subfertility, infertility, subfertility causes, subfertility in men

What do you know about Subfertility

Subfertility, also known as infertility, is failure to conceive after 12 months of regular unprotected intercourse. But there is no one universal definition of subfertility. However, delay in conception is one of the commonest reasons that a woman will consult her doctor. So you can find subfertility causes and available treatment options in this article.

About one in seven couples are suffering from subfertility. But most couples are afraid to get treatment services because of the social stigmata. However, there is an increment of couples getting treatments for subfertility over the last 10 years in UK. Because now there is an increased acceptance of fertility treatments.

There are specialized centers in almost all countries in the world to diagnose and treat subfertility. Therefore many of the couples who are suffering are getting treatments successfully.

Risk factors

  • Most important factor is female age. Because increased age reduces the quality and quantity of eggs. Actually, female fertility tends to fall sharply over age of 36. It dips further after age of 40 according to studies.
  • Male age is also an important factor. Quality and quantity of semen also tend to fall in men over age of 50. Also some studies suggest that the frequency of intercourse tends to fall in men over the age of 40.
  • Frequency of intercourse is another factor. For an example, couples having sex 3 times a week are 3 times more likely to conceive than couples having sex once a week. So have sex more frequently. It’s good for your physical health also.
  • Correct timing of intercourse is also important. Eggs are fertilizable for about 12-24 hours after ovulation. Usually ovulation occurs about 14 days before the menstruation. And sperms can survive in the female reproductive tract about 72 hours. Therefore, best time to have sex is between days 12 and 15 of woman’s menstrual cycle. This period is applicable only if woman’s menstrual cycle is of 28 days.
  • Smoking can decrease the quality and quantity of eggs. Alcohol and other substance are the same. So stop smoking and other substances.
  • BMI or Body Mass Index is another risk factor. Both higher and lower extremes of BMI reduces the chances of conceiving.
  • Stress has a direct effect with ovulation. It affects hypothalamus and pituitary. And interferes with regular ovulation. And also reduces the libido and hence frequency of intercourse.

Causes of subfertility

Did you know? In most of countries male subfertility is commoner than female subfertility. In UK it’s equal. Here are some common causes of male and female subfertility.

Female subfertility

Ovulation disorders

  • Polycystic ovary syndrome (PCOS) is the commonest cause
  • Hypothalamic disorders
  • Hyperprolactinemia
  • Premature ovarian failure
  • Thyroid diseases

Fallopian tube problems

  • Pelvic inflammatory disease (PID)
  • Endometriosis
  • Chlamydial infection

Uterine problems

  • Fibroids inside the uterus (Submucosal fibroids)
  • Polyps
  • Scarring of endometrium (Asherman’s syndrome)

Male subfertility

  • Inflammation of testes and epididymis (epididymo-orchitis)
  • Pelvic radiation
  • Previous surgeries for undescended or torted testes
  • Medical conditions like diabetes
  • Some chemicals
  • Erectile dysfunction and problems with ejaculation
  • Klinefelter syndrome

Diagnosis of subfertility

There are several blood tests and imaging investigations available for the diagnosis.

Blood tests

  • Follicular stimulating hormone (FSH) level
  • Luteinizing hormone (LH) level
  • Anti-Mullerian hormone (AMH) level
  • Thyroid function tests
  • Prolactin and testosterone levels


  • Transvaginal ultrasound scan is best for measuring ovarian reserve. Ovarian reserve is remaining number of oocytes, before developing into eggs, in the ovaries. If it’s good, response to the treatment is also better.
  • Hysterosalpingography is used to assess the patency of Fallopian tubes.
  • Semen analysis is the only routine investigation for men


Several treatment options are available. It may deffer from individual to individual. Here are the commonest options:

  • Ovulation induction
  • Surgery
  • Assisted reproductive technology

Ovulation induction

Ovulation induction is the first line treatment in PCOS. If there is no problem in tubes and uterus, this method is used.

Clomiphene citrate, letrozole and injectable gonadotrophins are available as treatments. Laparoscopic ovarian drilling is also another available method.


This may depend on the cause of subfertility. If subfertility is due to ovarian cysts, tubal problems or uterine fibroids surgery is useful.

Intrauterine insemination (IUI)

In this method a small sample of prepared sperms is inserted into the uterine cavity with a fine uterine catheter.

Intrauterine insemination is helpful in male infertility and mild endometriosis.

In-vitro fertilization (IVF)

If the women having some tubal problems the egg can’t come into the uterine cavity because of the obstruction. Then doctors can fertilize the egg outside and implant into the uterine cavity.

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