CONDITIONS
Subfertility
Subfertility: When Pregnancy Takes Longer Than Expected
Trying to conceive can be an emotional journey, especially when each month brings more questions than answers. Subfertility affects more than 48 million women worldwide. If you’ve been trying to get pregnant for over a year (or six months if you’re over 35) without success, you may be experiencing subfertility — a common but often misunderstood issue. While many couples can become spontaneously pregnant within a specific timeframe, the chances significantly decrease after prolonged unsuccessful attempts, indicating a transition from potential fertility to infertility.
At Happiher, we understand how frustrating and isolating subfertility can feel. As a private gynaecologist in London, I help women and couples investigate the possible causes of subfertility and explore effective, personalised treatment options with clarity and compassion.
Introduction to Subfertility
Subfertility is a condition characterised by reduced fertility, where a couple is unable to conceive after a prolonged period of regular, unprotected sex. Unlike infertility, which suggests a complete inability to conceive, subfertility means that conception is still possible but may require more time or medical assistance. According to various studies, about a third of subfertility cases are due to female factors, another third to male factors, and the remaining third to unknown reasons or a combination of both.
Understanding the common definition of subfertility is crucial for appropriate management. A basic infertility work-up after six unsuccessful cycles can help identify couples with significant infertility problems. The major factor affecting an individual’s spontaneous pregnancy prospect is the time of unwanted non-conception. Fertile couples have age-independent cumulative probabilities of conception, meaning that the likelihood of conceiving remains relatively stable across different ages. Early assessment and intervention can significantly improve the chances of conception, providing a reasonably good prognosis for many couples.
What Is Subfertility?
Subfertility refers to a delay in conceiving — when pregnancy takes longer than expected despite regular, unprotected sex. Subfertility generally describes a condition characterised by reduced fertility and prolonged periods of non-conception. A couple is considered subfertile if they have had regular unprotected intercourse for a year without conception. It does not mean that pregnancy is impossible, but that it may require support, investigation, or intervention.
Subfertility is different from infertility, which suggests a complete inability to conceive. Infertility is an absolute inability to conceive. Many people diagnosed with subfertility go on to have successful pregnancies with the right care and support.
When Should You Seek Help?
You should consider seeing a gynaecologist if:
You’ve been trying to conceive for over 12 months (or 6 months if over 35)
You have irregular, painful, or absent periods
You have a known gynaecological condition (e.g. endometriosis, PCOS)
You’ve had previous pelvic surgery or infections
You’ve experienced recurrent miscarriage
You simply want to understand your fertility earlier in the journey
Early assessment can reduce anxiety, guide lifestyle decisions, and sometimes identify simple solutions. Our comprehensive gynaecology services offer expert care and support for women at every stage of life.
Common Causes of Subfertility in Women
There are many reasons why conception may take longer than expected. About a third of cases of subfertility are due to a female factor. Common causes include:
Ovulatory dysfunction: irregular or absent ovulation due to conditions like PCOS, thyroid issues, or weight changes
Endometriosis: tissue similar to the womb lining growing outside the uterus, which can affect fertility
Tubal problems: scarring or blockage of the fallopian tubes from past infections (e.g. chlamydia, pelvic inflammatory disease). Pelvic inflammatory disease can cause scarring in the fallopian tubes and lead to subfertility.
Fibroids or uterine abnormalities: including large fibroids or congenital conditions like uterine septum. Fibroids can block a fallopian tube or prevent a fertilised egg from settling in the uterus.
Cervical factors: including abnormal mucus or structural changes after surgery. Cervical mucus problems can prevent sperm from reaching the egg, causing subfertility.
Unexplained infertility: where tests are normal but conception still hasn’t occurred. Couples with unexplained infertility may not benefit from intensive treatments and may be advised to try conceiving naturally for a longer time.
At Happiher, we provide a full assessment to look at all potential contributing factors with sensitivity and scientific accuracy.
Investigating Male Factors
Male factor subfertility can stem from various issues, including abnormal semen analysis results. A semen test can reveal problems such as low sperm count, poor motility, or abnormal morphology. Other causes of male subfertility include injury to the testes, varicocele (enlarged veins within the scrotum), substance abuse, cancer treatment, and hormonal disorders.
A private gynaecologist or fertility specialist can diagnose and treat male factor subfertility. In some cases, laparoscopic surgery may be necessary to treat conditions like varicocele. Assisted reproduction techniques, such as intrauterine insemination (IUI) or in vitro fertilisation (IVF), can also be effective. Additionally, a pelvic ultrasound scan can help investigate male factors, particularly when there are concerns about the reproductive organs. With the right diagnosis and treatment, many men can overcome subfertility and achieve successful pregnancies with their partners.
