Fertility Conditions

Receiving a diagnosis that affects your fertility can feel overwhelming. Suddenly you're faced with medical terms, treatment options, and uncertainty about what it all means for your future. This guide explains the most common conditions clearly and honestly-understanding your diagnosis is the first step toward taking control.

Why Fertility Challenges Happen

Before we dive into specific conditions, let's address something important: fertility challenges are not your fault.

Many people, when struggling to conceive, wonder what they did wrong. The answer, in most cases, is nothing. Fertility problems arise from biology-genetics, anatomy, hormones, environmental factors-not from personal failings.

The WHO estimates that about 1 in 6 people of reproductive age experience infertility at some point in their lives. Causes can lie with the female partner, the male partner, both, or neither:

• A male factor is the sole cause in about 20% of infertile couples and contributes in another 30-40%
• Female factors such as ovulation problems, blocked tubes and endometriosis are each common causes
• In about 30% of couples, no cause is found (unexplained infertility)

This isn't about blame. It's about understanding what's happening so you can find the best path forward.

PCOS: The Most Common, Often Misunderstood

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age and the most common cause of anovulation. It affects an estimated 10-13% of women worldwide, and the 2023 international guideline notes it may be more common in the Eastern Mediterranean region, which includes the UAE, although reliable UAE-wide figures are not yet available. In 2026 an international consensus agreed a new name, polyendocrine metabolic ovarian syndrome (PMOS), which is being phased in gradually; diagnosis and treatment are unchanged.

What PCOS Actually Is

Despite its name, PCOS isn't primarily about ovarian cysts. The "cysts" seen on ultrasound are actually immature follicles-eggs that started developing but didn't mature and ovulate.

PCOS is characterized by:

Irregular or absent ovulation: Without regular ovulation, pregnancy becomes difficult to achieve.

Higher levels of androgens: Male hormones like testosterone, which can cause symptoms like acne, excess hair growth, and hair thinning.

Polycystic-appearing ovaries: Many small follicles visible on ultrasound (or, in adults, a raised AMH blood test instead). You need two of these three features, after other causes have been ruled out.

How PCOS Affects Fertility

The primary way PCOS impacts fertility is through irregular or absent ovulation. If you're not releasing eggs, pregnancy can't happen naturally.

Treatment Paths for PCOS

There are several PCOS treatment options available depending on your specific situation.

Lifestyle modifications: For women with PCOS who have excess weight, losing 5-10% of body weight can restore ovulation in some cases.

Ovulation induction: Letrozole is the recommended first-line medicine; clomiphene is an alternative.

Insulin-sensitizing medications: Metformin can help some women, alone or combined with clomiphene, though it is less effective than letrozole.

IVF: If simpler treatments don't work, IVF is very effective for PCOS.

Endometriosis: More Than Painful Periods

Endometriosis occurs when tissue similar to the uterine lining (endometrium) grows outside the uterus-on the ovaries, fallopian tubes, pelvic lining, and sometimes beyond.

Understanding the Condition

Each month, this tissue responds to hormones just like the uterine lining-it thickens, breaks down, and bleeds. But unlike the uterine lining, this blood has no way to exit the body. The result is inflammation, pain, and the formation of scar tissue.

Endometriosis affects an estimated 10% of women of reproductive age, according to the WHO. It's often diagnosed late, on average somewhere between 4 and 12 years after symptoms start, partly because symptoms are dismissed as "normal" period pain.

Symptoms to Watch For

• Painful periods (dysmenorrhea)-often severe
• Pain during or after intercourse
• Pain with bowel movements or urination
• Chronic pelvic pain
• Heavy periods
• Difficulty conceiving

How Endometriosis Affects Fertility

Anatomical distortion: Scar tissue can block fallopian tubes or change pelvic anatomy.

Ovarian damage: Endometriomas (cysts) can damage ovarian tissue and reduce ovarian reserve.

Inflammatory environment: May be toxic to eggs, sperm, or embryos.

Treatment Approaches

Surgery: Keyhole surgery to remove mild (stage I-II) endometriosis can improve natural conception rates. Routine surgery on endometriomas before IVF is no longer recommended, because it can lower ovarian reserve without improving live birth rates.

IVF: For moderate to severe endometriosis, damaged tubes or when other treatments have not worked, IVF may offer the best chances.

Ovulation Disorders

Ovulation problems account for about a quarter of infertility cases. If you're not ovulating, pregnancy simply can't happen naturally.

Signs of Ovulation Issues

• Irregular menstrual cycles (shorter than 21 days or longer than 35 days)
• Very unpredictable cycle length
• Absent periods (amenorrhea)

Causes

PCOS: The most common cause.

Hypothalamic dysfunction: Low body weight, excessive exercise, or stress can disrupt hormonal signaling.

Premature ovarian insufficiency: Ovaries stop functioning normally before age 40.

Thyroid disorders and raised prolactin: Both overactive and underactive thyroid, and high prolactin levels, can affect ovulation.

Tubal Factors: When Tubes Are Blocked

The fallopian tubes are where fertilization happens-sperm meets egg. If the tubes are blocked or damaged, sperm can't reach the egg.

Causes of Tubal Issues

• Pelvic inflammatory disease (PID): Often from untreated sexually transmitted infections
• Previous surgery: Can cause adhesions
• Endometriosis: Can cause scarring
• Previous ectopic pregnancy

Treatment Options

Surgery: For some tubal damage, surgery can restore function.

IVF: Bypasses the tubes entirely and is often the recommended path for significant tubal damage. A fluid-filled tube (hydrosalpinx) should usually be removed or blocked first, as this improves IVF pregnancy rates.

