Fertility Conditions
Fertility Conditions
Several common health conditions can affect a woman's ability to conceive. Many are treatable or manageable with the right support. This guide provides evidence-based overviews of the most common fertility-affecting conditions.
For educational purposes only. Always consult your GP or fertility specialist for diagnosis and treatment.
Polycystic Ovary Syndrome (PCOS)
PCOS is the most common cause of anovulatory infertility, affecting approximately 1 in 10 women. It is characterised by hormonal imbalance (elevated androgens), irregular or absent ovulation, and polycystic-appearing ovaries on ultrasound.
How PCOS affects fertility
Irregular or absent ovulation means fewer opportunities to conceive each year. Insulin resistance (present in up to 70% of women with PCOS) further disrupts hormonal balance and ovulation.
Management for fertility
- Weight loss of 5–10% (if overweight) can restore ovulation in many women
- Myo-inositol (2–4g daily) improves insulin sensitivity and ovulation
- Metformin may be prescribed to improve insulin sensitivity
- Ovulation induction with letrozole or clomifene
- IVF if other treatments are unsuccessful
Endometriosis
Endometriosis affects approximately 1 in 10 women and is present in up to 50% of women with infertility. It can affect fertility through distorted pelvic anatomy, impaired egg quality, and a hostile environment for implantation.
Management for fertility
- Laparoscopic surgery to remove endometriosis deposits can improve natural conception rates
- IVF is often recommended for moderate to severe endometriosis
- Anti-inflammatory nutrition and omega-3 supplementation may reduce inflammation
Thyroid Disorders
Both hypothyroidism and hyperthyroidism can impair fertility. Thyroid hormones regulate the menstrual cycle, ovulation, and implantation. Even subclinical hypothyroidism (mildly elevated TSH with normal T4) is associated with reduced fertility and increased miscarriage risk.
Management
TSH should ideally be below 2.5 mIU/L when trying to conceive. Levothyroxine is prescribed for hypothyroidism. Selenium and iodine support thyroid function. All women trying to conceive should have thyroid function tested.
Diminished Ovarian Reserve (DOR)
Ovarian reserve refers to the quantity and quality of a woman's remaining eggs. DOR is diagnosed by low AMH (anti-Müllerian hormone), low antral follicle count on ultrasound, and/or elevated day 3 FSH. It becomes more common with age but can affect younger women too.
Management
- CoQ10 (400–600mg daily) has evidence for improving egg quality in women with DOR
- DHEA supplementation is used in some fertility clinics to improve ovarian response (under medical supervision only)
- IVF with own eggs or donor eggs depending on severity
Uterine Conditions
Fibroids
Non-cancerous growths in or on the uterus. Submucosal fibroids (inside the uterine cavity) have the greatest impact on fertility and implantation. Surgical removal (myomectomy) may be recommended before IVF.
Polyps
Endometrial polyps are overgrowths of the uterine lining. They can interfere with implantation and are removed by hysteroscopy.
Asherman's Syndrome
Scar tissue (adhesions) inside the uterine cavity, usually following uterine surgery or infection. Can cause absent periods and implantation failure. Treated by hysteroscopic removal of adhesions.
Unexplained Infertility
Approximately 25% of couples with infertility receive a diagnosis of unexplained infertility — meaning no identifiable cause is found after standard investigations. This does not mean nothing is wrong; it means current tests have not identified the cause. Options include expectant management, ovulation induction, IUI, and IVF.