Knowledge Centre

A new Hertility study of more than 16,000 women has found that current vaping is associated with lower levels of anti-Müllerian hormone (AMH), a commonly used marker of ovarian reserve. Vaping is often positioned as a less harmful alternative to cigarette smoking. And when it comes to overall health, evidence suggests vaping exposes people to fewer harmful substances than smoking. But less harmful does not mean risk-free. Until now, we have known surprisingly little about how vaping could affect female reproductive health. Most previous research has come from animal studies, small fertility-clinic populations or studies looking at pregnancy rather than ovarian function. New research from Hertility, published in the peer-reviewed journal BMC Women’s Health, looked at vaping, cigarette smoking and ovarian reserve markers in 16,087 women aged 18-45. The main finding? Women who currently vaped had 5.6% lower AMH levels, on average, than women who had never vaped, even after accounting for cigarette smoking and other factors such as age, BMI and ethnicity. That does not mean vaping has been proven to reduce fertility or that someone who vapes will struggle to get pregnant. But it is an important novel signal that deserves further investigation. Does vaping affect fertility? We don’t yet know whether vaping directly reduces female fertility. However, Hertility’s new study found that current vaping was associated with lower AMH, a hormone used as a marker of ovarian reserve. The study did not measure whether women became pregnant, how long it took them to conceive, egg quality, IVF success or live birth rates. Because it was cross-sectional, it also cannot prove that vaping itself caused the difference in AMH. Instead, the findings suggest there may be an association between current vaping and one aspect of ovarian biology. This distinction matters. Fertility is influenced by many different factors, including age, egg quality, ovulation, sperm health, the fallopian tubes and uterus. AMH is one piece of that puzzle. What did the study find? Researchers analysed reproductive health and hormone data from 16,087 women aged 18-45 across the UK. The main findings were: The association between vaping and AMH was relatively small. It represented an estimated absolute difference of around 0.71 pmol/L, which the researchers emphasise should not be interpreted as a clinically meaningful reduction in ovarian reserve for an individual woman. Instead, it is better thought of as a population-level signal that now needs to be investigated in studies that follow women over time. About the research The study used anonymised data collected through Hertility’s reproductive health service between November 2022 and February 2025. Women with reproductive health conditions that could independently influence ovarian reserve or hormone levels – including PMOS, previously known as PCOS, endometriosis, primary ovarian insufficiency and hypothalamic amenorrhoea — were excluded. Women using hormonal contraception were also excluded. Participants reported whether they had never, previously, occasionally or currently vaped and smoked. AMH and follicle-stimulating hormone (FSH) were measured from at-home capillary blood samples. Where applicable, samples were collected on day three of the menstrual cycle, and the researchers accounted statistically for age, BMI, ethnicity and cigarette-smoking behaviour. Importantly, vaping and cigarette smoking were included in the same statistical model. This allowed the researchers to examine the association with vaping independently of smoking, rather than assuming everyone who vapes has never smoked cigarettes. What is AMH and what does it have to do with fertility? Anti-Müllerian hormone, or AMH, is produced by cells within developing follicles in the ovaries. It is commonly used as a marker of ovarian reserve – broadly, the pool of eggs remaining in the ovaries. In general, AMH tends to decline as ovarian reserve decreases with age. AMH testing can therefore be useful when assessing ovarian reserve and estimating how the ovaries might respond to stimulation during fertility treatment. But there is an important caveat. AMH does not measure egg quality and it cannot tell you whether you can or cannot get pregnant naturally. Someone can have low AMH and conceive naturally, while someone with a high AMH can still experience fertility difficulties for completely unrelated reasons. So, when this study reports lower AMH among current vapers, it does not mean that current vapers were 5.6% less fertile or had a 5.6% lower chance of pregnancy. Those are different outcomes. Does vaping reduce your egg count? This study cannot tell us that vaping reduces someone’s egg count. AMH is associated with the number of developing follicles in the ovaries, but it does not directly count how many eggs someone has. The researchers also did not perform antral follicle counts (AFCs) using ultrasound, which would provide another measure of ovarian reserve. For that reason, the finding should be described as an association between vaping and lower AMH, rather than evidence that vaping directly destroys eggs or causes diminished ovarian reserve. Future studies combining repeated AMH measurements with AFC, detailed vaping exposure and long-term reproductive outcomes will be needed to answer this properly. How could vaping affect the ovaries? At the moment, we don’t know. There are several biologically plausible explanations, but most of the evidence comes from cigarette smoking, laboratory studies or animal research rather than large human vaping studies. Nicotine is one possibility. Experimental research suggests nicotine can influence follicular development, cell death and the normal production of reproductive hormones. Nicotine’s major metabolite, cotinine, has also been detected in follicular fluid — the fluid surrounding a developing egg — in people who smoke and vape. But nicotine may not be the whole story. E-cigarette aerosol can contain a complex mixture of substances depending on the device and liquid used, including metals, aldehydes and flavouring chemicals. Some laboratory and animal studies have suggested that certain components may affect ovarian follicles or endocrine function. That does not mean these substances have been shown to damage human fertility at the levels produced by normal vaping. It does mean there is enough biological uncertainty to justify much better research – particularly as vaping becomes more common among younger people. Is vaping worse for fertility than smoking? […]

