Subfertility

Subfertility: When Pregnancy Takes Longer Than Expected

Trying to conceive can be a emotional rollercoaster, 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 condition. While many couples can get spontaneously pregnant within a certain timeframe, the chances decrease significantly after prolonged unsuccessful attempts, meaning you’ve transitioned from potential fertility to infertility.

At Happiher, I understand how frustrating and isolating subfertility can be. As a private gynaecologist in London, I help women and couples investigate the possible causes of subfertility and explore treatment options with clarity and compassion.

What is Subfertility?

Subfertility is a condition where you’re unable to conceive after a prolonged period of regular, unprotected sex. Unlike infertility which means you can’t conceive at all, subfertility means you can conceive but may need more time or medical help. 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 definition of subfertility is key to management. A basic infertility work-up after 6 cycles of trying can 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 the chances of conceiving remain relatively stable across different ages. Early assessment and intervention can improve the chances of conception and provide a good prognosis for many couples.

When Should You Get Help?You should see 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 had 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 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 do a full assessment to look at all potential contributing factors with sensitivity and scientific accuracy.

Male Factors

Male factor subfertility can be due to various issues including abnormal semen analysis results. A semen test can show 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 needed to treat conditions like varicocele. Assisted reproduction techniques such as intrauterine insemination (IUI) or in vitro fertilisation (IVF) can also work. A pelvic ultrasound scan can also help investigate male factors especially when there are concerns about the reproductive organs. With the right diagnosis and treatment many men can overcome subfertility and have successful pregnancies with their partner.

What Happens During a Basic Infertility Work Up?

Your consultation will include a full discussion of your cycle, medical history and any previous investigations or attempts to conceive. Depending on your needs tests may include:

Pelvic ultrasound: to look at 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 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 so you receive comprehensive care.

Treatment Options for Subfertility

Treatment is always individualised and may include advanced, bespoke medical solutions and treatments for various gynaecological conditions.

Surgery may be needed 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 changes can improve the chances of conception in subfertile couples.Dr Kaur’s training in minimally invasive gynaecological surgery means expert, fertility-preserving care when surgery is needed.

Lifestyle Changes

Lifestyle changes can make a big difference for couples with subfertility. Losing weight, stopping smoking and reducing alcohol are key to improving fertility. Exercise and a healthy diet can also help. Managing stress and getting enough sleep are important too as they impact overall health and reproductive function.

Couples can also try fertility-focused intercourse which is timing sex to coincide with the fertile window of the woman’s cycle. This can increase chances of conception. Make these lifestyle changes 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 a pelvic ultrasound can investigate the reproductive organs. In some cases cancer treatment may be needed to treat underlying conditions affecting fertility. By combining lifestyle changes with medical treatment couples can improve their chances of conception and overcome subfertility.

Emotional and Psychological Support

Subfertility affects not just the body but relationships, emotions and mental wellbeing. At Happiher we approach care with compassion and can refer for fertility counselling or holistic therapies when needed. Recognise when subfertility becomes serious subfertility marked by prolonged periods of non-conception which requires timely intervention and couples need to seek assisted reproductive technology sooner.

You’re not alone and your experience matters.

Why Choose Happiher for Subfertility Support?

Looking for a private gynaecologist in London for fertility investigations? Happiher offers:

Consultant-led care in a calm, confidential environment

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 out or have been trying for a while we’ll help you find answers and take next steps with confidence.

Our team of dedicated gynaecology consultants means you have access to specialist care across London and surrounding areas.

Conclusion

Not getting pregnant as expected? Don’t wait in silence or uncertainty. Subfertility is common — and curable. With the right care many couples go on to conceive naturally or with support. Knowing your individual spontaneous pregnancy chances is key as most pregnancies occur within the first 6 cycles of fertility-focused intercourse after which the chances of spontaneous conception drop off.

At Happiher we bring together advanced diagnostics, surgical expertise and supportive care to help you move forward with hope.