Infertility is an all-too-common problem for many couples who hope to bring a baby into the world. It’s estimated that 10% - 15% of couples in the United States struggle with infertility. Luckily, infertility is not necessarily a permanent condition – there could be a number of reasons why you can’t get pregnant, many of which are treatable.
So, what should you do if you can’t get pregnant? Since infertility can spring from a variety of sources, the first step in finding the root of the problem is to talk to your doctor.
One of the first things your doctor will likely ask you, is whether or not you are testing for ovulation. Over-the-counter ovulation test kits check for luteinizing hormone (LH) in your urine, which your body releases when it’s ready to ovulate. This is especially helpful for women with irregular periods, or who have a hard time keeping track of their fertile window.
How do you know if you can’t get pregnant or if you’re simply missing your fertile days each month? If you regularly have sex during fertile days and wonder why you’re still not pregnant, it may be time to talk to your doctor about infertility.
Infertility is defined as not being able to get pregnant after one year for women under 35. That window of time is shortened to 6 months for women 35 and older. If you’ve been trying to conceive for 1 or 2 years and are still not pregnant, it’s time to start looking for answers. Keep in mind, that while testing for fertility is most common in females, there are many causes of infertility in males as well. Your provider will ask both partners about their overall health and medical history.
Hormonal imbalances and other underlying conditions can prevent the ovaries from releasing eggs. There are a number of reasons this could happen, many of which are treatable. Some of the most common causes of infertility are:
1. Blocked fallopian tubes
Symptoms of blocked fallopian tubes include pelvic pain, pain during intercourse, and abnormal or foul-smelling discharge. Fallopian tubes are ducts that connect the ovaries to the uterus. They provide a passageway for a fertilized egg to reach the uterus, where it will hopefully implant itself in the uterine lining. Pelvic inflammatory disease (PID) can block the fallopian tubes. PID is an infection of the ovaries or other parts of the female reproductive system, and is commonly caused by bacteria. Often, these infections can be treated with antibiotics, and fertility can be restored.
2. Not ovulating
Irregular periods, from not having a period at all to excessive bleeding during menstruation, is a common symptom of not ovulating. Anovulation can be caused by polycystic ovary syndrome (PCOS), thyroid issues, or simply aging. A failure to ovulate is responsible for 40% of women’s fertility problems.
3. Untreated STI
If you’re ovulating but not getting pregnant, this could be due to an untreated sexually transmitted infection (STI). Diseases like chlamydia and gonorrhea can cause scar tissue to grow in the fallopian tubes, impeding the egg’s journey to the uterus. It can also lead to more dangerous conditions, like an ectopic pregnancy, a condition in which a fertilized egg implants and begins to grow outside the uterus.
Endometriosis is a painful condition in which uterine cells grow and form tissue outside the uterus. Symptoms of endometriosis include abdominal and lower back pain, especially in conjunction with menstrual cramps. It can also lead to a very heavy menstrual flow, and painful bowel movements during your period
5. The age factor
Female fertility shifts a lot as women age. If you’re 19 and can’t get pregnant, your doctor’s approach to conception and infertility will be a lot different from when you’re 40 and can’t get pregnant. An age-based female fertility chart would show a gradual and steady decline from a woman’s twenties to her forties. At peak fertility in her early twenties, a woman’s chances of conceiving are about 25%. Once she reaches forty years old, that chance has dropped to about 5%.
There are many environmental factors that can also contribute to infertility. Many of these revolve around lifestyle choices, and can affect both male and female fertility.
It’s not just bad for your lungs and heart, it can also affect your ability to conceive. Smoking has been shown to diminish sperm count and quality in men. The chemicals present in cigarettes, like nicotine and cyanide, accelerate egg loss in women.
7. Poor diet
What we eat has an impact on our hormones. Diets that lack the necessary vitamins and minerals and are excessively high in fat and processed foods can lead to malnutrition and imbalanced hormones.
8. Too much alcohol
Excessive alcohol use also impacts hormones, which can lead to low sperm counts and anovulation.
Stress hormones can actually disrupt the hypothalamic–pituitary–gonadal axis, which is how the brain signals the ovaries to release an egg. In men, stress hormones can decrease testosterone levels, which lowers sperm counts and impedes sperm motility.
10. Excessive exercise
While keeping fit and healthy is a necessary part of fertility and pregnancy, taking fitness too far can actually lessen your chances of getting pregnant. It can lower testosterone levels in men, and can disrupt a woman’s menstrual cycle.
Not all infertility issues that couples face are due to female infertility. Symptoms of infertility in men include erectile dysfunction, pain or discomfort in the testicles, reduced ejaculate, and gynecomastia (increase of breast tissue in men). Infertility tests for males can include hormone testing, scrotal ultrasounds, and post-ejaculation urinalysis.
As with women, treatment of infertility in males depends on the cause of infertility in males. Male infertility can also be caused by untreated STIs, as well as hormonal imbalances. These can often be reversed with positive results.
Testing for fertility can be a multi-step process. To test for infertility in females, providers usually start by measuring hormone levels. From there, women may receive a pelvic ultrasound to check for any abnormalities that could be blocking the fallopian tubes. For men, providers may first order a urinalysis to check for infection, order a hormone test to check testosterone levels, then evaluate the semen itself. If no obvious issues are present, an ultrasound will likely be ordered to check for abnormalities in the prostate, scrotum, and seminal vesicles.
Depending on the cause of infertility, treatment may be as easy as taking hormone supplements or taking antibiotics to kill an underlying infection. In some cases, surgery to remove scar tissue or other blockages may be required. Unfortunately, infertility is not always able to be reversed, and some couples may have to explore alternative options, like adoption.
There are also many myths surrounding female infertility, such as that female masturbation causes infertility, that women can’t get pregnancy after having an abortion, or that they can’t get pregnant after using nexplanon or a similar implanted contraceptive. These are all 100% false, and should never be taken seriously.
If you’re facing infertility, don’t struggle with it alone. Reach out to your doctor and get to the bottom of the problem. You can find affordable, quality primary care physicians near you at Tripment.com who can help you with family planning and your overall health.