoming pregnant is easy, around one in seven heterosexual couples in the UK have difficulty conceiving. According to recent reports there has been a rise in infertility rates over the last 60 years.
Infertility is when a couple can’t get pregnant despite having regular unprotected sex (every two to three days). It’s usually only diagnosed when a couple haven’t managed to conceive after a year of trying.
The journey of infertility is different for everyone. While it can be an exhausting and emotional challenge, there are plenty of supportive organisations out there able to offer support. Whether it’s online resources, group forums or helplines to receive confidential emotional support. If you’re struggling with infertility try to remember that you are not alone and that help is available.
This article will cover:
- Types of infertility
- Causes of infertility
- Risk factors
- Impact on mental health
- Getting a diagnosis
- Treatment
- Fertility treatment and work
- Ways to boost fertility
- Further support
Types of infertility
There are two types of infertility:
- Primary infertility – where someone who’s never conceived a child in the past has difficulty conceiving.
- Secondary infertility – where someone has had one or more pregnancies in the past, but is having difficulty conceiving again.
What causes infertility?
There are many possible causes of infertility, and problems can affect both men and women. According to British Fertility Society, approximately 30% of fertility problems are due to the woman, 30% due to the man, and 30-40% to both or unknown causes.
Common causes of infertility amongst women include:
- Lack of regular ovulation (the monthly release of an egg).
- Blocked or damaged fallopian tubes.
- Endometriosis, where tissue that behaves like the lining of the womb (the endometrium) is found outside the womb.
- In men, the most common cause of infertility is poor quality semen.
Risk factors
Certain risk factors can increase the possibility of infertility in both men and women. These include:
- Age – both female and male fertility declines with age. The biggest decrease in fertility occurs around the mid-30s for women.
- Weight – being overweight or obese decreases your fertility. Being severely underweight or overweight can affect a women’s menstrual cycle and can, in some cases, cause it to stop completely.
- Sexually transmitted infections (STIs) – several STIs, including chlamydia, can affect fertility.
- Smoking – there is an association between smoking and a reduction in semen quality amongst men. Both smoking and passive smoking can negatively impact a woman’s fertility.
- Alcohol – drinking too much alcohol can reduce the quality of a man’s sperm.
- Stress – high stress levels can result in a loss of sex drive, and in severe cases it can negatively affect both sperm production and ovulation.
- Environmental Factors – certain solvents, pesticides and metals have been shown to negatively affect fertility, especially in men.
The impact on mental health
The road to fertility can be a lengthy process and take its toll on mental health. According to a report in the National Library of Medicine, those struggling to conceive experienced feelings of depression, anxiety, isolation and loss of control. It also mentioned that the inability to conceive can cause feelings of shame, guilt and low self-esteem.
A survey by Fertility Network UK found that four out of 10 experienced suicidal feelings (30% some of the time or occasionally, and 10% often or all of the time). It also found that 47% of respondents experienced feelings of depression, while the vast majority (83%) felt sad, frustrated and worried often or all of the time.
The stress of it all can also impact the relationship with your partner, adding strain and tension onto your relationship. Or for others, the journey can bring you closer together.
If your mental health is struggling during infertility it’s important to reach out for support. For example, you could see your GP to check what mental health services are available in your area. It is also worth checking what mental health support is available through your employer.
Getting a diagnosis
You should consider seeing your GP if you haven’t conceived after more than a year of trying. However, you should consider seeing them sooner if you are a woman over the age of 36 years old or if you have any other reason to be concerned about your fertility. For example, if you have previously had an STI or you’ve had treatment for cancer.
Treatment
There are three main types of fertility treatment:
- Medicines
- Surgical procedures
- Assisted conception – including intrauterine insemination (IUI) and in vitro fertilisation (IVF).
The availability of NHS treatment for fertility varies across the UK so it is best speaking to your GP to find out what services are accessible to you.
You can also choose to pay for fertility treatment privately. If you do decide to go down this route be sure to choose a private clinic carefully. Find out what clinics are available, treatments they offer, treatment success rates, the length of the waiting list, the costs and make sure the clinic is licensed by the Human Fertilisation and Embryology Authority (HFEA). You can also ask your GP for advice on choosing a private clinic.
Fertility treatment and work
Fertility investigations and treatment historically have been issues that employees have hidden for various reasons, and therefore open discussions with an employer about a supportive work environment haven’t always taken place.
Making compassionate employee support available as well as helping employees access adjustments at work allows the employee to work to the best of their ability, retains valuable talent and reduces the chance of long-term absence and the significant impact this can have on other team members and the business.
Fertility challenges, investigations and treatment should be recognised as an important workplace wellbeing issue. Most people in this situation will find it difficult to balance the demands of their situation alongside paid employment. These challenges can be compounded by a lack of understanding and openness regarding fertility issues, which can in turn prevent them from seeking support.
Employers are encouraged to have an effective framework of support to ensure that employees who are experiencing fertility challenges, investigations or treatment are managed fairly.
The legal context
At the point the embryo is transferred to the uterus, case law states that the woman is pregnant and is therefore protected under the same employment legislation as anyone else who discloses their pregnancy to their employer.
The employee is automatically protected against discrimination under the Equality Act 2010. The challenge is encouraging employees to share this information with their employer so that they know they are protected.
Sex discrimination legislation may also be a consideration at the point of egg collection. The Equality Act 2010 does not consider that infertility is a disability.
Future legislative developments
The Fertility Treatment (Employment Rights) Bill has been presented to the House of Commons and is progressing through the various stages. The bill would set out an employee’s right to take paid time off to attend fertility treatment-related appointments. Private members’ bills can take years to make it to the statute book (into UK law).
In the meantime, the voluntary Fertility Workplace Pledge that employers can sign up to contains four steps:
- Accessible information – Having an accessible workplace fertility policy to create an open culture free from stigma; to make sure employees feel comfortable in the workplace; and to prevent the best talent from leaving.
- Awareness in the workplace – Establishing the role of a fertility ambassador to open conversations internally and make people aware of available support.
- Staff training – Making sure line managers understand the realities of treatment for employees, including the physical, mental and financial impact – and how they can support someone going through it.
- Flexible working – Giving the right for employees to request flexible working, including reasonable working adjustments, so they can attend appointments.
Things you can do to help enhance your chances of conception
- Have sex every two to three days without using contraception.
- Try to have sex around the time you are ovulating.
- Women should take folic acid every day while trying to conceive.
- Eat a healthy balanced diet.
- Maintain a healthy weight.
- Stop or cut down on alcohol.
- Stop smoking.
- Keep up regular physical activity.
- Managing stress using healthy strategies.
Fertility issues are often a hidden struggle, but talking to someone you trust about how you are feeling can help to alleviate some of the emotional pressure and stress. It also gives people around you the opportunity to support you, and check-in to see how you are doing.
Further support
The Fertility Network UK – Provides a number of support groups, both nationwide and online, that will give you the opportunity to share your story and get advice from others who are also trying to conceive. Call their helpline on 0121 323 5025.
Support Line – List of organisations and helplines you can use for support.
Having a baby if you’re LGBTQ+ – The NHS provide an overview of the different options available.
Miscarriage Association – Support for those affected by miscarriage, molar pregnancy or ectopic pregnancy.
NHS IVF Overview – Information about getting started, risks and support.
Online Support Groups in Scotland – The Fertility Network UK list different groups you can reach out to online.
Fertility Scotland – Fertility support.
Download this information as a PDF.
Sources:
nhs.uk/conditions/infertility
fertilitynetworkuk.org
This information was published November 2023.
