The terms subfertility and infertility are often used interchangeably, but they aren’t the same. Subfertility is a delay in conceiving. Infertility is the inability to conceive naturally after one year of trying.
In subfertility, the possibility of conceiving naturally exists, but takes longer than average. In infertility, the likelihood of conceiving without medical intervention is unlikely.
According to research, most couples are able to conceive spontaneously within 12 months of having regular unprotected intercourse.
Most of the causes of subfertility are the same as infertility. Trouble conceiving may be due to problems with male or female infertility, or a combination of both. In some cases, the cause is unknown.
The most common cause of subfertility is a problem with ovulation. Without ovulation, an egg isn’t released to be fertilized.
There are a number of conditions that can prevent ovulation, including:
- polycystic ovary syndrome (PCOS), which can prevent ovulation or cause irregular ovulation
- diminished ovarian reserve (DOR), which is a reduction in a woman’s egg count due to aging or other causes, such as a medical condition or previous ovarian surgery
- premature ovarian insufficiency (POI), also referred to as premature menopause, in which ovaries fail before the age of 40 due to either a medical condition or treatment, such as chemotherapy
- hypothalamus and pituitary gland conditions, which interfere with the ability to produce the hormones needed to maintain normal ovarian function
Fallopian tube obstruction
Blocked fallopian tubes prevent the egg from meeting the sperm. It can be caused by:
- pelvic inflammatory disease (PID)
- scar tissue from a previous surgery, such as a surgery for ectopic pregnancy
- a history of gonorrhea or chlamydia
The uterus, also called the womb, is where your baby grows. Abnormalities or defects in the uterus can interfere with your ability to get pregnant. This can include congenital uterine conditions, which are present at birth, or an issue that develops later.
Some uterine conditions include:
- septate uterus, in which a band of tissue divides the uterus into two sections
- bicornuate uterus, in which the uterus has two cavities instead of one, resembling the shape of a heart
- double uterus, in which the uterus has two small cavities, each with its own opening
- fibroids, which are abnormal growths inside or on the uterus
Problems with sperm production or function
Abnormal sperm production or function can cause subfertility. This can be caused by a number of conditions and factors, including:
- cancer and cancer treatment
- enlarged veins in the testes, called varicocele
- genetic defects, such as Klinefelter syndrome
Problems with sperm delivery
Problems with the delivery of sperm can make it difficult to conceive. This can be caused by a number of things, including:
- genetic conditions, such as cystic fibrosis
- premature ejaculation
- injury or damage to the testes
- structural defects, such as a blockage in the testicle
Certain factors increase your risk for subfertility. Many of the risk factors are the same for male and female subfertility. These include:
A fertility specialist can help diagnose the cause of subfertility. A doctor will begin by collecting the medical and sexual history of both partners.
A fertility evaluation will also include a number of tests. Tests that may be ordered for women include:
- transvaginal ultrasound to check the reproductive organs
- blood tests to measure hormone levels related to ovulation
- hysterosalpingography to evaluate the condition of the fallopian tubes and uterus
- ovarian reserve testing to check the quality and quantity of eggs
Tests for men may include:
Being subfertile rather than infertile means that it’s still possible to conceive naturally. So treatment for subfertility is focused on lifestyle changes and learning how to increase your chances of getting pregnant.
Medical treatments and other options are available if needed.
Boosting the odds for conception
Here are some lifestyle changes and tips that can increase your chances of conceiving naturally:
- Avoid smoking, which can affect male and female fertility.
- Stop drinking alcohol.
- Maintain a healthy weight, as being underweight or overweight can affect fertility.
- Use ovulation predictor kits to figure out the best time during your cycle to have intercourse.
- Track your basal body temperature to help determine when you’re most fertile.
- Avoid excessive heat, such as saunas, which can affect sperm production and motility.
- Cut back on caffeine, which has been linked to subfertility in women.
- Speak to a doctor about your medications, as some are known to affect fertility.
Medical treatment will depend on the cause of subfertility or infertility. Treatment varies between males and females.
Treatment for men
Treatment options for men may involve treating sexual health problems or:
- surgery to repair a varicocele or blockage
- medications to improve testicular function, including sperm count and quality
- sperm retrieval techniques to obtain sperm in males who have problems ejaculating or when ejaculated fluid doesn’t contain sperm
Treatment for women
There a few different therapies available to help restore female fertility. You may need only one or a combination of more than one to be able to conceive.
- fertility drugs to regulate or induce fertility
- surgery to treat uterine problems
- intrauterine insemination (IUI), which is placing healthy sperm inside the uterus
Assisted reproductive technology
Assisted reproductive technology (ART) refers to any fertility treatment or procedure that involves the handling of the egg and sperm.
In vitro fertilization (IVF) is the most common ART procedure. It involves retrieving a woman’s eggs from her ovaries and fertilizing them with sperm. The embryos are them implanted into the uterus.
Other techniques may be used during IVF to help increase the odds of conception. These include:
- intracytoplasmic sperm injection (ICSI), in which a healthy sperm is injected directly into an egg
- assisted hatching, which assists implantation by opening the outer covering of the embryo
- donor sperm or eggs, which may be used if there are severe problems with either the eggs or sperm
- gestational carrier, which is an option for women without a functional uterus or those who are considered high-risk for pregnancy
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Most experts recommend talking to a doctor after trying to conceive for one year for women younger than 35, or after six months for women older than 35.
People with known medical conditions or injuries that can affect pregnancy should see a doctor before trying to conceive.
Subfertility means that trying to conceive is taking longer than what is typically expected. Although this can be frustrating, certain lifestyle changes can increase your chances of conception.
Speak to a doctor if you’re concerned about your fertility.