What Happens During a Basic Infertility Work Up?
Your consultation includes a detailed discussion of your cycle, medical history, and any previous investigations or attempts to conceive. Based on your needs, tests may include:
Pelvic ultrasound: to assess the ovaries, womb, and surrounding structures
Blood tests: to check hormone levels (FSH, LH, oestradiol, AMH, thyroid, prolactin)
Ovulation tracking: using blood tests or ultrasound to confirm egg release
Tubal patency testing (HyCoSy or HSG): to check if fallopian tubes are open. Laparoscopy may be performed to check the patency of the fallopian tubes and look for conditions like endometriosis.
Partner testing: including semen analysis for male fertility factors
We tailor each assessment to your goals, timing, and lifestyle — and take time to explain each step. A follow-up and ongoing care plan will be communicated clearly to ensure you receive comprehensive treatment.
Treatment Options for Subfertility
Treatment is always personalised and may include advanced, personalised medical solutions and treatments for various gynaecological conditions.
Surgery may be necessary to remove endometrial polyps or fibroids from the lining of the womb through various medical and surgical procedures.
Ovulation induction: using medication (e.g. letrozole, clomiphene) to stimulate egg release
Surgical treatment: for endometriosis, fibroids, or uterine septum using minimally invasive or robotic-assisted surgery
Hormonal support: for irregular cycles, thyroid imbalance, or premature ovarian insufficiency
Referral for assisted conception: such as IUI or IVF where appropriate, in collaboration with trusted fertility clinics
Lifestyle guidance: on weight optimisation, supplements, stress, and timing. Lifestyle modifications can improve the chances of conception in subfertile couples.
Dr Kaur’s specialist training in minimally invasive gynaecological surgery ensures expert, fertility-preserving care where surgery is needed.
Lifestyle Changes
Lifestyle changes can significantly improve the chances of conception for couples experiencing subfertility. Maintaining a healthy weight, quitting smoking, and reducing alcohol consumption are all crucial steps toward enhancing fertility. Regular exercise and a balanced diet can also play a significant role in increasing fertility. Managing stress and ensuring adequate sleep are equally important, as they can positively impact overall health and reproductive function.
Couples can also try fertility-focused intercourse, which involves timing intercourse to coincide with the fertile phase of the woman’s cycle. This method can increase the likelihood of conception. It’s essential to make these lifestyle changes in conjunction with medical treatment and under the guidance of a private gynaecologist or fertility specialist. Blood tests can check for underlying medical conditions affecting fertility, and an ultrasound scan can investigate the reproductive organs. In some cases, cancer treatment may be necessary to address underlying conditions impacting fertility. By combining lifestyle changes with medical treatment, couples can improve their chances of conception and overcome subfertility.
Emotional and Psychological Support
Subfertility doesn’t just affect the body — it affects relationships, emotions, and mental wellbeing. At Happiher, we approach care with compassion and offer referrals for fertility counselling or holistic therapies when needed. It is crucial to recognise when subfertility becomes serious subfertility, marked by prolonged periods of non-conception, which necessitates timely intervention and increases the urgency for couples to seek assisted reproductive technology.
You’re not alone, and your experience matters.
Why Choose Happiher for Subfertility Support?
If you’re looking for a private gynaecologist in London for fertility investigations, Happiher offers:
Expert consultant-led care in a calm, discreet setting
Full diagnostic workup for female subfertility
Personalised fertility plans tailored to your needs and goals
Minimally invasive surgical expertise
Coordination with trusted fertility specialists when IVF or IUI is needed
Whether you’re just starting your journey or have been trying for a while, we’ll help you find answers and take confident next steps.
Additionally, our team of dedicated gynaecology consultants ensures you have access to specialised care across London and surrounding areas.
Final Thoughts
If pregnancy is taking longer than expected, don’t wait in silence or confusion. Subfertility is common — and highly treatable. With expert care, many couples go on to conceive naturally or with support. Understanding your individual spontaneous pregnancy prospect is crucial, as most pregnancies occur within the first six cycles of fertility-focused intercourse, after which the likelihood of spontaneous conception significantly decreases.
At Happiher, we combine advanced diagnostics, surgical skill, and compassionate guidance to help you move forward with hope and confidence.
