In order to get pregnant, your body has to release an egg, a process called ovulation. Many things factor into this. Ovulation requires a delicate balance of hormones, and it doesn’t take much for the process to be thrown off. For ovulation to occur, gonadotropin-releasing hormone must stimulate the release of follicle-stimulating hormone and luteinizing hormone. Progesterone and estrogen also play a role in preparing the uterus to receive and grow the fertilized egg.
Ovulation disorders are the root cause behind about 25 percent of infertility cases. Most ovulation disorders can be diagnosed with a simple blood test that checks your hormone levels.
Ovulation disorders are the root cause behind about 25 percent of infertility cases and can include:
- Pituitary gland dysfunction — The pituitary gland is responsible for manufacturing and regulating many of the hormones in your body. An underactive or overactive gland can throw off your hormones and keep you from getting pregnant.
- Too much prolactin — Excess prolactin reduces the production of estrogen and may lead to infertility.
- Premature ovarian failure — This can happen because of an autoimmune response or premature loss of eggs from the ovary. When the ovary doesn’t produce eggs, the production of estrogen in women under 40 is decreased.
- Polycystic ovary syndrome (PCOS) — PCOS causes a hormone imbalance, which affects ovulation. This is one of the most common causes of infertility in women, but it can be treated with lifestyle changes and medication.
Most ovulation disorders can be diagnosed with a simple blood test that checks your hormone levels. Premature ovarian failure and PCOS may need an ultrasound to confirm. The good news is that hormone issues interfering with ovulation can usually be fixed within a few months once the problem is identified.
Blocked fallopian tubes
Assuming ovulation is happening as it should, the next step in a successful pregnancy is when the egg comes in contact with the sperm. This usually happens in the fallopian tubes, but if they are blocked or damaged, it will be harder to get pregnant. This could be the reason why you haven’t conceived if everything is normal with hormone levels and sperm count. Blocked fallopian tubes are common in women who have pelvic inflammatory disease or have had pelvic surgery, especially for an ectopic pregnancy. In many cases, doctors are able to unblock the tube and increase the chances of conception.
Endometriosis may also be a reason why you’re not getting pregnant. It’s often undetected until fertility problems arise. Endometriosis is when the endometrial tissue grows outside of the uterus and attaches to your organs and/or other tissues in the pelvic cavity.
Because endometrial tissue still responds to the monthly hormone fluctuations of your cycle, it can result in extremely painful cramps, heavy bleeding, long periods, nausea, bowel and bladder problems, and pain during sex. It’s estimated that around 200 million women worldwide have endometriosis. Because a laparoscopy and biopsy are the only official diagnosis methods, many women aren’t aware that they have this condition.
While many women assume the cause of infertility lies with them, this isn’t always the case. In about one-third of cases, it’s the man who is infertile. Male infertility can have several causes including:
- Low sperm count
- Low sperm motility
- A blockage in the vas deferens tube
- Erectile dysfunction
A fertility specialist is usually able to diagnose low sperm count and low sperm motility fairly easily by looking at a sample of the semen under a microscope. One of the most common causes of sperm issues is varicocele, which is a swelling in the veins that empty the testicles. This condition can be treated, improving the chances of conception.
Undiscovered medical problems
While getting pregnant may seem like it should be easy, it’s a very complex process that can be influenced by many of the body’s other systems. If other parts of your body aren’t working properly, it can very easily throw off the hormone balance required to get pregnant. Any time you are having difficulty conceiving, it’s a good idea to get a full physical from your doctor to rule out an underlying issue.
Your lifestyle (and/or your partner’s) may also be why you aren’t getting pregnant. Using drugs or alcohol and smoking can impact your body’s ability to conceive and support a healthy pregnancy. Drugs like cocaine and marijuana can decrease sperm count and motility. Tobacco and alcohol use have been linked to lower chances of conception and a higher risk of miscarriage. High caffeine intake, a sedentary lifestyle, and exposure to hot tubs and saunas (for men) have also been linked to infertility.
In 1972, the average age of first-time mothers was 21. In 2016, it was 26. Many women are trying to have their first child at even older ages. The average age of married first-time mothers was 28. For women with college degrees, it was 30. While there are often many good reasons to delay having children, being older can result in problems with fertility. The older you are, the higher your chances of infertility. Mothers who are 35 or older are considered to be of “advanced maternal age” by current obstetrical standards.
When to see a doctor
In general, couples trying for a baby who are having frequent, unprotected sex for longer than a year without conceiving should talk to their doctor about possible infertility problems. Couples who are 35 or older or have known medical conditions or histories that could interfere with fertility may want to visit a fertility specialist sooner. Some of these possible conditions include PCOS, anorexia, bulimia, obesity, or sexually transmitted diseases.
Your doctor will start out by asking about your medical history and checking blood work and sperm analyses. They might perform an ultrasound of your uterus and ovaries. If they detect any issues, they will give you information about how to treat any underlying causes and improve your chances of conceiving.
For couples who have significant fertility problems or don’t respond to treatment over time, solutions like artificial insemination and in-vitro fertilization may be recommended.
If you’re one of the more than 6 million women in the United States struggling with infertility, it’s normal to feel confused or like your body is failing you. However, many causes of infertility are very treatable. If you’re wondering why you can’t get pregnant, talking to your doctor can be the first step toward getting answers.