You started your fertility journey toward expanding your family with optimism, dreams for the future, and maybe a desire to hurry up and get started. Now it's been weeks, months, or maybe even years and you're still not pregnant. Maybe you never thought this would happen to you, or perhaps a nagging voice in the back of your head always warned you that pregnancy might be difficult.
In most cases, you should seek help after a year of trying with no success (or if you are over the age of 35 or have a medial condition, after six months of trying).
Every couple's fertility journey is unique, and there is no way to determine why you're not getting pregnancy without a comprehensive medical exam. But here are some common scenarios for that difficult question, “Why am I not getting pregnant?” --
Bad Timing / Lack of Reproductive Knowledge
Most couples will get pregnant within a year of trying even if they don't perfectly time their cycles. But sometimes, your efforts to time intercourse actually undermine pregnancy, particularly if you don't have an astute understanding of when you are most likely to get pregnancy. For example, most women ovulate around day 14, but this is merely an average. If you ovulate before then, you might never get pregnant if you only have sex after day 14.
Sometimes birth control pills take a few months to cycle out of your system, so if you've been on hormonal birth control, it may take up to three months to restore full fertility. A handful of other medications can affect fertility, particularly if they affect your endocrine system or disrupt hormone expression or production. If you have a chronic illness, or if you take prescription medications, talk to your doctor in advance about how your health history might affect your ability to get pregnant.
Women are often blamed for fertility issues, but men account for at least a third of such issues. This is why it's so important for both you and your partner to be tested. A number of sperm issues can undermine or completely eliminate the ability to get pregnant. Those include:
- Low sperm count
- Low sperm motility (the ability to move)
- Poor sperm morphology (poorly formed sperm)
- Inability to ejaculate, or ejaculating no sperm
- Sperm containing genetic anomalies
- Abnormalities in the seminal fluid that carries sperm to the egg
You only produce one egg in a normal cycle, so if that egg isn't healthy, you may not get pregnant, or you may end up with an egg that doesn't implant or that miscarries early. Among women over the age of 35, egg issues are especially prevalent. Women are born with their lifetime supply of eggs, so as you age, you have fewer and fewer eggs. That means fewer quality eggs, and a gradually diminishing chance of getting pregnant. Some other common egg issues include:
- Eggs that contain genetic anomalies
- Poor quality eggs that fail to implant in the uterus
Implantation occurs after the egg travels down the fallopian tube into your uterus, and implants itself in the uterine wall. A number of factors can disrupt this process, including uterine infections, uterine fibroids, and hormonal anomalies. For instance, if the luteal period—the time after ovulation—of your menstrual cycle is too short, your body will shed the egg and uterine lining before it has a chance to implant. If the egg is damaged or contains genetic defects, it may not implant, or might produce an early miscarriage. If your cycle is very short, or you know that you get your period shortly after ovulation, you may have implantation issues.
Anovulation means that you don't ovulate. It's relatively normal to have an anovulatory cycle once a year or so, due to stress, illness, and other factors. But many women never ovulate, or do so only rarely, greatly reducing the chances of a pregnancy. A number of illnesses can cause you not to ovulate, but one of the most common is polycystic ovarian syndrome. If your cycles are very irregular, you never get a positive ovulation test or a basal body temperature spike, or your body never produces egg white cervical fluid, you might not be ovulating.
Problematic Chemical Reactions
Rarely, the sperm and egg or sperm and cervical fluid may negatively interact, producing an inflammatory reaction or killing the sperm. Imbalances in vaginal or seminal pH can kill sperm before it has a chance to make it to the egg. It's unlikely that you will know if you have this condition, so if tests have ruled out other common problems, ask your doctor if an allergy or chemical reaction might be to blame.
Chronic illnesses such as diabetes, polycystic ovarian syndrome, and cancer don't in and of themselves cause reproductive issues. But the drugs used to treat them can. For instance, women who have undergone chemotherapy should generally go a year without cancer before trying to get pregnant. Likewise, some chronic illnesses can disrupt your menstrual cycle or throw your endocrine system into disarray, making it harder to get pregnant. Polycystic ovarian syndrome is a major cause of anovulatory cycles, while endocrine disorders may make it difficult to ovulate or impede the ability of a fertilized egg to implant in the uterine wall.
Speak with an Infertility Specialist
Bottom line, there are a lot of possibilities out there which could be preventing the incredibly complex process of conceiving. If you have been trying for six months to a year, it’s time to talk to an expert who can answer any questions you have about fertility. The sooner you reach out, the sooner you could be holding your new child.