Fertility Challenges Causes & Concerns Why Can't I Get Pregnant? 11 Possible Reasons By Rachel Gurevich, RN Rachel Gurevich, RN Facebook LinkedIn Twitter Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. Learn about our editorial process Updated on November 29, 2022 Medically reviewed by Brian Levine, MD, MS, FACOG Medically reviewed by Brian Levine, MD, MS, FACOG Brian Levine, MD, MS, FACOG, is board-certified in obstetrics-gynecology, as well as reproductive endocrinology and infertility (REI). He is the director and founding partner of CCRM New York and was named a rising star by Super Doctors from 2017 to 2019. Learn about our Medical Review Board Print Illustration by Joshua Seong. © Verywell, 2018. Table of Contents View All Table of Contents Not Trying Long Enough Not Ovulating Male Infertility Age-Related Infertility Blocked Fallopian Tubes Endometriosis Underlying Medical Problems Certain Medications Lifestyle Factors Unexplained Infertility Not Seeking Fertility Treatment If you've been trying unsuccessfully to get pregnant, you may be wondering, "Why am I not getting pregnant?" You could be worrying that you never will. However, there are many possible reasons why you aren't conceiving, including ovulation irregularities, structural problems in the reproductive system, low sperm count, underlying medical problems, or simply not trying 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. 11 Reasons You May Not Be Getting Pregnant You might not have been trying long enough.You might not be ovulating.Your male partner may be experiencing infertility.You may be experiencing age-related infertility.You may have blocked fallopian tubes.You may have endometriosis.You may have underlying medical problems.You may be on medications that impact fertility.You may have lifestyle factors that impact fertility.You could have unexplained fertility.You may need to seek fertility treatments.Read on for more on each of these factors. 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. When to Call a Doctor See a healthcare provider about your fertility ifYou're 35 years or older and have been trying for at least six monthsYou're younger than 35 and have been trying for at least one yearIf either of these situations matches your experience, seek medical advice, even if you have no symptoms of a fertility problem. What Is the Best Sex Position to Get Pregnant? 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. Anovulation and Ovulatory Dysfunction 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. Receiving a Diagnosis of Infertility 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. What to Know About Getting Pregnant After 35 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. 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 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). Is Pregnancy After an HSG More Likely? 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. How to Get Pregnant Despite Unexplained Fertility 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. What to Do When You Can't Get Pregnant 14 Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. 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. Hum Reprod. 2003;18(9):1959-1966. doi:10.1093/humrep/deg366 Hanson B, Johnstone E, Dorais J, Silver B, Peterson CM, Hotaling J. Female infertility, infertility-associated diagnoses, and comorbidities: a review. J Assist Reprod Genet. 2017;34(2):167-177. doi:10.1007/s10815-016-0836-8 Leaver RB. Male infertility: an overview of causes and treatment options. Br J Nurs. 2016;25(18):S35-S40. doi:10.12968/bjon.2016.25.18.S35 Crawford NM, Steiner AZ. Age-related Infertility. Obstet Gynecol Clin North Am. 2015;42(1):15-25. doi:10.1016/j.ogc.2014.09.005 Sasaki RS, Approbato MS, Maia MC, Fleury EA, Giviziez CR, Zanluchi N. Patients' auto report of regularity of their menstrual cycles. Medical history is very reliable to predict ovulation. A cross-sectional study. JBRA Assist Reprod. 2016;20(3):118-122. doi:10.5935/1518-0557.20160027 American College of Obstetricians and Gynecologists. Treating infertility. Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012;39(4):535-549. doi:10.1016/j.ogc.2012.10.002 Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. doi:10.1007/s13669-017-0187-1 Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354.e1-354.e12. doi:10.1016/j.ajog.2018.12.039 Casilla-Lennon MM, Meltzer-Brody S, Steiner AZ. The effect of antidepressants on fertility. Am J Obstet Gynecol. 2016;215(3):314.e1-5. doi:10.1016/j.ajog.2016.01.170 Sansone A, Di Dato C, de Angelis C, et al. Smoke, alcohol and drug addiction and male fertility. Reprod Biol Endocrinol. 2018;16(1):3. Published 2018 Jan 15. doi:10.1186/s12958-018-0320-7 Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018;20(1):41-47. doi:10.31887/DCNS.2018.20.1/klrooney Silvestris E, de Pergola G, Rosania R, Loverro G. Obesity as disruptor of the female fertility. Reprod Biol Endocrinol. 2018;16(1):22. doi:10.1186/s12958-018-0336-z Gunn DD, Bates GW. Evidence-based approach to unexplained infertility: a systematic review. Fertil Steril. 2016;105(6):1566-1574.e1. doi:10.1016/j.fertnstert.2016.02.001 By Rachel Gurevich, RN Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. She is a professional member of the Association of Health Care Journalists and has been writing about women’s health since 2001. Rachel uses her own experiences with infertility to write compassionate, practical, and supportive articles. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit