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It's common for people who take the IVF route or use other methods of assisted reproduction not to want to talk openly about it. Even though the first IVF baby was born in 1978, many people still feel a stigma attached to conceiving a baby in ways other than through sexual intercourse. But there is nothing to feel ashamed or embarrassed about, and explaining your situation to others and educating them might give you the extra support you need.

Common stigmas about trying to conceive

Stress is a common feature of modern life, but what many don't realise is its potential impact on our reproductive health. Stress and fertility share a complex relationship that can significantly influence a persons ability to conceive.

When stress becomes chronic or overwhelming, it can disrupt the delicate balance of hormones responsible for regulating the reproductive system. High levels of stress hormones, such as cortisol, can interfere with ovulation in women and sperm production in men, ultimately impacting fertility, but also affecting libido, sexual function, and overall reproductive health. While occasional stress is a normal part of life, managing stress effectively through relaxation techniques, mindfulness practices, and seeking support when needed can help mitigate its negative effects on fertility.

By understanding the connection between stress and fertility, individuals and couples can take proactive steps to optimise their chances of conceiving and embark on their journey to parenthood with confidence..

How can stress affect fertility?

Long-term stress can:

• disrupt your ovulation cycle, making it harder to pinpoint your most fertile days
• affect your relationship with your partner, resulting in a loss of sex drive
• affect sperm production
• affect egg quality
• reduce blood flow to the reproductive organs
• lead to turning to alcohol, smoking or eating more fatty or processed foods, which can have a negative affect on conception, pregnancy and in some cases the health of your unborn child

The good news is that making positive changes to your lifestyle can help to reduce stress and also increase your chances of conceiving naturally or with assisted conception.

The following ways are recommended to help to reduce your stress levels:

Communicate

When we’re stressed or anxious, talking to someone we trust about our fears and worries can provide release, either by working through solutions together, or just through the process of off-loading.

By talking to our partner, we may find that they are having similar concerns, doubts or worries. It can also help to release any built-up tension and avoids second guessing what they ‘might’ be thinking or feeling.

When others are made aware of our feelings, they are in a better place to understand our needs too.

By communicating openly with health professionals, the fertility specialist, GP or fertility counsellor, it will enable them to answer your questions or provide support.

Improve your diet

Having a healthy diet means you are less likely to experience mood swings and energy dips.

Keeping fit is important for health in general, but it’s also key in helping couples or individuals to conceive and to prepare for the demands of parenthood. 

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Maintaining a healthy BMI helps with fertility, so regular, moderate exercise is advised for anyone involved in trying to conceive, regardless of gender.

Going through tests and treatment for infertility can be a stressful time for many individuals and couples. Exercise is a great stress buster and reducing stress can have a positive impact on fertility and conception.  

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Exercise for male fertility 

Traditionally, most of the focus has been put on female health, when it comes to having a healthy pregnancy. However, the quality of sperm is not just important for conception, it’s also jointly responsible for the healthy development of the foetus and for the health of the child as it grows. 

Regular and moderate exercise reduces inflammation and helps the testicles to function better. It can also help to improve sperm quality and increase sperm count. Moderation is key, however, as strenuous exercise is believed to have a negative effect on fertility. As with any new form of exercise, it’s important to get advice from your GP, if you are uncertain whether your chosen form of exercise will aid or lessen your chances of conception. 

The testicles are outside of the male body, because for fertility, including good sperm quality, they need to kept at below body temperature. It’s advisable to remember this when exercising, as well as during everyday life. 

It’s also important to remember that exercise is most effective for good health and fertility, when undertaken in conjunction with maintaining a healthy diet and positive lifestyle choices. New sperm are being constantly created, so making positive changes now, could greatly increase your chances of conceiving in the near future. 

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Exercise for female fertility

For female fertility, regular, moderate exercise is also recommended, while strenuous exercise may have a negative impact. 

Walking, dancing, swimming and cycling are examples that could be easy to fit in for regular exercise. Certain yoga poses can increase the blood flow to the pelvic area which stimulates the reproductive organs and improves fertility. Yoga is also great for stress release and relaxation and can help to lift your mood. 

Exercises that should be avoided when trying to conceive are rigorous or strenuous exercises which over-heat or over-stress the body. 

Before deciding on how much exercise to do, it’s important to take into account how fit you already are, whether you are overweight and whether you have any pre-existing medical conditions. Your doctor can advise you on what type of exercise would be beneficial for you and how much to exercise.