Stopped the contraceptive pill but your period hasn’t returned yet? For most people, fertility returns quickly after stopping the pill and periods restart within a few weeks to a few months. If you have gone 3 months without a period, and pregnancy has been ruled out, it may be worth speaking to a healthcare professional. A short delay doesn’t necessarily mean anything is wrong – sometimes your natural cycle simply needs time to re-establish itself. However, stopping the pill can also reveal an underlying hormonal or reproductive health condition that was less obvious while you were taking it. Here’s what happens after you stop the pill, how long you can expect your period to take to return, and when a missing period is worth investigating. Quick facts: What happens when you stop the contraceptive pill? When you are on the pill, whether the combined pill or the progestogen-only pill (mini pill), synthetic hormones are keeping your natural hormonal cycle suppressed. This essentially puts the signals to the ovaries to trigger ovulation on pause. When you stop taking the pill, those synthetic hormones clear your system and your body has to restart its own hormone production. The brain begins releasing hormones again, which signals the production of Follicle-Stimulating Hormone (FSH) and Luteinising Hormone (LH), which in turn tells the ovaries to get back into action. That chain of communication takes time to re-establish and until ovulation actually happens, your period will not return. Your bleeding pattern can take a little longer to become predictable, particularly if your periods were irregular before you started contraception. Is it normal to have a late or irregular period after stopping the pill? Yes. Some change to your bleeding pattern after stopping the pill is common. Your first few periods may be: You may also simply notice the return of the menstrual pattern you had before starting contraception. For example, if you originally started the pill because you had heavy, painful or irregular periods, those symptoms may return after you stop it. This isn’t the pill making things worse – it may just mean the pill had been controlling symptoms that are now visible again. What is post-pill amenorrhoea? You may have come across the term post-pill amenorrhoea when searching for why your period has not returned after stopping the contraceptive pill. Amenorrhoea means not having periods. Primary amenorrhoea is when someone has not had their first period by around age 15. Secondary amenorrhoea is when someone who has had periods stops having them for at least 3 months.  Post-pill amenorrhoea describes a type of secondary amenorrhoea whereby a period does not return after stopping the pill. It is not thought to be a separate condition caused by the pill. For many people, the body simply needs time to restart its natural hormonal cycle. Periods usually return within a few months. However, a missing period can sometimes point to an underlying condition that the pill had been masking, such as PMOS (formerly PCOS), thyroid problems, raised prolactin, hypothalamic amenorrhoea or premature ovarian insufficiency. Importantly, there is no evidence that the pill itself causes long-term amenorrhoea or permanently stops your menstrual cycle.  How long does it take for your period to return after stopping the pill? Many people’s first natural period will usually return within a few weeks to a few months after stopping the pill. One important distinction is the difference between a withdrawal bleed and a natural menstrual period. You may experience bleeding within a few days of stopping the active tablets. This happens because the level of contraceptive hormones falls. Research has found that cycles in the first few months after stopping the pill can be slightly longer than average, one study found an average cycle length of 33.3 days in recent pill stoppers, compared to 29.6 days in non-pill users. So if your cycles feel long initially, this is expected. Factors like weight, physical health, stress levels, exercise and conditions such as PMOS can all influence your natural cycle. These might affect how quickly your period returns or how regular it is.  A natural period happens after your own hormonal cycle has resumed. Ovulation generally occurs first, followed by a period around two weeks later if pregnancy has not occurred. For some people this happens quickly. For others, the first few cycles may be longer or less predictable. If you have not had a natural period after 3 months, take a pregnancy test if there is any possibility of pregnancy and get it checked out. Why has my period not returned after stopping the pill? If you’re outside the expected window and still haven’t had a period, there are several possible causes. Pregnancy This is the first thing to rule out. You can ovulate before your first period after stopping the pill, which means you can become pregnant without having seen a natural period first. If you have had sex without contraception since stopping the pill and your period hasn’t arrived, take a pregnancy test. Your natural cycle is still re-establishing itself For some people, the first ovulation after stopping hormonal contraception takes a little longer. A short delay can therefore happen without there being an underlying medical problem. But if you have missed 3 periods, it is worth investigating it. PMOS PMOS is a common cause of irregular or absent periods. The pill can create a predictable bleeding pattern and reduce symptoms such as acne or excess hair growth, meaning the underlying condition may be less apparent while you are taking it. After stopping, irregular ovulation and other symptoms may become noticeable again. If you had irregular periods before starting the pill, or you now have irregular periods alongside acne, increased facial or body hair or other signs of androgen excess, PMOS may be worth investigating. Hypothalamic amenorrhoea Hypothalamic amenorrhoea (HA) is a condition where the brain suppresses the hormonal signals needed to trigger ovulation, usually in response to chronic stress, significant under-eating, or high exercise volumes without enough fueling. The […]

A new Hertility study reveals that testosterone levels in women change continuously throughout adult life, challenging the idea that one broad reference range can accurately define what is “normal” for every woman at every age (Wainwright et al., 2026). Testosterone is often thought of as a male hormone but women produce it too. It plays an important role in sexual function, mood, muscle mass, bone health, metabolism and wider reproductive physiology (Davis and Wahlin-Jacobsen, 2015). It is also commonly tested when investigating symptoms such as excess facial or body hair, persistent acne, irregular periods, scalp hair loss and possible polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS). But interpreting the result is not always straightforward. Testosterone results are generally compared with a laboratory reference range and labelled as either inside or outside that range. However, many existing ranges are based on relatively small groups of women and use broad age categories. Published in the peer-reviewed Journal of Endocrinological Investigation, Hertility’s study suggests that age should become a much bigger part of how testosterone results are understood. What did the study find? Researchers analysed testosterone levels from 5,323 carefully screened women aged 19-59 from across England, Scotland and Wales. The main finding was clear: average testosterone levels were approximately 1.4% lower with each additional year of age. The amount of variation between women