Why Am I Not Getting Pregnant?

If you've been trying unsuccessfully to get pregnant, you may be wondering, "Why can't I get pregnant?" You could be worrying that you never will. However, there are many possible reasons why you aren't conceiving and many possible solutions.

You may have ovulation irregularities, structural problems in the reproductive system, low sperm count, or an underlying medical problem. Or you simply haven't tried long enough.

While infertility can have symptoms like irregular periods or severe menstrual cramps, most causes of infertility are silent. Male infertility, for example, rarely has symptoms. Here are 11 possible reasons you haven't conceived yet.

Not Trying Long Enough

The first thing to consider is how long have you been trying. It may feel like you've been trying forever—and maybe you have—but it's important to know that many couples don't conceive right away.

About 80% of cisgender, heterosexual couples conceive after six months of trying. Approximately 90% will be pregnant after 12 months of trying to get pregnant. These rates assume you have well-timed intercourse every month.

Not Ovulating

Human conception requires an egg and sperm. If you're not ovulating, you won't be able to get pregnant. Anovulation is a common cause of female infertility and it can be triggered by many conditions.

Polycystic ovary syndrome (PCOS) is one possible cause of anovulation. Other possible causes include being overweight or underweight, primary ovarian insufficiency, thyroid dysfunction, hyperprolactinemia, and excessive exercise.

Most people who are experiencing ovulation problems have irregular periods. However, regular menstrual cycles don't guarantee that ovulation is occurring normally. If you have irregular cycles, talk to your doctor, even if you haven't been trying for a year yet.

Male Infertility

Unless you are using medical interventions like sperm or egg donation. it takes both partners to conceive. Fertility issues do not just happen to the person intending to carry the baby. In 20% to 30% of infertile male-female couples, the male partner has a fertility problem. Another 40% of couples have infertility factors in both partners.

Male infertility rarely has symptoms that are observable without a semen analysis, which is a test that measures the health of the semen and sperm. Make sure both partners' doctors know you're trying to get pregnant, and that you are both tested for fertility issues.

Age-Related Infertility

For women after age 35, it can take longer to get pregnant. Many people assume if they still get regular periods, their fertility is fine, but this isn't necessarily true. Age impacts egg quality as well as quantity. Men after age 40 may also face problems conceiving.

Blocked Fallopian Tubes

Ovulation problems account for about 25% of female infertility cases. In other cases, women may experience blocked fallopian tubes, uterine abnormalities, or endometriosis.

The fallopian tubes are the pathway between the ovaries and the uterus. When an egg is released from the ovaries, hair-like projections from the fallopian tube draw the egg inside.

Sperm must swim up from the cervix, through the uterus, and into the fallopian tubes. Conception takes place inside the fallopian tube, where the sperm and egg finally meet.

There are many possible causes of blocked fallopian tubes. While some people with blocked tubes experience pelvic pain, many others have no symptoms. Only fertility testing can determine if your tubes are open. A hysterosalpingogram (HSG) is a specialized X-ray used to determine if the fallopian tubes are open. An OB/GYN can order this test (you don't need a fertility specialist).

Endometriosis

Endometriosis is when endometrium-like tissue (which is the tissue that lines the uterus) grows outside of the uterus. It's estimated that up to 50% of people with endometriosis will have difficulty getting pregnant.

The most common symptoms of endometriosis include painful periods and pelvic pain at times besides menstruation. However, not everyone with endometriosis has these symptoms. Some people only discover they have endometriosis as part of an infertility work-up.

About 10% to 15% of women have endometriosis, but it is commonly misdiagnosed or simply missed. Endometriosis can't be diagnosed with a blood test or ultrasound. It requires diagnostic laparoscopic surgery. Because of this, proper diagnosis can take 4 to 11 years from when symptoms being.

Underlying Medical Problems

Underlying medical conditions can lead to male and female infertility. For example, a thyroid imbalance or undiagnosed diabetes can cause infertility. Some autoimmune diseases, like lupus, can cause infertility, as well. While it's not well understood, mental health conditions like anxiety and depression are also associated with infertility.

Also, an undiagnosed sexually transmitted infection (STI) can cause infertility. Note that you may not have any symptoms of an STI but still have one.

Certain Medications

Some prescription medications that may impact fertility. For example, research has shown that taking some antidepressants makes it harder to get pregnant. In one 2016 study, researchers concluded: "Our data suggest that antidepressants may reduce the probability of a woman with a history of depression to conceive naturally."

However, never stop taking a medication without talking to your doctor first. If you have concerns that a drug you've been prescribed may be interfering with getting pregnant, consult a healthcare provider. They may need to put you on another medication, have you try a different type of treatment, or reassure you that the medication isn't an issue.

Lifestyle Factors

Marijuana, whether taken recreationally or for medicinal purposes, may also impair fertility. Likewise, studies show that smoking tobacco, excessive alcohol use, and illicit drug use, such as cocaine, ecstasy, ketamine, and amphetamines, can contribute to fertility issues.

Additionally, living with extreme or chronic stress, experiencing trauma, or having insomnia and other sleep issues may reduce fertility.

Being significantly overweight or underweight is also known to disrupt fertility. Exercising excessively or not at all can also cause problems getting pregnant. Following a program to reach a healthier weight and physical activity level often increases rates of conception.

Unexplained Infertility

Between 10% and 30% of infertile couples never find out why they can't get pregnant. This is called unexplained infertility, or more accurately, lack of good diagnosis. Many doctors make the point that there really is no such thing as unexplained infertility but only undiscovered or undiagnosed problems.

The fact remains, though, that some couples don't get answers. However, not having answers doesn't mean you can't be treated. You can still receive treatment for infertility even if your diagnosis is unexplained.

Not Seeking Fertility Treatment

If you're having difficulty getting pregnant, know that there is help available. The best way you can know if you have fertility issues is to consult an OB/GYN. Whether you are trying to get pregnant for the first time, you're hoping to conceive after a miscarriage, or you've been pregnant before but are having difficulty conceiving now. your doctor can evaluate you for fertility problems and treatment.

Many couples put off testing and treatment, thinking they should just "try a little longer" first. This is a mistake. Many causes of infertility are silent and worsen with time. The sooner you get help, the more likely fertility treatments will work for you.

Another reason couples sometimes delay testing is they feel and seem to be in perfect health. But many people who have infertility issues do not have outward signs or symptoms of a fertility problem. You may have a textbook 28-day menstrual cycle, but that doesn't mean you're guaranteed fast and smooth results when trying to get pregnant, and it doesn't mean you may not have a fertility problem.

A Word From Verywell

While the majority of people conceive naturally if they continue trying for 6 to 12 months, some people have more difficulty getting pregnant. There are a variety of causes for fertility issues—and the reasons for infertility aren't always observable to the layperson. If you've been trying to conceive for one year (or six months if you're 35 years or older), please get help. Don't wait.