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Is it OK to exercise during an IVF cycle or during IUI treatment?

Other people may have undergone treatment for cancer and had their eggs or sperm frozen, to preserve their fertility. They are aware that they’ll be likely to need to have IUI, IVF or ICSI, in order to have a biological child.

For many men and women, there have been no symptoms to indicate potential fertility issues, until they start trying to conceive and are unsuccessful, after repeated attempts. They are often then diagnosed with ‘unexplained infertility.’

How soon should I see a doctor if I’m struggling to conceive?

“More than 8 in 10 couples, where the woman is under 40, will conceive naturally within a year of having regular, unprotected sex.

Regular unprotected sex means having sex every 2 to 3 days without using contraception.” NHS website.

If you are a woman under 36 and struggling to conceive, it is advisable for you to contact your doctor after a year of regular unprotected sex. For women over 36, or people who think they may have an STI (sexually transmitted infection), then it’s suggested that you contact your GP sooner.

It’s a good idea to make an appointment for both of you together. Your doctor will want to know the medical history of you and your partner and any relevant family medical history too. They will also want to know how long you have been trying for.

After an initial appointment, they will be likely to refer you for tests.

What fertility tests are available for women?

The type and number of tests carried out, will differ for each individual, but may include:

·      Ovulation testing – this is a blood test that measures hormone levels, to check if you are ovulating

·      Ovarian reserve testing – carried out through a hormone test, this is to find out how many eggs you have available, as women are born with all of the eggs they will ever have

·      Hysterosalpingography – an x-ray is carried out, to check the condition of your uterus and fallopian tubes and to see if there are any blockages

·      Hysteroscopy – a thin device inserted through your cervix into your uterus, to look for any abnormalities

·      Laparoscopy – a small incision made beneath your navel, with a thin device inserted, to examine your fallopian tubes, ovaries and uterus

·      Other hormone tests

·      Pelvic ultrasound – to check for any signs of disease

What fertility tests are available for men?

The type and number of tests carried out will differ for each individual, but may include:

·      Semen analysis – your doctor may ask for a semen sample, which will be analysed in the lab

·      Genetic testing

·      Hormone testing – to check the level of testosterone and other hormones

·      Testicular biopsy – occasionally used to identify any abnormalities

·      Ultrasound

What if the tests show unexplained infertility?

For many couples and individuals, using a sperm donor is the only way for them to conceive a child. This can be achieved through IUI (Intrauterine insemination) or IVF (in vitro fertilisation).

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Why choose to use a sperm donor?

In the case of female same-sex couples and women without a partner, this is an obvious choice, if they want to have a baby that is biologically connected to them, rather than fostering or adopting.

For heterosexual couples, the male partner may have known for many years that he has fertility issues, or they may have been trying for a baby for a long time, and failed to conceive and tests may have revealed male infertility as the cause. It may be that there is a genetic disorder in the male partner’s family and the couple prefer to use donor sperm, rather than risk passing it to their child or children.

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Using a sperm donor for IVF

Are IVF and IUI with donor sperm free on the NHS?

This is not a simple question, as many factors are taken into consideration when it comes to funding IVF and IUI treatments, with or without donor sperm. Although the National Institute of Care and Excellence (NICE) has guidelines around the funding of IUI and IVF, the answer to this question still varies considerably. Some of the factors include the age of the female partner, whether heterosexual or in a same sex relationship, how long you have been trying to conceive, whether you have previously self-funded, whether you or your partner already have children and the policy of your local NHS trust.

Where can I find a sperm donor?

Sometimes people will decide to ask someone they know to be a sperm donor. If you choose to do this, it’s important to be aware of the legalities around parental responsibilities and rights, before going through the IUI or IVF process.

Most people, they will use donor sperm from a sperm bank, either directly through their fertility clinic or from another source. It is illegal in the UK for sperm donors to be anonymous and when the child is 18, they can ask for details of the donor and any donor siblings.

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What checks are done on sperm donors and donor sperm?

Choosing a licensed fertility clinic for your donor sperm means that the donor will have undergone rigorous checks. The medical tests include blood tests, urine tests, tests for sexually transmitted illnesses (STIs) and HIV and a physical examination. They will be questioned about their family medical history, to find out if there are any known, hereditary diseases present in the family. A full semen analysis will also be conducted to check sperm count, motility and morphology.

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What is donor insemination?