also increased with age. This means testosterone did not simply decline at one defined life stage, such as menopause. Instead, levels changed gradually throughout adult life. In practical terms, the same testosterone result may not mean exactly the same thing for a 22-year-old and a 52-year-old. The researchers therefore developed an age-continuous reference model. Rather than placing women into broad groups such as ages 20-49, which is what one of the current reference ranges does, the model shows how a result compares with the testosterone distribution expected at each individual age. About the research The study retrospectively analysed anonymised data collected through Hertility’s reproductive health service between September 2020 and August 2025. More than 30,000 records were initially available. Strict criteria were then applied to establish a reliable ‘healthy’ reference population. The final reference group included 5,323 women who had regular menstrual cycles, a normal BMI and no reported history of reproductive health conditions or hirsutism (excess hair growth). Samples were collected during the early part of the menstrual cycle, following a fast, and analysed using the same laboratory platform. This helped reduce some of the variation caused by sample timing and different testing methods. A separate group of 2,338 women who reported hirsutism was also assessed. What did the study find about excess facial or body hair? Hirsutism describes the growth of thicker, darker hair in areas such as the face, chest, abdomen or back. It can be a clinical sign of androgen excess and is commonly associated with PMOS, although not everyone with hirsutism will have raised testosterone or PMOS (Escobar-Morreale et al., 2012). The study found that women reporting hirsutism had significantly higher testosterone levels on average than women in the reference population. The difference was most noticeable at younger ages. At age 18, the most typical testosterone level in the hirsutism group was around 24% higher than in the reference group. This difference became smaller with age but remained present throughout adult life. However, there was considerable overlap between the two groups. This is important because it shows why symptoms should not be dismissed simply because a testosterone result is labelled normal. Equally, a raised testosterone result cannot diagnose the cause of someone’s symptoms on its own. Blood results and symptoms need to be interpreted together. What is a normal testosterone level in women? There is no single testosterone level that is universally normal for every woman. The reference range shown on a blood test can vary depending on the laboratory, the testing method and the population used to create it. Testosterone levels can also be influenced by menstrual-cycle timing, time of day, body mass index, stress, hormonal contraception, pregnancy and menopausal stage (Schiffer et al., 2023). Hertility’s findings add age as another essential consideration. A result may fall inside a broad laboratory range while still being relatively high or low compared with what is typically expected for someone of that specific age. It is also important to understand that a reference range is not the same as a diagnostic threshold. A reference range describes the values found in a selected population; it does not create a clear dividing line between health and disease. Why current testosterone reference ranges may be limited One widely used testosterone assay manufacturer established its female reference range using just 149 women, divided into two broad categories: ages 20-49 and ages 50 and over. By comparison, Hertility’s new model was developed using 5,323 carefully selected women and estimated expected testosterone distributions continuously across ages 19-59. Reference ranges may also differ between NHS trusts, private providers and laboratories because testing sites use different platforms or locally established ranges. This means the same testosterone level may be interpreted differently depending on where someone is tested. The study does not propose that clinical decisions should be made from age alone. Instead, it provides greater context to help clinicians understand how common or unusual an individual result is compared with other women of the same age. What does this mean for PMOS? Higher testosterone is commonly associated with PMOS, a complex hormonal and metabolic condition that can affect menstrual cycles, ovulation, skin, hair and fertility. Androgen excess may be identified through visible symptoms, such as hirsutism, or through hormone testing. International guidance recognises both clinical and biochemical signs of androgen excess when assessing someone for PMOS (Teede et al., 2023). The Hertility study does not create a new diagnostic cut-off for PMOS. Instead, it reinforces that a testosterone result within a broad laboratory range does not automatically exclude androgen excess or PMOS – particularly where someone has relevant symptoms or irregular periods. Testosterone should be considered alongside menstrual […]

As GLP-1 medications have skyrocketed in popularity over recent years, they have sparked a lot of conversation, and a fair amount of confusion. If you have been scrolling through social media lately, you have probably come across the phrase “Ozempic Babies,” leaving many wondering what these weight loss “jabs” actually do to reproductive health and fertility. Whether you are taking a GLP-1 medication for diabetes management, weight loss, or metabolic health, and you’re thinking about trying to conceive, here is everything you need to know to navigate your journey safely. Quick Facts: What Exactly Are GLP-1 Medications? Some Quick Clarification: Originally developed by pharmaceutical companies to manage type 2 diabetes and insulin resistance, their highly effective weight-management properties mean they are now widely used to manage and treat obesity [2]. Obesity is a major global health crisis, with approximately 30% UK adults living with obesity, serving as a primary risk factor for cardiovascular disease and other chronic conditions [3]. Because GLP-1 RAs have been revolutionary for metabolic health, clinicians are also exploring their benefits for managing the metabolic features of Polyendocrine Metabolic Ovarian Syndrome or PMOS, formerly Polycystic ovary syndrome (PCOS) [4]. This is because a lot of the symptoms and indications of PMOS are treated by the effects of GLP-1 RAs as they are highly effective for managing the condition’s metabolic features such as improving insulin sensitivity, suppressing appetite, and promoting weight loss [5]. If you think you might have PMOS, read our blog on How PMOS is Diagnosed for more information. Note: In the UK, GLP-1 RA medications are licensed for the treatment of type 2 diabetes and obesity management [6]. While GLP-1 RAs are commonly referred to by their brand names such as Ozempic, Mounjaro or even colloquially called “the jabs”, here’s a look at the most common GLP-1 RA medications currently available: New in 2026: The GLP-1 Pill Until recently, every