“The greatest advance has been in understanding how fertility changes with age, of ovarian function and eggs within the ovaries,” he says. “We have new hormone blood tests for ovarian reserve, namely the fertility potential of eggs in the ovaries. This can now be combined with an ultrasound scan of the ovaries to give a prediction of a woman’s fertility.”

One step forward has been informing people about the whole area as there has been a great deal of ignorance surrounding women’s fertility in the past. “People often don’t anticipate that fertility problems can happen without any previous issues in the past,” says Balen. “For example, a woman may stop taking the pill and expect to get pregnant right away which may not happen, so it is important to educate people in how their fertility can chance and how to plan ahead.”

One major advance has been in IVF treatment. “We have a much greater chance of success now,” says Balen. “For a woman of 35 or under, there is a 50 per cent success rate after one go of IVF. A few years ago this was just 20 per cent and this is occurring when her chances of getting pregnant naturally would be less than one per cent.” For older women, too, there is a much better outlook, as long as she is under 45: by the age of 40 there is still a 15 per cent chance IVF will work. However, after 45, unless the egg has been donated, IVF will still not work.

A combination of modern drugs and technological advances in the laboratory means it is possible to assess the health of the fertilised egg as it turns into an embryo and make an informed decision about which egg to choose to return to the womb although further advances will become, according to Balen, “an ethical minefield. We will be able to test for genetic problems in embryos and may be able to manipulate genes to eliminate disease. However, this means that not only are we changing the future in terms of the descendants of that embryo but that in the future technically you might be able to manipulate, for example, intelligence, appearance or sporting ability. This could never happen here as the UK is probably the most strictly regulated regime in the world, but we have to be aware of it.” The Human Fertilisation Embryology Authority (HFEA) is responsible for setting what Balen calls “tight but permissive regulation.”

But one piece of advice remains the same: the first port of call for anyone concerned about these problems should be to see their GP.  “There are clear pathways for GPs to follow that have been mapped out, to go first from a basic investigation to the appropriate fertility clinic,” says Balen. “NICE has clear guidelines for treatment but unfortunately it can still be a bit of a postcode lottery as to whether the treatment will be funded.”