The woman’s menstrual cycle is monitored and the donor sperm is inserted into her vagina, as near to ovulation as possible.

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What is IVF with donor sperm?

The good news is, that as new sperm are continually being created, by making positive lifestyle changes now, in as little as 3 months, your sperm could be healthier and your fertility increased.

Strict guidelines are enforced in the UK and your employer is legally required to ensure that you have the training and equipment that you need, in order to keep you safe. However, if you are concerned, then speak to your GP and consider some of the measures below, to reduce your risk.

Working with pesticides and solvents

Painters, printers and those working in the plastics industry, are some of the people whose fertility may be affected by their profession.

Some pesticides may have oestrogen-like effects and some solvents have, in the past, been shown to negatively affect sperm creation. The risk now appears to be much lower, due to modern regulations, but if you are concerned, you can seek advice from the HSE.

You should always take the advised precautions and shower and change after coming into contact with any hazardous chemicals.

Working with heavy metals

Certain types of heavy metals, for example lead and cadmium, have been shown to be associated with lower sperm counts. Mercury and manganese, may also have a negative effect on fertility.  

If you work with them, you should always take the advised precautions and shower and change after coming into contact with any in powdered form.

Working with radiation

Ionising radiation, such as X-rays and gamma rays, has been shown to reduce sperm counts, but if you are working with it, clear guidelines will be there to reduce any risk.

Non-ionising radiation, such as wifi, could potentially affect fertility, if the temperature of your groin area increases because of it. You could reduce the risk by keeping phones, etc, away from your groin area.

Working in a hot environment

Bakers, welders and men who work in hot environments, may find that their sperm is affected.

The testicles hang outside of the body, as they need to be at a lower temperature. If you are working in a hot environment, their temperature can rise, which can affect both the quality and quantity of sperm produced.

Long-distance runners can also be at risk from the rise of temperature of the testicles.

Wearing cool clothes may help.

Remaining seated at work for long periods

Office workers, taxi drivers, long distance lorry drivers and driving instructors may find that their fertility is affected by long periods of sitting still, due to the temperature of the testicles rising. The vibrations of the vehicle may also have a negative impact, if you spend long periods of time driving.

Standing up and moving around, whenever you get the opportunity, could be beneficial.

Additional advice

As well as speaking to your GP, you could also ask your union for advice.

Healthy sperm is key, not just for conception, but during pregnancy and for your child’s development.

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While some aspects of fertility may be out of your control, making positive changes to your lifestyle can have a really positive impact on your chances of conceiving a healthy child, either naturally, or with IVF.

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What is meant by ‘healthy sperm’?

To conceive a baby naturally, you will need to have enough sperm in your semen that is mobile enough to reach an egg and are in the best shape to do so. The quantity, motility and shape are all important factors in natural conception. 

Healthy sperm are also important for IVF and IUI treatments, however, some of the processes involved allow for the healthiest sperm to be selected and override the need for the sperm to be as mobile, as the sperm is placed next to or into the egg in the lab. 

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Discover key factors in male fertility and how to improve them for IVF

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Which lifestyle factors can make a difference in male fertility?

For good general health, longevity and mental well-being, it’s recommended that you have a healthy diet, healthy BMI and exercise regularly.  The same is true for increasing your fertility. Following these guidelines may improve your chances of conceiving: 

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• Eat healthy foods (see Fertility diet, below)
• Maintain a healthy BMI (Body Mass Index – weight to height ratio) 
• Exercise regularly - moderate exercise, rather than strenuous 
• Stay calm – long-term stress can affect sperm production, so taking time to relax is important
• Have intercourse regularly – 2-3 times a week, especially around the time of ovulation
• Avoid smoking – smoking can reduce fertility and affect your baby’s development
• Reduce your alcohol intake – alcohol reduces sperm production
• Avoid strong chemicals where possible
• Make an appointment with your GP to check whether any medication you are taking may affect your fertility
• Reduce tea and coffee intake – like alcohol, they can lead to dehydration
• Stay cool - clothing and temperature can also affect fertility. As sperm need to be kept cooler than body temperature, the testicles are located outside of your body. Wearing light, loose-fitting underwear and moving around, rather than sitting still all day, can help to maintain a good temperature for your sperm. 

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What is a fertility diet?

A fertility diet is a healthy diet, containing foods that can maximise fertility. Having a whole food diet with yellow, orange and red fruits and vegetables and the right type and quantity of vitamins and minerals, is important for both your fertility and the health of your unborn baby.