GLP-1 licensed for weight loss in the UK was a weekly injection. In June 2026, the MHRA approved an oral semaglutide tablet (the “Wegovy pill”) as the first GLP-1 tablet for weight management in the UK, and the first in Europe [7]. It is currently available on private prescription, with NHS availability still under NICE review. A quick point of clarification, because the names get confusing: oral semaglutide already existed in the UK as Rybelsus, but Rybelsus is only licensed for type 2 diabetes, not weight loss. The new, higher-dose tablet is the one licensed for weight management. Unlike the injection, it has to be taken first thing on an empty stomach after fasting overnight, with only a sip of water, and you then wait around 30 minutes before eating or drinking, otherwise your body won’t absorb it properly. A second oral option, orforglipron (Foundayo), is expected to follow. It has been approved in the US and is currently under MHRA review, but it is not yet licensed or available in the UK. Does the pill form change any of the fertility advice? No. The oral tablet contains the same drug as injectable semaglutide, so exactly the same rules apply: it is not recommended in pregnancy, while trying to conceive, or when breastfeeding, and the same wash-out period stands. If anything, the arrival of these tablets is a good prompt to double-check your contraception, the documented interaction with the contraceptive pill is specific to tirzepatide (Mounjaro), not semaglutide, but any GLP-1 that causes vomiting or diarrhoea can affect how well an oral pill is absorbed. The Truth Behind “Ozempic Babies” You might have heard of the term “Ozempic Babies” in the press, which refers to women unexpectedly or spontaneously conceiving while taking GLP-1 medications. It is incredibly important to clarify GLP-1 RAs are metabolic therapies, not fertility treatments. So, why is this happening? There are two primary biological reasons behind it. Obesity and insulin resistance heavily impact the reproductive system. Excess adipose (fat) tissue produces extra oestrogen and drives insulin resistance, which can prevent regular ovulation from occurring [8]. This can cause irregular cycles, heavy, or absent periods. Because of these irregular cycles, many women might assume they cannot get pregnant and not use contraception. When someone starts a GLP-1 RA, the resulting weight loss and metabolic improvement have an indirect, positive effect on their reproductive hormones. Suddenly, cycles and ovulation become more regular, and pregnancy can occur spontaneously. GLP-1 medications slow down gastric emptying (how fast your stomach empties food), and this can affect how some oral medications are absorbed. Importantly, the evidence here is drug-specific rather than a blanket effect across the whole class. The clearest interaction is with tirzepatide (Mounjaro). Studies have shown it can reduce the amount of contraceptive hormone your body absorbs, so it is recommended to use a barrier method (such as condoms) or switch to a non-oral method for 4 weeks after starting tirzepatide, and for 4 weeks after each dose increase [9]. For semaglutide (Ozempic, Wegovy, Rybelsus), a meaningful reduction in oral contraceptive effectiveness has not been demonstrated. That said, if any GLP-1 medication causes vomiting or diarrhoea, an oral pill may not be fully absorbed, so it is always sensible to use backup contraception if you are unwell. GLP-1 Medications Are Not Recommended in Pregnancy While these medications can indirectly boost fertility by improving metabolic health, GLP-1 medications are strictly not recommended during pregnancy, while actively trying to conceive, or during breastfeeding. Because these medications are relatively new, we do not yet have enough long-term safety data to know their impact on foetal development or future outcomes. The human data available so far have not shown a clear increase in birth defects, but there simply isn’t enough of it to confirm these medications are safe in pregnancy, which is exactly why a precautionary approach is taken [10]. If you are planning a pregnancy, you must observe a strict “wash-out period” to allow the medication to completely leave your system before you start trying to conceive [6]. If pregnancy does occur while taking a GLP-1 RA, […]

If you’re an HR leader or employer in the UK or Ireland, you’ve likely felt the tension between supporting your people and navigating the realities of limited budgets, rising sickness rates, and turnover from colleagues quietly leaving because they feel unsupported.  Hertility gives UK and Ireland employers a diagnostic-first approach to fertility and hormone health benefits, combining at-home testing and virtual specialist care, to help you close support gaps before they become costly sickness, treatment or talent losses.  This guide will walk you through exactly how fertility and hormone health benefits can build genuine workplace equity – and what practical steps you can take starting today. Key Takeaways: Fertility and Hormone Health Benefits for Workplace Equity Fertility and Hormone Health benefits address a missing link in UK and Irish workplace wellbeing strategies, reducing absenteeism and boosting retention. The gender health gap costs UK and Irish businesses billions annually through lost productivity, presenteeism, and avoidable employee turnover. Supporting specific life-stages or conditions like menopause, fertility,  or PCOS and endometriosis helps close the gender pay gap. Hertility’s at-home testing and virtual specialist care pathways give employees fast answers to their health and access to care. UK employers have legal obligations to make reasonable adjustments for employees with health conditions. What Is the Gender Health Gap and Why Does It Matter for UK Employers? The gender health gap refers to the systemic difference in how women’s health concerns are diagnosed, treated, and supported compared to men’s. Women are significantly more likely to have their pain dismissed or misdiagnosed, leading to delayed diagnoses, later-stage treatment, and higher healthcare costs. According to research from REBA, women receive fewer workplace benefits than men, with 65% getting company perks compared to 75% of men. This disparity contributes to a cycle where women are less supported, more stressed, and more likely to leave. A report by Deloitte highlights that working women spend more than £1.5bn more per year on out of pocket healthcare than their male counterparts. Fuelled by gaps in public healthcare and benefit strategies.  