What Is Infertility?

  • 1st Revision: Holly Morgan


Facing infertility can be upsetting if you and your partner are considering starting a family. It can also create other problems concerning your own health depending on the root cause.

Different conditions cause infertility in those assigned male at birth (AFAB) - i.e. sperm production, hormonal deficiency or a structural defect in the reproductive organs - and those assigned female at birth (AFAB) - i.e conditions that affect the production of an egg from the ovaries and/or the implantation of a fertilised egg into the uterine lining.  

It is important to get diagnosed and receive treatment for any underlying health condition causing infertility. This can ultimately improve your chances of successfully conceiving in a natural way and will enable doctors to assess your suitability for fertility treatments. 

Causes of infertility

Male (AMAB) infertility

Problems with fertility can arise when sperm is not present in enough quantity in the ejaculate fluid and/or when sperm is not mobile enough to reach an egg for fertilisation. 

Hypergonadotropic hypogonadism 

People AMAB may be affected with hypergonadotropic hypogonadism (impaired response of the testes to hormones) and  experience a reduced testicular function due to low testosterone and other androgen hormone production.1 This will ultimately result in low count and/or quality sperm that is less likely to successfully fertilise an egg during conception.  

Underlying health problems

Low count and low quality sperm could also indicate health problems including:

  • Sexually transmitted infections (STIs)2  
  • Autoimmune antisperm antibodies3 
  • Testicular tumours4 
  • Genetic conditions such as Klinfelter’s syndrome5

Structual problems in the reproductive organs

Infertility can also arise in men with defects in the structure and function of the reproductive organs.6,7,8

Structural problems include:


You will also be unable to conceive naturally after certain surgeries, for example, a vasectomy or a prostatectomy. Radiation and chemotherapy can also reduce your sperm count and quality, affecting fertility.9

Female (AFAB) infertility

Primary ovarian insufficiency 

Primary ovarian insufficiency (POI) also known as early menopause can affect you while you are young and still going through your menstrual cycle.10 The main symptoms of POI are the absence of menstrual bleeding (period) and the failure of the ovary to release an egg. An absence of an egg during ovulation means there is little chance of falling pregnant from unprotected intercourse as there is no egg present to be fertilised by a sperm.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a condition that can affect anyone assigned female at birth (AFAB). Individuals with PCOS are likely to experience infertility due to:11

  • Abnormally high androgen hormone levels
  • Irregular periods/menstrual bleeding 
  • Ovarian cysts 


Endometriosis is a condition that causes extra uterine tissue to grow outside of the uterus. Patients can experience painful, heavy and/or irregular periods.12 Endometriosis often (somewhere between a third and a half of all cases) causes infertility due to excess endometrial tissue interfering with the functional structure of the reproductive system.  

Uterine Fibroids/Polyps 

Uterine fibroids are benign (non-cancerous) growths of muscle/fibrous tissue that occur inside and on the uterus.13 They can cause a number of symptoms including pelvic pain, abnormal periods and infertility.

Uterine polyps are a different diagnosis with similar symptoms.14 Polyps are made up of excess endometrial tissue and are mostly considered benign though some can become cancerous. 

Management and treatment for infertility

Male (AMAB) infertility

Infertility treatments for people AMAB mainly focus on counteracting low sperm count and/or low quality sperm caused by hypergonadotropic hypogonadism. This is done through gonadotropin therapy where patients are treated with two reproductive hormones (human chorionic gonadotropin and follicle stimulating hormone) which enhance sperm production.15

Assisted reproduction techniques are also used to improve the chances of sperm fertilising an egg including: 

  • In vitro fertilisation (IVF) - where a specialised fertility clinic will use a sperm sample to fertilise extracted eggs in a lab and implant them into the uterus
  • Intracytoplasmic sperm injection - similar to IVF but one sperm in injected into the egg in a lab to allow fertilisation before intrauterine implantation

If you don’t respond to treatment you might want to consider using a sperm donor. Sperm samples taken from donors are thoroughly screened for genetic and transmissible diseases so they are of the highest possible quality for fertilising an egg and producing a viable embryo. 

Female infertility

Hormone treatment is often recommended to patients with POI and PCOS to balance out the menstrual cycle and reduce symptoms associated with infertility.10,11 

Endometriosis and uterine fibroids/polyps can be treated through surgery if necessary.12,13,14

You may also be recommended for fertility treatment if you are struggling to conceive naturally while dealing with a reproductive health issue. Treatments include intrauterine insemination (IUI) or implantation of IVF embryos, though not all patients will be suitable for these kinds of treatments because the chance of successful implantation of a fertilised egg into the uterus with certain conditions is still low.

In such a case that you are unable to carry your own pregnancy you may consider surrogacy. This may be an option provided that your AMAB partner or sperm donor has no fertility issues themselves.

Risk factors

Other commonly identified risk factors for both AMAB and AFAB infertility include:16

  • Drinking alcohol 
  • Smoking 
  • Obesity 
  • Being extremely underweight 
  • Stress 

Diagnosis of infertility

Doctors would consider you as having an issue with infertility if you have not been able to conceive after around 1 year of having consistent unprotected sex.13 

You should contact your GP to discuss your symptoms if you believe you are suffering from infertility or an associated reproductive health issue. You will then most likely be referred to a doctor specialised in reproductive health and fertility.


Preventing infertility will usually involve limiting your exposure to its risk factors such as limiting your consumption of alcohol, cutting your usage of cigarettes, following a healthy diet and exercise regime, and looking after your mental wellbeing.16

However, even with lifestyle changes infertility cannot be completely prevented if it is caused by, for example, a genetically inherited condition or another reproductive health issue that is hard to manage and treat. 