Subfertility: When Pregnancy Takes Longer Than Expected
Trying to conceive can be an emotional journey, especially when each month brings more questions than answers. Subfertility affects more than 48 million women worldwide. If you’ve been trying to get pregnant for over a year (or six months if you’re over 35) without success, you may be experiencing subfertility — a common but often misunderstood issue. While many couples can become spontaneously pregnant within a specific timeframe, the chances significantly decrease after prolonged unsuccessful attempts, indicating a transition from potential fertility to infertility.
At Happiher, we understand how frustrating and isolating subfertility can feel. As a private gynaecologist in London, I help women and couples investigate the possible causes of subfertility and explore effective, personalised treatment options with clarity and compassion.
Introduction to Subfertility
Subfertility is a condition characterised by reduced fertility, where a couple is unable to conceive after a prolonged period of regular, unprotected sex. Unlike infertility, which suggests a complete inability to conceive, subfertility means that conception is still possible but may require more time or medical assistance. According to various studies, about a third of subfertility cases are due to female factors, another third to male factors, and the remaining third to unknown reasons or a combination of both.
Understanding the common definition of subfertility is crucial for appropriate management. A basic infertility work-up after six unsuccessful cycles can help identify couples with significant infertility problems. The major factor affecting an individual’s spontaneous pregnancy prospect is the time of unwanted non-conception. Fertile couples have age-independent cumulative probabilities of conception, meaning that the likelihood of conceiving remains relatively stable across different ages. Early assessment and intervention can significantly improve the chances of conception, providing a reasonably good prognosis for many couples.
What Is Subfertility?
Subfertility refers to a delay in conceiving — when pregnancy takes longer than expected despite regular, unprotected sex. Subfertility generally describes a condition characterised by reduced fertility and prolonged periods of non-conception. A couple is considered subfertile if they have had regular unprotected intercourse for a year without conception. It does not mean that pregnancy is impossible, but that it may require support, investigation, or intervention.
Subfertility is different from infertility, which suggests a complete inability to conceive. Infertility is an absolute inability to conceive. Many people diagnosed with subfertility go on to have successful pregnancies with the right care and support.
When Should You Seek Help?
You should consider seeing a gynaecologist if:
You’ve been trying to conceive for over 12 months (or 6 months if over 35)
You have irregular, painful, or absent periods
You have a known gynaecological condition (e.g. endometriosis, PCOS)
You’ve had previous pelvic surgery or infections
You’ve experienced recurrent miscarriage
You simply want to understand your fertility earlier in the journey
Early assessment can reduce anxiety, guide lifestyle decisions, and sometimes identify simple solutions. Our comprehensive gynaecology services offer expert care and support for women at every stage of life.
Common Causes of Subfertility in Women
There are many reasons why conception may take longer than expected. About a third of cases of subfertility are due to a female factor. Common causes include:
Ovulatory dysfunction: irregular or absent ovulation due to conditions like PCOS, thyroid issues, or weight changes
Endometriosis: tissue similar to the womb lining growing outside the uterus, which can affect fertility
Tubal problems: scarring or blockage of the fallopian tubes from past infections (e.g. chlamydia, pelvic inflammatory disease). Pelvic inflammatory disease can cause scarring in the fallopian tubes and lead to subfertility.
Fibroids or uterine abnormalities: including large fibroids or congenital conditions like uterine septum. Fibroids can block a fallopian tube or prevent a fertilised egg from settling in the uterus.
Cervical factors: including abnormal mucus or structural changes after surgery. Cervical mucus problems can prevent sperm from reaching the egg, causing subfertility.
Unexplained infertility: where tests are normal but conception still hasn’t occurred. Couples with unexplained infertility may not benefit from intensive treatments and may be advised to try conceiving naturally for a longer time.
At Happiher, we provide a full assessment to look at all potential contributing factors with sensitivity and scientific accuracy.
Investigating Male Factors
Male factor subfertility can stem from various issues, including abnormal semen analysis results. A semen test can reveal problems such as low sperm count, poor motility, or abnormal morphology. Other causes of male subfertility include injury to the testes, varicocele (enlarged veins within the scrotum), substance abuse, cancer treatment, and hormonal disorders.
A private gynaecologist or fertility specialist can diagnose and treat male factor subfertility. In some cases, laparoscopic surgery may be necessary to treat conditions like varicocele. Assisted reproduction techniques, such as intrauterine insemination (IUI) or in vitro fertilisation (IVF), can also be effective. Additionally, a pelvic ultrasound scan can help investigate male factors, particularly when there are concerns about the reproductive organs. With the right diagnosis and treatment, many men can overcome subfertility and achieve successful pregnancies with their partners.