How Does Unsupported Fertility and Hormone Health Affect UK Business Performance? Unsupported reproductive health conditions alone cost UK businesses approximately £11 billion every year through absenteeism related to heavy and painful periods, endometriosis, fibroids, and ovarian cysts. One in ten women surveyed by the Fawcett Society left work entirely due to menopause symptoms. Losing experienced employees at this career stage not only results in institutional knowledge and leadership losses – but widens your gender pay gap. But this isn’t just about lost workdays and turnover. Presenteeism – where employees show up but can’t fully function – drains productivity and is hugely damaging to businesses. A recent Hertility report using the aggregated biometric data of thousands of female employees highlights that they are living with an average of 5 career impacting symptoms each, ranging from fatigue and anxiety to pain and low-mood. Without access to screening and care, they’re forced to let them escalate and not get to the bottom of what could be a manageable condition or treatable deficiency. Typically, benefit providers and public healthcare are reactive, but many progressive organisations are bringing preventative strategies into their workforce to keep people well and working – which is exactly what Hertility does; unlike other women’s health support on the market, we support women to screen their hormone health and fertility proactively.  Giving them the fastest and most accessible way of getting a diagnosis, managing conditions and accessing treatment, making informed decisions about their fertility future, and supporting them through key life-stages.  What Is the Link Between Fertility and Hormone Health Benefits and the Gender Pay Gap? The gender pay gap in the UK has fallen over the past five years, but male health professionals still earn on average 10.2% more than their female counterparts, according to NHS Employers guidance, and the UK has recently received its lowest workplace gender equality ranking in a decade.  Fertility and hormone health play a significant, but often overlooked role in this disparity. Women disproportionately carry caring responsibilities and experience health-related career interruptions.  When menopause symptoms force someone to reduce hours or step back from promotion opportunities, the pay gap widens. When fertility challenges remain taboo and unsupported, talented employees check out or leave the workforce entirely. Proactive Fertility and Hormone health workplace benefits help you address these root causes directly.  Supporting employees through fertility journeys, conditions, perimenopause, and menopause is a measurable strategy for closing your organisation’s gender pay gap and being an employer of choice against your competitors.  What Should Fertility and Hormone Health Employee Benefits Include? Effective reproductive health benefits go beyond a single service like fertility or menopause care. They should cover the full spectrum of hormonal and reproductive health needs across all life stages, starting with menstruation through to menopause. Diagnostic Testing and Clinical Insights At-home hormone and fertility testing removes barriers to diagnosis and is accessible, reducing time off for appointments. Employees shouldn’t need to wait years for NHS gynaecology appointments when they’re experiencing symptoms now.  Hertility delivers clinical-grade results in just six days, with Doctor-Written Reports and onward Virtual Specialist Care Pathways.  Available testing should consider the individuals needs, and be completely personalised based on their symptoms, but screen for common conditions that could impact future fertility and quality of life, like PCOS, thyroid imbalances, egg reserve indicators, iron deficiency, perimenopause markers and more. The goal is to empower employees to be proactive with their health, take action and get the care they need to support their wellbeing; reducing the need for reactive care further down the line. Access to Clinical Services and Care Pathways Diagnostics are only the starting point. Benefits should include pathways to clinical care – consultations with specialists, treatment options, and ongoing support. As well as referral pathways for fertility treatment like egg freezing and IVF. When employees receive their results, they need clear next steps and a provider who is with them every step of the way.  Education and Policy Development Workshops for managers and […]

From PMDD symptoms and AMH levels to managing PMOS without contraception, Hertility’s clinical team answers your most pressing cycle and hormone questions.

In 2024, around 1 in 31 babies born in the UK were conceived through IVF. That is roughly one child in every classroom. Two decades ago, it was around 1 in 65. That single statistic, from the latest report by the Human Fertilisation and Embryology Authority (HFEA), shows how mainstream fertility treatment has become. The HFEA’s report, Fertility treatment 2024: trends and figures, gives us the clearest picture of fertility treatment in the UK. It shows who is having treatment, how IVF is changing, and what outcomes look like. But the headline does not tell the whole story. IVF has become more common. Success rates have improved. More single people and same-sex couples are using fertility treatment to build families. Egg and embryo freezing now sit firmly within mainstream fertility planning. At the same time, access has become more unequal. NHS funding has fallen and regional access varies sharply. More patients now pay privately for some or all of their treatment. So, what does the latest HFEA data actually show, and what does it mean if you are thinking about your own fertility? Quick facts IVF is now behind 1 in 31 UK births The scale of the shift is hard to overstate. In 2024, around 21,400 babies were born through IVF in the UK, more than double the number born via IVF in 2004. IVF now accounts for around 3.2% of all UK births, compared with under 1.4% two decades ago. Part of what’s driving this is how common fertility challenges really are. The World Health Organization estimates that around 1 in 6 people worldwide experience infertility at some point in their lives. Add the well-established trend of people starting families late, and the fact that IVF success is tightly bound to age and rising demand represents more like a structural shift in how and when people build families. The number of IVF patients has almost tripled over 30 years. IVF is no longer a last resort for a small number of people. It now plays a central role in how families across the UK are built. So far, so encouraging. The catch is what the averages conceal, and the rest of the report is really a story about two things that still decide an individual’s odds: age and access. Success rates are climbing, but age is still the biggest factor There’s genuine progress here. The average IVF birth rate per embryo transferred rose from 20% in 2014 to 30% in 2024. Clinics are getting better at what they do. But the single most powerful variable remains age. In 2024, the birth rate per embryo transferred was: That’s not a small gap, it’s the difference between a strong chance and a long shot. It reflects something biology makes unavoidable: both the number and quality of eggs decline with age, and that decline accelerates from the mid-30s onwards. The report also lays bare disparities the averages hide. For patients aged 18–37 in 2022–24, the average birth rate per embryo transferred was around 30% for both Asian and Black patients, compared with 36% for White patients and 35% for those from a Mixed background. The HFEA is careful to note its data can’t explain why; the reasons likely span age at treatment, underlying health conditions, and social and economic factors. None of this means panicking in your 30s. It means fertility decisions get easier when you have information earlier. Understanding your ovarian reserve, cycle pattern and hormone profile early gives you time to plan. Finding out during an IVF workup at 40 usually means fewer options and far more pressure. Hertility’s Advanced Hormone & Fertility Test measures AMH, a key marker of ovarian reserve, alongside other reproductive and thyroid hormones. Based on your results, our clinical team builds you a personalised care plan with clear next steps. It’s a simple way to understand your fertility on your own timeline.  