How common is infertility

Infertility affects approximately 10% of couples across the world. It is equally as common in those AMAB as it is in those AFAB.17

When should I see a doctor

You should see a doctor if you are trying to conceive and are worried about you or your partner's reproductive health. Conceiving naturally can take up to a year to be successful so it is important to consider this before trying expensive and potentially invasive treatments.13

You should see your doctor if you are experiencing symptoms of any of the mentioned reproductive health conditions. Your doctor will be able to diagnose you, help you manage pain and avoid complications.


Infertility can be stressful and life-altering ailment to deal with. It is important that as well as receiving treatment for any physical symptoms of your reproductive health condition, you also look after your mental wellbeing. Don’t hesitate to reach out to your doctor, a counselling service and others like your partner, friends or family if you are struggling mentally. There are many supports and treatments available to increase your chances of successful pregnancy - your doctor or fertility clinic will be able to guide you in the direction that is best for your situation. 


  1. Ferlin A, Garolla A, Ghezzi M, Selice R, Palego P, Caretta N, et al. Sperm count and hypogonadism as markers of general male health. European Urology Focus [Internet]. 2021 Jan 1 [cited 2023 May 12];7(1):205–13. Available from: https://www.sciencedirect.com/science/article/pii/S240545691930210X 
  2. Pellati D, Mylonakis I, Bertoloni G, Fiore C, Andrisani A, Ambrosini G, et al. Genital tract infections and infertility. European Journal of Obstetrics & Gynecology and Reproductive Biology [Internet]. 2008 Sep 1 [cited 2023 May 12];140(1):3–11. Available from: https://www.sciencedirect.com/science/article/pii/S030121150800136X 
  3. Cui D, Han G, Shang Y, Liu C, Xia L, Li L, et al. Antisperm antibodies in infertile men and their effect on semen parameters: A systematic review and meta-analysis. Clinica Chimica Acta [Internet]. 2015 Apr 15 [cited 2023 May 12];444:29–36. Available from: https://www.sciencedirect.com/science/article/pii/S0009898115000558 
  4. Ammar T, Sidhu PS, Wilkins CJ. Male infertility: the role of imaging in diagnosis and management. BJR [Internet]. 2012 Nov [cited 2023 May 12];85(special_issue_1):S59–68. Available from: http://www.birpublications.org/doi/10.1259/bjr/31818161 
  5. Deebel NA, Bradshaw AW, Sadri-Ardekani H. Infertility considerations in klinefelter syndrome: From origin to management. Best Practice & Research Clinical Endocrinology & Metabolism [Internet]. 2020 Dec 1 [cited 2023 May 12];34(6):101480. Available from: https://www.sciencedirect.com/science/article/pii/S1521690X2030107X 
  6. Jensen CFS, Østergren P, Dupree JM, Ohl DA, Sønksen J, Fode M. Varicocele and male infertility. Nat Rev Urol [Internet]. 2017 Sep [cited 2023 May 12];14(9):523–33. Available from: https://www.nature.com/articles/nrurol.2017.98 
  7. Rohayem J, Luberto A, Nieschlag E, Zitzmann M, Kliesch S. Delayed treatment of undescended testes may promote hypogonadism and infertility. Endocrine [Internet]. 2017 Mar 1 [cited 2023 May 12];55(3):914–24. Available from: https://doi.org/10.1007/s12020-016-1178-0 
  8. Jarzabek K, Zbucka M, Pepiński W, Szamatowicz J, Domitrz J, Janica J, et al. Cystic fibrosis as a cause of infertility. Reprod Biol. 2004 Jul 1;4(2):119–29. 
  9. Meistrich ML. The effects of chemotherapy and radiotherapy on spermatogenesis in humans. Fertil Steril [Internet]. 2013 Nov [cited 2023 May 12];100(5):10.1016/j.fertnstert.2013.08.010. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826884/ 
  10. Hernández-Angeles C, Castelo-Branco C. Early menopause: A hazard to a woman’s health. Indian J Med Res [Internet]. 2016 Apr [cited 2023 May 12];143(4):420–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928547/ 
  11. Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome. P T [Internet]. 2013 Jun [cited 2023 May 12];38(6):336–55. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737989/ 
  12. Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet [Internet]. 2010 Aug [cited 2023 May 12];27(8):441–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/ 
  13. Freytag D, Günther V, Maass N, Alkatout I. Uterine fibroids and infertility. Diagnostics (Basel) [Internet]. 2021 Aug 12 [cited 2023 May 12];11(8):1455. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391505/ 
  14. Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med [Internet]. 2019 May 2 [cited 2023 May 12];7:2050312119848247. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501471/ 
  15. Rajkanna J, Tariq S, Oyibo SO. Successful fertility treatment with gonadotrophin therapy for male hypogonadotrophic hypogonadism. Endocrinol Diabetes Metab Case Rep [Internet]. 2016 [cited 2023 May 12];2016:150124. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4722247/ 
  16. Rossi BV, Abusief M, Missmer SA. Modifiable risk factors and infertility. Am J Lifestyle Med [Internet]. 2016 Jun 23 [cited 2023 May 12];10(4):220–31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007064/ 
  17. Agarwal A, Baskaran S, Parekh N, Cho CL, Henkel R, Vij S, et al. Male infertility. The Lancet [Internet]. 2021 Jan 23 [cited 2023 May 12];397(10271):319–33. Available from: https://www.sciencedirect.com/science/article/pii/S0140673620326672 
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Amy Murtagh

BSc Veterinary Bioscience - Bachelors of Science, University of Glasgow

Amy is a recent graduate from Glasgow's School of Biodiversity, One Health and Veterinary Medicine with a particular interest in science communication in these subject areas.

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