What to Do When You're Having Trouble Conceiving

You're so ready to get this baby show on the road, but your body might not be on board. Learn what can cause problems getting pregnant and how to get past the issues.

Couple at Fertility Doctor
Photo: Photographee.eu/Shutterstock

You've made up your mind: you're ready for a baby (or another one.) So why isn't your body cooperating? While there are many reasons for not conceiving on the first (or second or third) try, it may help to know that not getting pregnant right away is pretty common.

According to the Centers for Disease Control and Prevention (CDC), about 19% of people of childbearing age have trouble getting pregnant within one year of trying. Unfortunately, it can happen to anyone, regardless of the great shape you're in—or how many ovulation trackers you've downloaded on your phone.

"The reasons for not conceiving will depend on where you are in your reproductive life," explains David Diaz, M.D., a reproductive endocrinologist and fertility expert at MemorialCare Orange Coast Medical Center in Fountain Valley, California. He says younger people tend to have ovulation problems, blocked tubes, and sperm problems in their partners, while older people have more issues with their egg quality.

Get to know the most common reasons for not conceiving yet—and the steps to take next.

Ovulation Problems

According to the National Institutes of Health (NIH), some ovulation-based reasons for infertility include:

  • Primary ovarian insufficiency (POI) (when your ovaries stop functioning before they should)
  • Polycystic ovary syndrome (PCOS) (an imbalance of hormones that causes ovarian problems)
  • Diminished ovarian reserve (low number of eggs in your ovaries due to normal aging)
  • Endocrine disorders, such as thyroid disease
  • Being over- or underweight
  • Excessive exercise

A tumor or cyst, common with PCOS, could keep you from getting pregnant. So could an underactive thyroid since this gland produces a hormone that tells your body to release an egg during ovulation. Further, you might stop ovulating altogether if you have an eating disorder or are committed to a super-intense workout.

Structural Problems

Endometriosis is a condition where uterine tissue starts growing outside your uterus. According to the Office on Women's Health, it affects 11% of people of childbearing age in the U.S. Up to 40% of people with the condition experience infertility.

The cause of endometriosis isn't entirely clear, but problems with menstrual flow, genetics, immune system problems, hormonal irregularities, and surgical scarring may be to blame.

The NIH explains that endometriosis can lead to infertility because it changes the structure of your reproductive organs, making it more difficult for sperm to meet the egg. Additionally, changes in the uterine lining can make it difficult for an embryo to implant properly.

Other structural problems that could cause trouble getting pregnant include fibroids, polyps, uterine scarring, and an unusually shaped uterus.

Cervical Problems

"Cervical cancer, cervical stenosis [a very narrow cervical opening], and even trauma from an abnormal Pap smear can all cause fertility issues," says Lisa Valle, D.O., an OB-GYN at Oasis Women's Sexual Function Center in Santa Monica, California.

In addition, chronic infections in the cervix, like HPV, can also affect cervical mucus, leading to difficulty getting pregnant.

Stress

Stress is a real chicken or egg conundrum when trying to get pregnant. Did the stress cause you not to get pregnant, or did not getting pregnant cause the stress? Perhaps it's a vicious loop.

According to the American Society for Reproductive Medicine (ASRM), while infertility is a major cause of stress, there is no conclusive evidence stress causes infertility. However, they say that high stress levels can cause changes in hormone levels, leading to delays in ovulation.

You don't necessarily need to have a high-stress career. "When people are always thinking about why they're not getting pregnant, they can get anxious and begin to feel inadequate," says Dr. Diaz.

Aging

"As we age, fertility rates decrease," says Dr. Valle. In fact, as the American College of Obstetrics and Gynecologists (ACOG) explains, your peak reproductive years are in your late teens to late 20s. After that, fertility starts to decline. In your 20s and 30s, you have about a 25% chance of getting pregnant in a given menstrual cycle; by 40, it drops to 10%.

Sperm-Related Problems

One-third of conception problems stem from sperm-related issues. "Usually, a low sperm count is to blame," Dr. Diaz says. However, your partner's sperm could also have an abnormal shape or not enough forward motion to reach an egg.

The NIH lists the following as possible culprits of infertility in people who make sperm:

  • Testicular function problems
  • Hormone imbalances
  • Blockages in reproductive organs
  • Lack of sperm

While some of these issues are chromosomal, meaning they're present at birth, people with sperm who are regularly exposed to environmental toxins, high temperatures, or radiation are at higher risk of fertility issues, says Dr. Diaz

Steps to Take When You're Having Trouble Conceiving

"If you're under 35 and have been having unprotected sex two to three times a week for 12 months, it's time to call your doctor," says Dr. Valle. If you're 35 or older, don't wait that long. Seek counseling after six months from an OB-GYN or fertility specialist.

Set up an appointment

Expect lots of questions—a health care provider will want to review your medical and menstrual history to get a picture of your overall health.

Schedule testing

Blood tests can measure your hormone levels and check your egg count. Your doctor can also do imaging tests to check your uterus, ovaries, and fallopian tubes. They will likely also want a semen analysis from your partner.

Seek treatment

There's no "one size fits all" fertility fix. Depending on your reasons for not conceiving, fertility drugs may be all you need to get back on the baby track. And in some cases, hormones may do the trick for you or your partner. Surgery's also an option for removing a blockage or repairing your tubes.

Discuss assisted reproductive technology options

If fertility drugs don't help, there are still plenty of other ways to get pregnant. For example, with intrauterine insemination (IUI), a doctor will insert specially prepared sperm directly into your uterus.

Assisted reproductive technology (ART), like in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT), removes some of your eggs to assist with fertilization either in a laboratory or within your fallopian tubes. You could also consider sperm donation, egg donation, or surrogacy.

Take a deep breath

Finally, try not to panic. "We can diagnose and help as many as 75% of all [infertility] cases we see," Dr. Diaz reassures. "Still, try to find out what's wrong sooner than later."

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