If you've been trying to conceive but haven't been successful, you may be thinking, "Why am I not getting pregnant?" You may be concerned that you will never. However, there are a variety of reasons why you aren't conceiving, such as ovulation irregularities, structural problems in the reproductive system, low sperm count, underlying medical issues, or simply not trying hard enough.
While infertility can create symptoms such as irregular periods or severe menstrual cramps, the majority of infertility reasons are quiet. Male infertility, for example, is rarely accompanied by symptoms. Here are 11 reasons why you haven't conceived yet.
"The vast majority of people will become pregnant within the first 12 months of trying to conceive with regular unprotected intercourse," Cross said. "We recommend that a couple come in for an infertility evaluation after six months to a year of trying — depending on the age of the woman." At that time, it's more likely that there's an issue with pregnancy prevention.
Irregular uterine shape: A uterus that is unevenly shaped can make it difficult for a fertilized egg to connect to the uterine wall. Uterine fibroids (noncancerous growths on the uterine wall) or scar tissue after surgery or infection can cause abnormalities. It could also be due to the shape of your uterus.
Fallopain tube obstruction: Infertility is frequently caused by blocked or damaged fallopian tubes that prevent sperm from accessing the egg, especially among African Americans. A history of pelvic infection, sexually transmitted disease, or endometriosis raises the possibility of fallopian tube occlusion.
Ovulation disorder: Women do not always ovulate on a regular and consistent basis. Conditions such as polycystic ovarian syndrome (PCOS), hormonal imbalances, or obesity can all contribute to sporadic menstrual cycles. Excessive activity, stress, or being underweight can all have an effect on ovulation.
Male factor: More than 30% of infertility cases have a sperm issue, such as low sperm count or aberrant sperm motility or morphology. Male factor infertility can be caused by a variety of factors, including trauma, medical disorders such as diabetes, and bad lifestyle choices such as heavy drinking and smoking.
When you're trying to conceive, it's normal to feel nervous. However, whether or not this has an effect on fertility is debatable. What we do know is that stress management is beneficial to everyone, regardless of age.
You’ve probably heard the phrase “your biological clock is ticking.” This phrase refers to your fertile window. Women can’t conceive after their menstrual cycles stop, usually sometime in your 40s or 50s. Men produce sperm throughout their lives, but women are born with a set number of eggs that decreases as you age.
“At birth you have about two million eggs but naturally lose hundreds of thousands of them by the time you reach puberty,” says Cross. “Your body continues to lose eggs no matter what you do. And the rate at which women lose eggs accelerates around the age of 37.”
The quality of eggs stored in the ovaries also declines over time. “The eggs you’re born with are naturally paused in the process of dividing their DNA,” Cross explains. “They complete that process, or ripen, when you ovulate them 20 to 40 years later. The longer eggs are stuck in the mid-division stage, the more likely that process will go wrong — creating eggs with the wrong number of chromosomes. That results in not becoming pregnant, experiencing miscarriages or having babies with genetic syndromes due to chromosomal abnormalities.”
The bottom line: The quality and number of eggs a woman has decreases throughout her lifetime and egg loss accelerates around the age of 37, which makes it more difficult to become pregnant.
If you're experiencing difficulty conceiving, an infertility specialist may be able to assist you. After 12 months of attempting to conceive (six months if you're 35 or older), the first step is to schedule an infertility evaluation. This multi-part evaluation comprises the following components:
The uterus and fallopian tubes are examined (by specialized x-rays or ultrasounds).
If you or your spouse have a known medical issue that affects the uterus, fallopian tubes, sperm, or ovulation, consult with your doctor to see whether you should be checked sooner. For example, if you know that both of your fallopian tubes are obstructed, you should contact an infertility specialist before attempting to conceive.
Infertility treatment options
There are numerous therapy options available based on the results of your infertility evaluation:
Medications for ovulation: Oral or injectable drugs can improve ovulation patterns or induce the production of more than one egg per month, boosting the chances of conceiving.
IUI (intrauterine insemination): This procedure can be done alone or in conjunction with ovulation drugs. A tiny catheter is used to deliver high-quality sperm straight into a woman's uterus, removing the need for sperm to swim up the vaginal canal.
In vitro fertilization (IVF): In this technique, one or more eggs are extracted from the ovaries and fertilized in a laboratory setting using sperm. The resultant embryo is subsequently put into the uterus, circumventing the body's fertilization hurdles.
Endometriosis: In many cases of unexplained infertility, everything appears normal on the surface. Tubes are clear, ovulation occurs on schedule, and other factors seem fine. However, when a laparoscopy is performed, endometriosis can be identified as the culprit. Treatment options vary depending on the severity of the disease. In cases of minimal or mild endometriosis, Superovulation & IUI (intrauterine insemination) may be recommended for 2-3 cycles. If IUI proves unsuccessful, couples can consider moving on to IVF. Waiting passively often isn't beneficial and may even be detrimental because corrections made via laparoscopy may revert in six or more months. For moderate to severe endometriosis, it's often advisable to proceed directly with IVF without delay.
Semen Factor: High DNA Fragmentation Index: Typically, semen analysis measures parameters like sperm count and motility. Unfortunately, the morphology (appearance) of sperm is often overlooked. According to WHO (World Health Organization) guidelines, couples with severely abnormal sperm morphology (less than 4 percent normal) should be advised to consider IVF with ICSI (Intracytoplasmic Sperm Injection). This advanced technique involves taking eggs and sperm to the lab and deliberately injecting normal-looking sperm into the eggs. Frequently, females undergo multiple tests to identify the cause of infertility, while the crucial semen factor is overlooked.
Genetic Abnormalities in Eggs: Some infertility issues stem from molecular-level defects in eggs. These defects often come to light when couples undergo IVF procedures. In some cases, ultrasound may reveal normal-looking follicles, but during egg retrieval for IVF, they are found to be empty. Other times, eggs may be retrieved, but their quality is suboptimal. Some eggs may not fertilize, others may fail to develop, and some may become blastocysts but lack the quality necessary for successful implantation. With advancements in genetic science, future solutions may emerge for these challenges. Currently, for such patients, IVF cycles must be meticulously customized to maximize the chances of successful pregnancy.
In cases of unexplained infertility, precise diagnosis and timely management are of paramount importance. As age advances, there is a natural decline in egg quality, which can be disheartening for women, especially when they realize that after 35 years of age, the quantity and quality of their eggs decrease rapidly. Interestingly, age has a minimal impact on semen parameters in male partners. Nevertheless, the field of modern medicine has opened doors to parenthood for couples facing unexplained infertility through a variety of fertility treatments, including IVF.
If you're experiencing fertility challenges, consulting with an infertility specialist can provide the insights and guidance needed to navigate this complex journey towards parenthood.
Every couple and their journey to starting a family is unique. Consult your doctor about your options.