IVF treatment is changing, not just growing The rise in IVF isn’t only about more people having treatment,it’s about how they’re using it. Frozen embryo transfers now make up 48% of all IVF cycles, nearly double the 24% recorded in 2014. Almost half of all cycles now use frozen rather than fresh embryos. This is driven by better freezing techniques and more people storing embryos for future family-building.  Treatment has also become markedly safer. The average IVF multiple birth rate, twins and triplets, which carry higher risks for both patients and babies, including preterm birth, pre-eclampsia and stillbirth, fell from 14.4% in 2014 to just 3.2% in 2024, among the lowest rates in the world. This largely reflects the shift to single embryo transfer, used in 84% of UK embryo transfers in 2024. Crucially, birth rates kept improving even as multiple births fell is proof that safer IVF doesn’t have to mean less successful IVF. Taken together, these shifts show fertility treatment moving beyond immediate pregnancy. More and more, people are using it to preserve options, plan ahead and build families over time. Egg freezing is also on the rise in the UK Nowhere is that shift clearer than in fertility preservation. The number of people freezing eggs grew from around 700 in 2014 to 5,580 in 2024, though for the first time since 2020, the number of egg freezing cycles held steady rather than rising year-on-year. People freeze for all sorts of reasons: they’re not ready for children, haven’t met the right partner, are in a same-sex relationship, face medical treatment that could affect fertility, or simply want more choice. Whatever the reason, a few things are worth understanding before you start: At Hertility, we can provide a comprehensive fertility assessment that combines hormone blood testing with an ultrasound scan to build a more complete picture of your reproductive health. Blood tests can measure AMH and other key reproductive and thyroid hormones, while an antral follicle count (AFC) scan provides additional information by estimating the number of follicles in your ovaries. Neither blood tests nor scans can predict your future […]

Deciding to try for a baby is a big step, and one of the first practical questions many people ask is: when should I stop using contraception if I want to get pregnant? The answer depends on the type of contraception you’re using. For most methods, fertility can return quickly, sometimes within days or weeks. For others, particularly the contraceptive injection, it can take several months for ovulation and periods to return. The reassuring news? Contraception does not impact your long-term fertility. Most people are able to start trying as soon as they stop their method, although your cycle may take a little time to settle. This guide explains when to stop each type of contraception, how quickly fertility may return, what can affect your chances of conceiving, and when to seek support if things are not progressing as expected. Quick facts: When should you stop using contraception if you want to get pregnant? One of the most common concerns about stopping contraception is whether it can make it harder to get pregnant later. The reassuring answer is no. Reversible contraception does not permanently affect your fertility. Hormonal contraception works by temporarily changing your reproductive hormones. Depending on the method, it may stop ovulation, thicken cervical mucus, thin the womb lining or create an environment that prevents pregnancy. Once you stop using it, these effects wear off. What can vary is how long it takes for ovulation to return. For most methods, this happens quickly. For the contraceptive injection, it can take longer because the hormone is designed to stay active in the body for several months. Sometimes, stopping contraception can reveal symptoms that were previously being masked. For example, if you had irregular periods before starting contraception, they may return once you stop. Conditions such as PMOS (formerly known as PCOS), thyroid dysfunction, endometriosis or hypothalamic amenorrhoea may also become more noticeable after stopping hormonal contraception. This does not mean contraception caused the issue. It may simply have been managing or hiding the symptoms. How long does it take to get pregnant once your stop contraception? A review of 22 studies across 15,000 women found that 83.1% became pregnant within 12 months of stopping any form of contraception, which is comparable to the general conception rate. The NHS data similarly shows that 82–92% of people conceive within one year of trying, depending on age. Some people get pregnant in the first cycle after stopping contraception. For others, it can take several months, and that can still be completely normal.  When to Stop the Combined Pill Before Trying to Get Pregnant The combined contraceptive pill contains synthetic versions of oestrogen and progesterone. It prevents pregnancy mainly by stopping ovulation, meaning your ovaries do not release an egg each month. When to stop: You can stop the combined pill whenever you are ready to start trying for a baby. There is no medical need to finish your current pill pack, although some people prefer to do this because it can make bleeding easier to predict. When fertility returns: Fertility can return quickly after stopping the combined pill. Some people ovulate within the first month, although it can take one to three months for your natural menstrual cycle to become regular again. If your periods were irregular before you started the pill, they may become irregular again once you stop. When to start trying: You can start trying to conceive as soon as you stop the pill. If you get pregnant before your first natural period, it may be slightly harder to date the pregnancy, but this is not harmful and is not a reason to delay trying. When to Stop the Mini Pill Before Trying to Get Pregnant The progestogen-only pill, often called the mini pill, contains a synthetic version of progesterone. It can prevent pregnancy by thickening cervical mucus, thinning the womb lining and sometimes stopping ovulation. When to stop: You can stop the mini pill at any point. Fertility usually returns very quickly, often within days to a few weeks, because the mini pill does not always suppress ovulation in the same way as the combined pill. When fertility returns: You can start trying for a baby as soon as you stop taking the mini pill. Your period may take a little time to return, but ovulation can happen before your first bleed, which means pregnancy may be possible straight away. When to start trying: You can start trying to conceive as soon as you stop the pill. If you get pregnant before your first natural period, it may be slightly harder to date the pregnancy, but this is not harmful and is not a reason to delay trying. When to Stop the Contraceptive Patch Before Trying to Get Pregnant The contraceptive patch is worn on the skin and releases oestrogen and progestogen. It works in a similar way to the combined pill by stopping ovulation. When to stop: You can stop using the contraceptive patch by removing it when you are ready to try for pregnancy.  