Overview
Fertility refers to the ability to conceive a pregnancy, and conception begins when a sperm joins with an egg. For pregnancy to happen, ovulation, sperm production, fertilization, and implantation in the uterus all need to occur. Many pregnancies happen within months of trying, but the time it takes can vary widely.
Causes and Risk Factors
Many factors can affect fertility, including irregular or absent ovulation, blocked fallopian tubes, endometriosis, fibroids, hormonal conditions, low sperm count, or problems with sperm movement. Age is an important factor because egg number and quality decline over time, and sperm quality can also change with age. Smoking, heavy alcohol use, some sexually transmitted infections, certain medicines, exposure to toxins, and being significantly underweight or overweight may also affect fertility.
Who Is Affected
Fertility challenges can affect people of any sex, gender, or background who are trying to conceive. Difficulty conceiving may involve female factors, male factors, both partners, or sometimes no clear cause after testing. People with irregular periods, a history of pelvic infection, undescended testes, cancer treatment, or known reproductive conditions may have a higher chance of fertility problems.
Prevention
Some causes of reduced fertility cannot be prevented, but protecting overall reproductive health may help. Steps include preventing sexually transmitted infections, avoiding tobacco and recreational drugs, limiting alcohol, managing chronic health conditions, and seeking medical care for menstrual problems, pelvic pain, or testicular concerns. If possible, discussing fertility preservation before treatments such as chemotherapy or radiation can also be important.
Diagnosis and Tests
A healthcare professional may ask about menstrual cycles, timing of sex, prior pregnancies, surgeries, infections, medicines, and overall health in both partners. Testing may include ovulation assessment, hormone blood tests, pelvic ultrasound, semen analysis, and sometimes imaging or procedures to look at the uterus and fallopian tubes. Evaluation is often suggested after 12 months of trying if the female partner is under 35, after 6 months if age 35 or older, or sooner if there are known risk factors or absent periods.
Treatment Categories
Treatment depends on the cause and may include lifestyle changes, treatment of underlying medical conditions, medicines to support ovulation, surgery for certain structural problems, or assisted reproductive technologies such as intrauterine insemination or in vitro fertilization. Male-factor fertility problems may be addressed with evaluation and treatment of hormone issues, varicoceles, or sperm-related concerns. A fertility specialist can explain possible benefits, limits, costs, and risks of different options.
Diet and Lifestyle
Healthy habits may support reproductive health, even though they do not guarantee pregnancy. These include getting regular physical activity, aiming for a weight range that supports health, eating a balanced diet, sleeping well, and reducing stress where possible. Avoiding tobacco, anabolic steroids, overheated testicles from frequent hot tubs or saunas, and exposure to harmful chemicals may also help some people.
When to Seek Medical Care
Talk with a healthcare professional if you have been trying to conceive without success, if periods are very irregular or absent, or if there is pelvic pain, painful sex, repeated pregnancy loss, erectile or ejaculation problems, or testicular pain or swelling. Seek earlier advice if there is a history of endometriosis, pelvic inflammatory disease, sexually transmitted infections, cancer treatment, or known reproductive conditions. Preconception care is also helpful for people planning pregnancy, especially if they have chronic health conditions.
Questions to Ask a Healthcare Professional
You may want to ask what factors could be affecting fertility, when testing should begin, and whether both partners should be evaluated. Other useful questions include which tests are recommended, what treatment categories might fit your situation, and how age or medical history could affect chances of conception. If treatment is being considered, ask about likely timelines, side effects, emotional support, and financial planning.