Diminished Ovarian Reserve

Your ovarian reserve refers to the number and quality of eggs remaining in your ovaries. All women have diminishing reserves as they age, but some experience this decline earlier or more rapidly than expected.

How It's Diagnosed

AMH (Anti-Müllerian Hormone): A blood test that gives an indirect measure of egg quantity.

Antral follicle count (AFC): Ultrasound counting small follicles visible on the ovaries.

FSH levels: Elevated FSH early in the cycle can indicate the body is working harder to stimulate the ovaries, but current guidelines prefer AMH or AFC for predicting response to IVF.

What It Means

Diminished reserve doesn't mean you can't conceive. AMH and AFC mainly predict how many eggs you would produce with IVF medication; they do not predict your chance of conceiving naturally, where age matters more. Still, if you want children, it is worth discussing your plans with a specialist sooner rather than later.

Male Factor Infertility

Male factors play a part in roughly half of infertile couples: they are the sole cause in about 20% and contribute in another 30-40%. Yet male fertility often receives less attention due to stigma. This is changing.

Common Male Factor Diagnoses

Low sperm count (oligospermia): Fewer than 16 million sperm per milliliter, the WHO's 2021 lower reference limit.

Poor motility (asthenospermia): Sperm that don't swim well can't reach the egg.

Abnormal morphology (teratospermia): Sperm with abnormal shapes may not fertilize eggs effectively.

Azoospermia: No sperm in the ejaculate.

Causes

• Varicocele: Enlarged veins in the scrotum-present in about 15% of all men and around 40% of men with fertility problems
• Hormonal imbalances
• Genetic factors
• Previous infections
• Lifestyle factors: Smoking, excessive alcohol, obesity, heat exposure

Treatment Approaches

Lifestyle modifications: Weight loss, quitting smoking, reducing alcohol.

Surgery: Repair of a varicocele that can be felt on examination, or surgical sperm retrieval.

IUI: May help with mild male factor by concentrating the best sperm.

IVF with ICSI: For severe male factor, a single sperm is injected directly into each egg.

Unexplained Infertility

About 20-30% of infertile couples receive a diagnosis of "unexplained infertility." This can be frustrating-something is clearly not working, but tests don't reveal why.

What It Means

It doesn't mean nothing is wrong. It means current testing can't identify the issue. The problem may involve egg quality, subtle sperm function problems, fertilization issues, or factors we don't yet know how to test for.

The Good News

Couples with unexplained infertility often have reasonable success rates with treatment-sometimes even without treatment if given enough time.

Treatment Approaches

Expectant management: Younger couples may conceive on their own given more time; NICE suggests trying for 2 years in total before treatment.

IUI with ovarian stimulation: Recommended by ESHRE as a first-line treatment, improving odds even when we don't know the specific issue.

IVF: Bypasses many potential barriers.

Recurrent Pregnancy Loss

Recurrent pregnancy loss (RPL) is defined by ESHRE and ASRM as two or more pregnancy losses, and affects about 1-2% of couples. It's devastating-you can conceive, but the pregnancies don't continue.

Possible Causes

• Chromosomal abnormalities in embryos: The most common cause
• Uterine abnormalities: Fibroids, polyps, or structural issues
• Antiphospholipid syndrome: An autoimmune condition that makes blood clot more easily
• Hormonal factors: Such as untreated thyroid problems or poorly controlled diabetes
• Unexplained: In many couples no specific cause is found, but 50-80% still have a successful next pregnancy without specific treatment

Treatment Options

Treatment depends on findings and may include surgical correction of uterine issues, aspirin and heparin for antiphospholipid syndrome, thyroid treatment, progesterone if there is bleeding in early pregnancy, or IVF with genetic testing of embryos (PGT-SR) when a parent carries a chromosome translocation. Routine embryo screening (PGT-A) has limited benefit for recurrent loss.

Condition-Specific Treatment Paths

Donor eggs and donor sperm are not permitted in the UAE, so where they are the next step, UAE residents have that part of treatment abroad.

Moving Forward

A diagnosis is not a dead end-it's information. Information gives you options, helps you make decisions, and connects you with appropriate treatment.

Most conditions that affect fertility have treatment paths. Some are simpler than others. But very few conditions mean you absolutely cannot have a child.

Frequently Asked Questions

Sources

• WHO: Infertility fact sheet (2025) (checked October 2026)
• WHO: Polycystic ovary syndrome fact sheet (2026) (checked October 2026)
• WHO: Endometriosis fact sheet (2025) (checked October 2026)
• Teede et al. Recommendations from the 2023 International Evidence-based PCOS Guideline. Hum Reprod, 2023 (checked October 2026)
• Yale Medicine: PCOS is renamed PMOS (2026) (checked October 2026)
• ESHRE guideline: endometriosis (2022) (checked October 2026)
• ESHRE: Evidence-based guideline on unexplained infertility (2023) (checked October 2026)
• ASRM Practice Committee: Recurrent pregnancy loss (2026) (checked October 2026)
• AUA/ASRM: Diagnosis and Treatment of Infertility in Men (guideline, amended 2024) (checked October 2026)
• EAU Guidelines on Sexual and Reproductive Health: Male infertility (checked October 2026)
• NICE NG257: Fertility problems: assessment and treatment (2026) (checked October 2026)
• Wang et al. Treatment strategies for women with WHO group II anovulation. BMJ, 2017 (checked October 2026)

This content is for educational purposes only and should not replace professional medical advice. If you're experiencing fertility challenges, please consult with a qualified healthcare provider for personalized guidance.