When fertility returns: Fertility may return quickly after stopping, although your period may take one to two months to return to its usual pattern, but even if your periods don’t come back immediately, it may still be possible to get pregnant right after stopping the patch  When to start trying: You can start trying to conceive immediately after removing the patch. As with other hormonal methods, ovulation can happen before your first period, so pregnancy may be possible straight away. When to Stop the Vaginal Ring Before Trying to Get Pregnant The vaginal ring is a small, flexible ring placed inside the vagina. It releases hormones that prevent pregnancy by stopping ovulation, thickening cervical mucus and thinning the womb lining. When to stop: You can stop using the vaginal ring by removing it when you are ready to start trying for a baby. When fertility returns: As with the combined pill and patch, the ring is a combined hormonal method and […]

Anti-Müllerian Hormone (AMH) is one of the most talked-about fertility hormones, but also one of the most misunderstood. Because AMH is closely linked to your eggs, testing it can offer valuable insight into your ovarian reserve (the number of eggs you have left). But it’s not a fertility “yes or no” test. In this guide, we break down exactly what AMH testing can and can’t tell you about your reproductive health.  Quick facts: What is AMH and why is it so important? Anti-müllerian hormone (AMH) is made by small fluid-filled sacs in the ovaries called follicles, each of which houses an immature egg. Because AMH is made by these follicles, your AMH level gives an indication of how many eggs you may have remaining at a given time. However, this is only one piece of the fertility puzzle. There are a few myths out there about what exactly AMH testing can tell us. In this article, we cover the main things an AMH test can and can’t tell you. Let’s get into it. What can AMH testing tell me? Whether your ovarian reserve is a normal for your age AMH testing will give you insights into whether your ovarian or egg reserve is what is expected with other healthy people in your age group. It helps you understand whether your egg reserve is higher, average, or lower than expected for your age. If you are not using any hormonal contraception, testing other hormones, like follicle-stimulating hormone (FSH) and oestradiol alongside AMH can also help to build a more complete picture of egg reserve. Generally, people with low egg reserves are known to have higher levels of FSH and lower levels of oestradiol. Whether you have polycystic ovaries or polycystic ovary syndrome AMH testing can also be used as an indicator of whether you could have polycystic ovaries (PCO). PCO is a common reproductive health condition affecting around 30% of reproductive-aged people assigned female-at-birth. PCO is benign and does not affect fertility, but it can cause other unwanted symptoms.  People with PCO have a higher-than-expected number of immature follicles in their ovaries. More follicles mean a higher level of AMH in the blood.  Some people with PCO also have the syndrome that can be associated with it polycystic ovary syndrome (PCOS), which often presents as symptoms like irregular periods, acne, hair thinning or loss and high testosterone levels. According to updated guidelines, AMH can now be used as an indicator for polycystic ovaries in place of doing an ultrasound scan for the diagnosis of PCOS. However, at Hertility, we would always recommend getting a pelvic ultrasound scan to further assess your ovarian reserve. During this scan, your ovaries are assessed to determine your antral follicle count (the number of eggs sacs seen within your ovaries) and to confirm the diagnosis. Whether IVF or egg freezing could be right for you In fertility treatment settings, AMH plays an important role in guiding decisions around interventions such as IVF and egg freezing . It is commonly used to estimate how the ovaries may respond to stimulation and to guide medication dosing.  Lower AMH levels are generally associated with retrieving fewer eggs during IVF, while higher levels may indicate a stronger response but also carry a risk of developing a rare but potentially life threatening condition called OHSS (ovarian hyperstimulation syndrome). This makes AMH a valuable tool for planning treatment safely and effectively. Many NHS-funded and private IVF clinics therefore require a minimum AMH level for you to be eligible for a free IVF treatment cycle. The minimum level on the NHS will depend on where in the UK you are currently residing. Whether you may be perimenopausal or menopausal or have POI Menopause marks the point at which your periods stop permanently, typically between the ages of 45 and 55, with the average age for menopause in the UK being 51. After menopause, natural conception is no longer possible. It is associated with a very low, or completely depleted, ovarian reserve. Clinically, menopause is usually diagnosed retrospectively, after 12 consecutive months without a period in someone not using hormonal contraception. In individuals under the age of 45, follicle-stimulating hormone (FSH) is more commonly used as a diagnostic marker, as levels tend to rise when ovarian function declines. While AMH is not currently recommended as a standalone test to diagnose menopause, it is well established that AMH levels fall to very low levels as ovarian reserve diminishes. This makes AMH a useful indicator of overall ovarian activity. Declining or very low AMH levels can suggest that you are approaching menopause, although it cannot predict the exact timing. In younger individuals, particularly those under 40, significantly low AMH levels may raise suspicion of premature ovarian insufficiency (POI), a condition in which the ovaries stop functioning earlier than expected. What can’t AMH testing tell me? While AMH testing is a useful tool for understanding your ovarian reserve, it only represents one part of your overall fertility picture. There are several important limitations to be aware of, and understanding these can help you interpret your results more accurately and avoid common misconceptions. It can’t determine your egg quality One of the biggest limitations is that AMH cannot tell you anything about your egg quality. Although AMH reflects the number of eggs you may have remaining, it does not provide any insight into how healthy those eggs are. Egg quality is one of the most important factors influencing fertility and pregnancy outcomes, and it is largely driven by age and genetics. At present, there is no reliable test to measure egg quality directly, except through assessing embryos during IVF treatment. It can’t determine your exact egg quantity AMH also cannot determine your exact number of eggs. While it gives an indication of the size of your ovarian reserve, it is not a precise measurement. This is because AMH is made by ovarian follicles, and each follicle can release different amounts of the hormone depending on its size and […]

