Why Aren't You Getting Pregnant?

You might think that you can get pregnant at any time during the month - but that isn't true. There are about 6 days in your cycle when you're actually fertile. So it's important to figure out if your body is ovulating, and aim to have sex around that time (including up to 5 days before).Some people become concerned if they don't get pregnant on the first shot, but it's actually not that common to do so. About 84% of couple get pregnant within their first year of trying, while 92% of couples get pregnant after 2 years of trying.Depending on your age, there's a certain time period where you might want to do some investigating if you haven't become pregnant.

Types of Infertility

Primary Infertility (also known as Subfertility)

This happens when you're younger than 36, and haven't gotten pregnant within 1 year of having regular, unprotected sex, or you may not be able to carry a pregnancy to term.If you're 35 or older, you might have primary infertility if you haven't become pregnant within 6 months of having unprotected sex, or you may not be able to carry a pregnancy to term. This might be due to the declining egg quality as you age.

Secondary Infertility

This happens if you haven't been able to get pregnant after 1 year of having regular, unprotected sex, or you can't carry a pregnancy to term, DESPITE being able to have done so at least once.Women who are experiencing irregular or absence of periods, endometriosis, PCOS, painful periods, pelvic inflammatory disease, more than one miscarriage, should seek care before the 6 month or 1 year mark. 

What Causes Infertility?

Female Factor

You need to be ovulating and have unobstructed fallopian tubes for conception to occur. Keep in mind that this may not account for unexplained infertility if both those factors are normal.When you aren't able to ovulate, this is known as anovulation. Some conditions that can affect ovulation are:

• PCOS: A condition that may cause anovulation in women, or irregular periods
• Diminished ovarian reserve: Fewer eggs remaining in the ovaries than normal
• Hypothalamic functional amenorrhea: Symptoms include low body weight, excessive stress and exercise
• Premature ovarian insufficiency: Decline of ovarian function at a younger age (ie. before your 40s).
• Menopause: A decline in ovarian function, usually when you are in your 50s

An egg needs to pass through a fallopian tube to be fertilized by semen. But some conditions may cause obstruction. These include:

• History of pelvic infection
• History of sexually transmitted infections like chlamydia and gonorrhoea
• Endometriosis
• History of abdominal surgery

Male Factor

Men may also contribute to infertility, and it's commonly based on sperm parameters. These parameters include: sperm count, how the sperm is moving, if the sperm is moving in the right direction, the size and shape of the sperm, total semen volume, and if sperm can transition from a gel-like to liquid state after ejaculation.Causes may also include testicular trauma, chemotherapy, hernia surgery, or infertility with another partner.

Unknown Factor

Sometimes we don't know why infertility happens. This is known as unexplained infertility.

Risks of Infertility

In women, risks include:

• Age
• Smoking
• Excessive alcohol intake
• Extreme weight gain or loss
• Excessive physical or emotional stress

Fertility Tests

A diagnostic workup can include:

• Hysterosalpingogram: an X-ray investigating the shape of your uterine cavity and fallopian tubes, as well as investigating if there are any obstructions within your fallopian tubes.
• Sonohysterography: ultrasound exam that will create images of your uterine lining. It uses fluid (administered into the cervix) and sound waves to do so.
• Laparoscopy: The insertion of a thin telescope-like instrument vis a small incision in your belly button. It allows doctors to visually examine your abdominal and pelvic organs (uterus, fallopian tubes, ovaries), and determine if you have endometriosis, scar tissue, fibroids, or any other 'defects'.
• Lutenizing Hormone: This is the hormone that triggers ovulation. If there is no LH surge mid-way through your cycle, it's suggestive of anovulation. It can also provide information about your ovarian reserve, and if your ovaries are functioning normally.
• Hysteroscopy: Examining your cervix and the inside of your uterus using a thin, tube called a hysteroscope.
• Transvaginal Ultrasound: Examining a your uterus, ovaries, tubes, cervix and pelvic area, using a ultrasound probe inserted in your vagina.
• Ovarian Reserve Time: Estimating the supply of remaining eggs within your ovaries.
• Other blood tests

In men, a work-up includes: a semen analysis and blood work to evaluate testicular function. These usually include: testosterone, follicle stimulating hormone (supports sperm production), lutenizing hormone (prompts testosterone production), and sex hormone binding globulin.

Final Thoughts

Trying to get pregnant and not being able to do so can be isolating and frustrating. You might be trying to do all the things on this fertility journey, like tracking cervical mucus and temperature, using LH strips. You might even be cutting back on smoking, drinking alcohol, or trying to lose weight.Sometimes treatment can be as easy as reducing toxic exposure (like smoking or alcohol), decreasing stress, or losing weight. It really all depends what you're ready to do.If you're looking for support getting pregnant, let's work together to make the process less stressful, figure out what's going on if there are any changes can you and/or your partner can make now, to help in the longterm.If you found this information helpful, be sure to sign up for my monthly newsletter called The Flow for more informative articles like this!