For many people, starting a family (or trying to) can be something that happens later in life, whether due to careers, finances, relationships, or simply life panning out that way. While many over-35s have no difficulty conceiving, for others it can be challenging to get pregnant and carry a baby to term. Fertility issues can be particularly tricky to navigate when you are away from your loved ones, or navigating a new health system. So what should you do when you find yourself in this situation, and when is it time to seek help?
Fertility and Age
Female fertility declines with age in a predictable way. Egg number and quality both decrease over time, with a more noticeable drop after 35 and a steeper decline in the early 40s. This affects not only the chance of conceiving, but also the risk of miscarriage. Male fertility also changes. While men continue to produce sperm throughout life, sperm quality - particularly DNA integrity - declines with age. This can affect both conception rates and pregnancy outcomes.
The key point is not that later pregnancy is impossible - it often isn’t - but that it may take longer and require more support.
When Should You See a Doctor?
Don’t be shy about seeking help: early treatment and investigation helps you to make the most of your chances to get pregnant.
- If you are under 35: try for 12 months before seeking medical advice
- Aged 35–39: seek help after 6 months
- Aged 40 or over: seek advice early rather than waiting
You should also speak to a doctor sooner if you have irregular or absent periods, known conditions such as PCOS or endometriosis, a history of pelvic infection, previous cancer treatment, or concerns about sperm quality.
Initial fertility assessment is relatively straightforward. It usually includes hormone blood tests (such as AMH and FSH), a pelvic ultrasound, and a semen analysis. These tests can provide valuable information and guide next steps. Medical conditions that affect fertility should also be considered at this time.
Public or Private?
Spain is one of Europe’s leading centres for fertility treatment, and Mallorca is no exception.
In the public healthcare system, fertility treatment is available but subject to eligibility criteria. These often include age limits (commonly up to 40 for women), BMI thresholds, and the absence of certain health conditions. Up to 3 IVF cycles may be funded, but waiting lists can be long.
As a result, many people choose private care. Private clinics offer faster access, a wider range of treatments, and more flexibility, but at a cost. Spain’s reputation as an IVF hub means standards are generally high, but choosing a reputable clinic is essential.
Practical considerations include insurance coverage, language barriers, and continuity of care.
IVF: What It Can (and Can’t) Do
IVF has transformed fertility treatment, but it is not a guarantee. Success rates are closely linked to age and health. In women under 35, the chance of a live birth per cycle is typically around 30–40%. By the early 40s, this drops significantly, often below 10–15% using a woman’s own eggs. Success rates can also be affected by health conditions.
For some people, egg donation offers higher success rates. This is widely available in Spain, but represents a different pathway to parenthood that needs to be considered carefully. A common misconception is that IVF can fully compensate for age-related decline. While it can help, it isn’t universally successful.
Legal and Social Realities
Spain is progressive in its approach to fertility treatment, but there are important legal boundaries.
Surrogacy is not legal in Spain. Some people pursue surrogacy abroad, but this can involve complex legal processes when returning with a child.
In contrast, fertility treatment is accessible to a wide range of people. Single women and same-sex female couples can access treatment, both privately and, in many regions, within the public system. Egg and sperm donation are also widely used and are legally anonymous in Spain.
What else can you do?
While age and medical issues are common causes of fertility struggles, lifestyle still plays a role. Fertility investigation and treatment take a toll on the mind and body, and it’s important to try and stay as healthy as possible throughout this time.
Alcohol can affect ovulation and sperm quality, so reducing or avoiding it is advisable. Maintaining a healthy weight and balanced diet supports hormonal balance in both men and women. Smoking has a clear negative impact on fertility and accelerates reproductive ageing. Fertility is often discussed in extremes: either overly reassuring or unnecessarily alarming. The reality sits somewhere in between.
Many people will conceive later in life, sometimes naturally, sometimes with help. But the process is not always straightforward. The most important thing is to seek help early and look after yourself through the process – whatever the outcome.
Dr Wilkinson is a British-trained GP and médico general based in Palma. She runs The Huxley Practice, which provides medical care for Mallorca’s residents and visitors. For more information see www.huxleymallorca.com or call +34 651 981 633