If you’re in your 40s and suddenly notice irregular periods, brain fog, broken sleep, anxiety, night sweats or hot flushes that seem to appear out of nowhere, it’s natural to wonder: could this be perimenopause? And if you are wondering that, the next question often follows quickly: how is perimenopause actually diagnosed? One of the most frustrating things about perimenopause is that many people feel dismissed whilst searching for answers. You may arrive at a GP appointment with months of poor sleep, mood changes, heavy or unpredictable periods and symptoms that are affecting your work, relationships and confidence, and  be told to just wait and see. This guide explains how perimenopause is diagnosed in the UK, what happens if you are under 45, when blood tests are useful, when they are not, and how Hertility can help you get clarity. Quick facts: What is perimenopause? Perimenopause is the transitional phase leading up to menopause. During this time, the ovaries gradually become less responsive and start producing hormones such as oestrogen and progesterone less consistently. Importantly, hormone levels do not decline in a neat, predictable line. They can fluctuate significantly from one day to the next, and sometimes even within the same day. This hormonal turbulence is what can drive many of the symptoms people associate with perimenopause, including hot flushes, night sweats, mood changes, sleep disruption and cycle changes. Perimenopause can last for a few months, but for many people symptoms may persist for 7 to 9 years, sometimes longer, and they can change over time. It most commonly begins in the mid-40s, although it can start earlier. Menopause itself is confirmed retrospectively when you have gone 12 consecutive months without a period, assuming there is no other cause, such as pregnancy, medication or hormonal contraception. The average age of menopause in the UK is around 51, with a typical range between 45 and 55. Everything before that final period, while symptoms and cycle changes are happening, is considered perimenopause. Can perimenopause happen before 45? When menopause happens before the age of 45, it is called early menopause. When ovarian function reduces significantly before the age of 40, it is called premature ovarian insufficiency, or POI. This is less common than menopause at the average age, but it is not rare. Spontaneous early menopause affects around 5% of the population before age 45, while POI is estimated to affect around 1% of women under 40 and around 0.1% under 30. This distinction matters because early menopause and POI can affect more than periods. They can have implications for fertility, bone density, cardiovascular health, sexual health, emotional wellbeing, cognition and long-term hormone support. People under 45 may also find it harder to get their symptoms recognised because perimenopause is often associated with the late 40s and early 50s. But being younger does not mean your symptoms are irrelevant. It means they should be assessed carefully, with the right investigations and support. What are the symptoms of perimenopause? Because perimenopause is mainly diagnosed through symptoms, it helps to understand what those symptoms can look like. Perimenopause affects everyone differently. Some people have mild symptoms that come and go, while others experience symptoms that significantly affect sleep, mental health, work, relationships and day-to-day life. One of the earliest signs is often a change in your menstrual cycle. Your periods may become closer together, further apart, heavier, lighter, longer, shorter or simply less predictable than before. You might also notice spotting, missed periods or a cycle pattern that feels completely new for your body. Other common perimenopause symptoms include: There can also be symptoms that feel more surprising, such as dry eyes, brittle nails, dizziness, tinnitus, gum sensitivity or changes in taste and smell. Not everyone will experience all of these symptoms. What matters most is the pattern: new or worsening symptoms in midlife, particularly when they appear alongside changes to your menstrual cycle. Perimenopause should also be considered if someone develops new mood or anxiety symptoms in midlife, especially if they have no previous history of depression or anxiety. How is perimenopause diagnosed in the UK? In the UK, perimenopause is usually diagnosed through a clinical assessment. This means a doctor will ask about your age, symptoms, menstrual cycle, medical history, contraception use and how your symptoms are affecting your quality of life. If you are under 40: possible premature ovarian insufficiency should be investigated If you are under 40 and have symptoms that suggest menopause, this should not be brushed off as stress, lifestyle, anxiety or “just hormones” without proper assessment. In this age group, doctors should consider premature ovarian insufficiency, or POI. POI happens when the ovaries stop working normally before the age of 40. It is not the same as typical menopause in the early 50s, and it needs a different level of investigation and support. FSH blood testing is usually important if POI is suspected. Because hormone levels can fluctuate, diagnosis requires two high FSH results taken 4-6 weeks apart, alongside symptoms and menstrual changes. Your doctor may also consider other tests depending on your situation, such as thyroid function, prolactin, pregnancy testing, reproductive hormone testing, autoimmune screening or genetic investigations. This depends on your symptoms, medical history and whether you are trying to conceive. A timely diagnosis matters because POI can affect fertility, bone density and cardiovascular health. Hormone replacement therapy is often recommended until at least the average age of natural menopause, unless there is a medical reason not to use it. If you are under 40 and your periods have become irregular or stopped, especially alongside hot flushes, night sweats, vaginal dryness or fertility concerns, it is reasonable to ask directly whether POI has been considered. If you are 40 to 45: early menopause may need to be assessed Early menopause means menopause before the age of 45. Like POI, it can affect fertility, bone health, cardiovascular health and long-term wellbeing, so it is important not to simply dismiss symptoms. In this age group, a […]