Why Am I Not Getting Pregnant?

So, you've been trying to get pregnant for awhile, but nothing is happening. Why are you not getting pregnant? There are many possible reasons, including ovulation irregularities, structural problems in the reproductive system, low sperm count, or an underlying medical problem.

While infertility can have symptoms like irregular periods or severe menstrual cramps, the truth is that most causes of infertility are silent.

Male infertility rarely has symptoms. Here are eight possible reasons you haven't conceived yet.

You Haven't Been Trying for 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 won't conceive right away.

About 80 percent of couples conceive after six months of trying. Approximately 90 percent will be pregnant after 12 months of trying to get pregnant. This assumes you have well-timed intercourse every month.

Doctors recommend that you see a doctor about your fertility if

• You're 35 years or older and have been trying for at least six months
• You're younger than 35 and have been trying for at least one year

If either of these fit your situation then see a doctor, even if you have no symptoms of a fertility problem.

You're 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. PCOS is one possible cause of anovulation. Other possible causes include being over or underweight, primary ovarian insufficiency, a thyroid dysfunction, hyperprolactinemia, and excessive exercise.

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

The Problem Is With Him, Not You

Women may carry the baby, but it takes two to tango. Twenty to 30 percent of infertile couples discover fertility factors on the man's side. Another 40 percent find infertility factors on both sides.

Another thing you need to know: 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. When you do see the doctor, make sure you are both tested. 

Age-Related Infertility Is Causing a Problem

For women after age 35, and for men after age 40, it can take longer to get pregnant.

Some women assume if they still get regular periods their fertility is fine, but this isn't true. Age impacts egg quality as well as quantity. 

Also, if your partner is five or more years older than you are, this can further increase your risk of fertility problems after age 35.

Your Fallopian Tubes Are Blocked

Irregular ovulation accounts for 25 to 30 percent of female infertility cases.

The rest can have problems with blocked fallopian tubes, uterine structural problems, or endometriosis.

In case you don't know, the fallopian tubes are the pathway between your ovaries and the uterus. The fallopian tubes do not directly attach to the ovaries. Sperm must swim up from the cervix, through the uterus, and into the fallopian tubes. When an egg is released from the ovaries, hair-like projections from the fallopian tube draw the egg inside. Conception takes place inside the fallopian tube, where the sperm and egg finally meet. If anything prevents the fallopian tubes from working properly, or if scarring blocks the sperm or egg from meeting, you won't be able to get pregnant.

There are many possible causes of blocked fallopian tubes. While some women with blocked tubes experience pelvic pain, many others have no symptoms. Only fertility testing can determine if your tubes are open. An HSG is a specialized X-ray used to determine if your fallopian tubes are open. This can be ordered by your OB/GYN.

You Have Endometriosis

Endometriosis is when endometrium-like tissue (which is the tissue that lines the uterus) grows in places outside of the uterus. It's estimated that up to 50 percent women 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 all women with endometriosis have these symptoms. Some women who discover they have endometriosis as part of an infertility work-up.

Endometriosis is commonly misdiagnosed or simply just missed. Endometriosis can't be diagnosed with a blood test or ultrasound. It requires diagnostic laparoscopic surgery. Because of this, proper diagnosis takes an average of 4.4 years.

Underlying Medical Problems

Underlying medical conditions can lead to infertility in both men and women. For example, a thyroid imbalance or undiagnosed diabetes can lead to infertility. While it's not well understood, depression is associated with infertility. Some autoimmune diseases, like lupus or undiagnosed celiac disease, can cause infertility.

There are prescribed medications that may impact fertility. Never stop taking a medication without talking to your doctor first. Make sure both your doctor and your partner's doctor know you're trying to get pregnant.

Also, an undiagnosed sexually transmitted illness can cause infertility. You may not have any symptoms of the disease.

Unexplained Infertility

Between 25 to 30 percent of infertile couples never find out why they can't get pregnant. Some doctors say this is a lack of good diagnosis. They say there 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 (and should) still receive treatment for infertility even if your diagnosis is unexplained.

A Word From Verywell

If you're having difficulty getting pregnant, know that there is help available. Many couples put off testing and treatment, waiting for a miracle or thinking they should just "try a little longer" first. This is a mistake. Some causes of infertility 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. It's true that you and your partner may have no 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 that doesn't mean you may not have a fertility problem.

The reasons for infertility aren't always observable to the lay person. For this reason, 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.

Sources:

Gnoth C, Godehardt D, Godehardt E, Frank-Herrmann P, Freundl G. "Time to pregnancy: results of the German prospective study and impact on the management of infertility." Human Reproduction. 2003 Sep; 18(9):1959-66.

G. L. Schattman et al. (eds.), Unexplained Infertility, DOI 10.1007/978-1-4939-2140-9_1, Springer Science+Business Media, LLC 2015.

Soliman AM1, Fuldeore M1, Snabes MC1. “Factors Associated with Time to Endometriosis Diagnosis in the United States.” J Womens Health (Larchmt). 2017 Apr 25. doi: 10.1089/jwh.2016.6003. [Epub ahead of print]