What Happens During a Basic Infertility Work Up?
Your consultation includes a detailed discussion of your cycle, medical history, and any previous investigations or attempts to conceive. Based on your needs, tests may include:
Pelvic ultrasound: to assess the ovaries, womb, and surrounding structures
Blood tests: to check hormone levels (FSH, LH, oestradiol, AMH, thyroid, prolactin)
Ovulation tracking: using blood tests or ultrasound to confirm egg release
Tubal patency testing (HyCoSy or HSG): to check if fallopian tubes are open. Laparoscopy may be performed to check the patency of the fallopian tubes and look for conditions like endometriosis.
Partner testing: including semen analysis for male fertility factors
We tailor each assessment to your goals, timing, and lifestyle — and take time to explain each step. A follow-up and ongoing care plan will be communicated clearly to ensure you receive comprehensive treatment.
Treatment Options for Subfertility
Treatment is always personalised and may include advanced, personalised medical solutions and treatments for various gynaecological conditions.
Surgery may be necessary to remove endometrial polyps or fibroids from the lining of the womb through various medical and surgical procedures.
Ovulation induction: using medication (e.g. letrozole, clomiphene) to stimulate egg release
Surgical treatment: for endometriosis, fibroids, or uterine septum using minimally invasive or robotic-assisted surgery
Hormonal support: for irregular cycles, thyroid imbalance, or premature ovarian insufficiency
Referral for assisted conception: such as IUI or IVF where appropriate, in collaboration with trusted fertility clinics
Lifestyle guidance: on weight optimisation, supplements, stress, and timing. Lifestyle modifications can improve the chances of conception in subfertile couples.
Dr Kaur’s specialist training in minimally invasive gynaecological surgery ensures expert, fertility-preserving care where surgery is needed.
Lifestyle Changes
Lifestyle changes can significantly improve the chances of conception for couples experiencing subfertility. Maintaining a healthy weight, quitting smoking, and reducing alcohol consumption are all crucial steps toward enhancing fertility. Regular exercise and a balanced diet can also play a significant role in increasing fertility. Managing stress and ensuring adequate sleep are equally important, as they can positively impact overall health and reproductive function.
Couples can also try fertility-focused intercourse, which involves timing intercourse to coincide with the fertile phase of the woman’s cycle. This method can increase the likelihood of conception. It’s essential to make these lifestyle changes in conjunction with medical treatment and under the guidance of a private gynaecologist or fertility specialist. Blood tests can check for underlying medical conditions affecting fertility, and an ultrasound scan can investigate the reproductive organs. In some cases, cancer treatment may be necessary to address underlying conditions impacting fertility. By combining lifestyle changes with medical treatment, couples can improve their chances of conception and overcome subfertility.
Emotional and Psychological Support
Subfertility doesn’t just affect the body — it affects relationships, emotions, and mental wellbeing. At Happiher, we approach care with compassion and offer referrals for fertility counselling or holistic therapies when needed. It is crucial to recognise when subfertility becomes serious subfertility, marked by prolonged periods of non-conception, which necessitates timely intervention and increases the urgency for couples to seek assisted reproductive technology.
You’re not alone, and your experience matters.
Why Choose Happiher for Subfertility Support?
If you’re looking for a private gynaecologist in London for fertility investigations, Happiher offers:
Expert consultant-led care in a calm, discreet setting
Full diagnostic workup for female subfertility
Personalised fertility plans tailored to your needs and goals
Minimally invasive surgical expertise
Coordination with trusted fertility specialists when IVF or IUI is needed
Whether you’re just starting your journey or have been trying for a while, we’ll help you find answers and take confident next steps.
Additionally, our team of dedicated gynaecology consultants ensures you have access to specialised care across London and surrounding areas.
Final Thoughts
If pregnancy is taking longer than expected, don’t wait in silence or confusion. Subfertility is common — and highly treatable. With expert care, many couples go on to conceive naturally or with support. Understanding your individual spontaneous pregnancy prospect is crucial, as most pregnancies occur within the first six cycles of fertility-focused intercourse, after which the likelihood of spontaneous conception significantly decreases.
At Happiher, we combine advanced diagnostics, surgical skill, and compassionate guidance to help you move forward with hope and confidence.
Book your appointment today
Book your appointment today
Book your appointment today