The key questions are why are you struggling to get pregnant and what can you do about it?

There are many reasons why you may be having trouble. The most common reasons relate to eggs, sperm or the fallopian tubes.

Problems related to the eggs
A normal ovary has a good store of eggs, and releases an egg every month. With eggs, you can have two problems. First relates to the number of eggs in the ovaries. The egg number could be very low. A woman with low number of eggs is said to have a poor ovarian reserve. It is simple to check for this condition with blood tests (FSH blood test, or ideally an AMH blood test) and a pelvic ultrasound scan to assess for the follicle count in the ovary.

The second egg problem relates to the eggs not being released from the ovaries. This is called anovulation, and it is often related to a condition called polycystic ovary syndrome. Clinical symptoms include long menstrual cycles, putting on weight, excessive body hair and acne. Simple hormone blood tests and a pelvic ultrasound scan will help diagnose polycystic ovary syndrome. A blood test, urine test or ultrasound scan can be used to check for ovulation.

Problems related to the sperm
Sperm problems can be related to the number (or the concentration), movement (motility) or the shape (morphology) of the sperm. A sperm test will look at all three of these issues: sperm concentration needs to be more than 15million per millilitre of semen. Normal sperm motility, or movement, is when at least 40% of sperm are moving. Finally, we want at least 4% of sperm to have normal shape (normal morphology).

Sometimes a sperm test may show absence of sperm.

Sometimes it may be necessary to do advanced sperm tests such as sperm DNA fragmentation assessment to unearth sperm related fertility problems.

Problems related to the Fallopian tubes
Finally, there may be a problem with the fallopian tubes. A fallopian tube can be blocked, or the tube lining can be damaged. We can look for blocked fallopian tubes using an X-ray test called hysterosalpingogram or an ultrasound dye test called HyCoSy. Sometimes it may be necessary to do an operation called laparoscopy which involves the surgeon inserting a camera through the belly button to fully assess the fallopian tubes with a dye test. Some blocked tubes can be treated with surgery, but for most women, IVF will be necessary. Do watch our video on Fallopian tubes and infertility.

So, we have discussed egg, sperm and fallopian tube problems as causes of infertility. Can there be any other problems? Yes, there are problems such as endometriosis, fibroids, and scarring in the womb that can be associated with infertility.

All these potential causes of infertility can make you feel anxious. The good news is that modern fertility treatment can do a lot address most of these problems. Fertility science and practice are advancing at a phenomenal speed, bringing answers and babies to couples struggling to conceive a pregnancy. If you have been struggling to conceive, do seek professional help, either from your general practitioner or a fertility clinic.