For good sperm health, opt for polyunsaturated fats, found in vegetable oils, oily fish, seeds and nuts, rather than saturated and trans fats. 

Vegetables, nuts, seeds and asparagus provide natural sources of vitamins and minerals, which are important factors in male fertility. Eating Greek-style yoghurt has been shown to improve semen quality.

I’m trying for a baby now – will these lifestyle

“According to the government's advisory body, the HumanFertilisation and Embryology Authority (HFEA), the number of single women choosing to have IVF is up 35% since 2014.” (Anisa Kadri, BBC News, August2018)

“Surrogacy UK, who help introduce so-called 'intended parents' with surrogates, said they have seen an increase in the number of single people, including men, wanting to become members.” (AlexJennings and Lucy Ballinger, BBC News, 2021)

If you are beginning your journey as a solo parent, it is wise to look into the variety of options available to you, before committing to fertility treatment.

Where do I start?  

Having a conversation with your GP is a good place to start. As well as being able to give you advice tailored to your personal medical history and doing an initial fertility assessment, they can also advise you on whether you may be entitled to NHS funding (where you live in the UK, will influence your eligibility for funding). If you qualify for funding, the GP can then refer you to a specialist.As a single person, you may still be required to self-fund several cycles ofIUI, to prove your infertility, in order to qualify for funded IVF treatment.

What ifI’m not entitled to funding?

The NHS website gives the following guidance:

‘If you’re not eligible for NHS treatment or you decide to pay for IVF, you can have treatment at a private clinic.

Some clinics can be contacted directly without seeing your GP first, but others may ask for a referral from your GP.

The cost of private treatment can vary, but 1 cycle of IVF can cost up to £5,000 or more. There may be additional costs for medicines, consultations and tests.’

It is very important to find out what is included and not included in the quote.

Overseas treatment may sound cheaper, but you will need to check what is included. Factor in costs like flights and accommodation and be aware that in some countries, the regulations around fertility treatments aren’t as stringent as those in theUK.

As a single woman, what treatment options might be available for me?

If, after fertility tests, you have no obvious barriers to conception, then the least invasive and cheapest option for you would be IUI. Your cycle would be monitored and donor sperm would be inserted around the optimum time for conception.  If your fallopian tubes are blocked or damaged, then you may be advised to have IVF.

Sperm can be obtained via someone you know, from a sperm bank or through the clinic. It will be screened first, to check for infection or genetic disorders. Alternatively, you may choose to co-parent, conceiving using sperm from a man who will share parental rights with you.

If you are unable to carry a baby to term, but you have viable eggs, then surrogacy may bean option.

Solo parenting may not be how you’ve always imagined parenthood, but it’s an option that many people go for.

Being a mum or dad may be something that you’ve wanted all of your life, but maybe you’ve not been with the right person at the right time. Perhaps having a partner isn’t something you want and you would prefer to raise a baby alone. If you are a woman and aware that your biological clock is ticking, maybe you’ve decided that the right time is now and that you’d rather parent alone than leave it too late. Maybe you are a man without a partner and you want to have a child with a genetic connection to you.

There are numerous reasons why people decide to parent without a partner and a number of ways in which this can be achieved with assisted reproductive techniques (ART).

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As a single woman, what options are available to help me to conceive?

There are various options open to you. If you have had fertility tests and there are no obvious barriers to conception, then a popular choice is to have IUI (intrauterine insemination). IUI involves sperm being inserted around the optimum time for conception. If you have blocked or damaged fallopian tubes, you may be advised to have IVF instead. Both IUI and IVF can be performed using donor sperm, either from someone you know or from a sperm bank. The sperm will be screened first, to check for infection or genetic disorders.

If you have your own eggs but are unable to carry a baby to term, then surrogacy may be an option for you, however, in the UK, parental rights rely on the surrogate agreeing to sign over rights after the birth of the baby. To take away the risk of the surrogate changing her mind, many people choose a surrogate who is living overseas, from a country where a surrogacy agreement is legally enforceable, with automatic parental rights.

Another option is co-parenting, where, rather than having a sperm donor, you could choose to conceive using sperm from a man who will have parenting rights too. It's important to look into your legal rights when using donor sperm or a surrogate or where you are entering into a co-parenting agreement.

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As a single man, what options are available for me to have a child of my own?

Surrogacy would allow you to have a child where you will be the biological father. If you have healthy sperm, then IUI (intrauterine insemination) is the most straightforward option. You would need to provide a sperm sample, which will then be washed and the healthiest sperm selected to be inserted via a thin tube into the surrogate. If your sperm show any weakness in terms of motility, for example, then you may be advised that IVF would increase your chances of fathering a child.

For conception to happen, the hormones, the genes and the environmental conditions need to be right.

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For some people, they know early on that they may have fertility issues. The reasons for this may be if they have undergone cancer treatment, if they have irregular or no periods, if they have had surgery involving their reproductive organs, if they have a family history of early menopause, or if they have already been diagnosed with infertility. It may be that their sexual orientation means that they will need assisted conception techniques, to help them to become parents.Many of these people will start to consider their options for fertility treatment as soon as they are aware of their potential hurdles.

For people who have had no such diagnosis, it is a very common assumption that if they try to get pregnant in their 20s or early 30s, it will happen for them. So many people spend such a large part of their early adult life trying NOT to get pregnant, that it comes as a great shock to them when they want to get pregnant and can’t.

Is infertility mainly an issue for people over 35?

It’s true that age plays a massive factor in fertility and with women in particular, their chances of conceiving start to drop rapidly after the age of 35. There are, however, many couples who are much younger, who find that even with regular unprotected sex around the time of ovulation, they still fail to conceive. This could be due to a number of factors that, once diagnosed, can be treated, or sometimes the diagnosis is unexplained infertility. In many cases, assisted conception can enable these couples or individuals to become parents.

How long should people leave it before they have their fertility checked?

If regular, unprotected intercourse has not resulted in pregnancy within 6 months for women over 35, or within a year for women under 35, then it is advisable to consult aGP or fertility specialist, as there may be underlying medical reasons.

How can doctors assess fertility in women?

A GP will ask you questions about medical history, family medical history, current medication, working conditions, frequency and regularity of menstrual period sand general medical health. The next step is referral to a fertility specialist, they can do a blood test, an ultrasound to assess the ovaries and other investigations to look for things like blocked tubes, a low egg reserve, or other potential complications.

How can doctors assess fertility in men?

As with women, assessment starts with a conversation that will help to build up a picture about lifestyle, medical conditions, current medication, working conditions and more. They may also do a physical examination of the genital area and ask for a semen sample, to assess the quality, quantity and motility of the sperm.

Communicate openly with each other

Many couples are reluctant to open up about their true feelings because:

·      they might upset their partner

·      their partner might think they areblaming them

·      there’s nothing that can be done, so why talk about it?

In reality, being completely open with each other, can often relieve any underlying tension and it avoids any second guessing of what the other person is thinking.

When people are aware of our feelings, they are in a better place to understand what we need and offer us support.

Attending counselling together, before starting IVF treatment (and throughout, if you need it) can be beneficial. It can help to air your thoughts and feelings aboutyour infertility, the process and the possible outcomes.

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Communicate with others

Your fertility specialist will be used to answering a wide range of questions. No question isa daft question, if knowing the answer is going to help you. Ask them anything that will help you to feel really clear about your treatment plan. The more informed you are about everything,  the less there will be to be anxious about and that will help with your relationship too.

Talk to trusted friends or family members that you know will be supportive. It can be good to offload sometimes, to someone who is not directly involved.

Have a conversation with your employer, so they understand your need to take time off at short notice, for appointments.

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Take time out to enjoy being a couple

It’s very easy to become all-consumed with thinking about your fertility and treatment.Thinking of things that you can do together, to take your mind off of it, can really help.

Having date days out, cuddly nights in watching a film, or sharing things you usually enjoy doing together, can be a great stress reliever and bring you closer.

Walks are a great idea, to boost your vitamin D and walking is a good, stress-busting, gentle form of exercise.

Do something spontaneous, like having an impromptu weekend away, as a change can be as good as a rest.

Try learning a new skill. Doing something that requires focus, can distract you from thinking about and talking about fertility and treatment. It can also give you something new to talk about together.

Going outwith good friends, who are in the know, but happy to help with distraction, canal so be a good idea. They can help you to focus on something else and you’ll know that you won’t be faced with awkward questions from them.

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Take time out for yourself

Treat yourself to doing an activity that you enjoy. Walking, swimming, having a massage, meeting friends, whatever you like to do. Giving each other a bit of space can make the time you spend together better.

Prioritise what is important