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Confused about why you’re still not seeing those two pink lines on the test strip? Worrying to yourself: Why can’t I get pregnant? Is something wrong with me?
Before you continue reading, please pause for a moment. Take a deep breath. It’s very possible that everything is normal. If that’s the case, then yes, you can get pregnant. You may just need to make some tweaks to your approach and lifestyle.
It’s also possible that you or your partner have an underlying health condition at play. This could include conditions like anovulation, endometriosis, or poor sperm health to name a few. If that’s the case, it’s still possible to get pregnant. You may simply need extra help and support.
In this article, we’ll cover all the possible reasons for not getting pregnant when everything is normal. We’ll also dig into male and female infertility, signs you can’t get pregnant on your own, and how to get help.
Why am I not getting pregnant when everything is normal?
There are many reasons for struggling to get pregnant. This can be true even if you have no underlying health conditions. Here are a few causes that could be at play.
1. Not trying in your fertile window (or not trying enough)
You’re not alone if you’ve ever wondered: Why am I not getting pregnant even though I am ovulating?
To get pregnant, you must have unprotected sex during your fertile window. Your fertile window is the time of your menstrual cycle when sperm is most likely to fertilize your egg.
This window typically lasts about 6 days. Here’s why. Sperm can survive for up to 5 days in the female reproductive tract. But a female egg can only survive for 12 – 24 hours.
For conception to occur, the egg must be fertilized within the half-day to one-day window. If the sperm is already there ready to meet the egg, that can boost your chances of pregnancy.
So your fertile window includes the 4 days before you ovulate, the day of ovulation, and the day after ovulation.
But your chances of pregnancy are highest the previous two days before ovulation. In fact, your chances of conception 2 days before and one day before ovulation are 33% and 42% respectively.
How often you have sex matters too. It’s recommended to “baby dance” at least every other day during your fertile window to give yourself the best chance of pregnancy.
And having intercourse every day increases your chances by about 3%.
The best way to stay on top of your fertile window is to track your luteinizing hormone (LH). This will help you know exactly when you are ovulating.
You can use an at-home fertility monitor like Inito. It measures your fertility hormones to give you a full picture of your cycle. It’s basically like having a personalized fertility lab in your home.
Here’s what makes Inito so effective:
- You can effectively track your fertile window and predict when you’re going to ovulate by measuring your LH, estrogen, and FSH levels.
- You can confirm ovulation with the PdG (urine metabolite of progesterone) reading.
- You get actual numerical values instead of thresholds so you have a full picture of your hormones.
- Unlike other fertility tests, Inito can measure all your hormones on a single test strip.
It may help you to view “getting pregnant” in two distinct phases.
- First, fertilization occurs (when you have sex in your fertile window). Successful fertilization doesn’t always lead to pregnancy despite what many people believe.
- Second, implantation occurs. This is when the fertilized egg (or ‘blastocyst’) implants into your uterine lining.
The second is endometrial receptivity. This refers to the ability of your uterine lining to accept the egg. For implantation to be successful, the ideal thickness of the uterine lining is 7 mm.
3. Hormonal Imbalance
You have four main hormones that play a critical role in reproduction. If these hormones are out of whack, you will face challenges when trying to conceive.
Here’s how each of these hormones affect fertility:
- Estrogen must also be at an optimal level. This hormone is key for successful ovulation and implantation. If your estrogen levels are off, you may not even ovulate at all (anovulation).
If you have too much estrogen, your uterus will not be in a receptive state. This makes implantation a huge challenge. The range of healthy estrogen levels in the blood for successful conception is 3.0 – 25.0 ng/mL. - Luteinizing hormone (LH) is the hormone that initiates ovulation. The ideal range for LH surges to trigger ovulation is 12.2-118.0 mIU/mL with the average around 44.6 mIU/mL.
- Progesterone helps with endometrial receptivity because it triggers the uterine lining to thicken. If your body isn’t producing enough progesterone, then implantation will be difficult.
- Follicle-stimulating hormone (FSH) helps follicles grow in your ovaries. FSH helps one dominant follicle mature into a released egg each month. It also cues the ovaries to produce estrogen.
Knowing the actual numerical values of your hormones is key when trying to conceive. And right now, Inito is the only fertility monitor that allows you to track specific values for estrogen, LH, PdG (urine metabolite of progesterone), and FSH using a single test strip.
4. Poor Egg Quality
Healthy eggs lead to healthy pregnancies. So, the quality of the egg that you release could be a reason for not getting pregnant when everything is normal.
Your body will naturally try to prevent unsuccessful pregnancies. If the egg you release is chromosomally abnormal, it won’t develop into a healthy embryo. And it is not likely to implant into your uterus. This is actually a good thing because abnormal eggs can lead to issues like birth defects.
Egg quality is mostly dependent on age and genetics. It’s actually normal for you to produce some poor quality eggs.
In fact, for a woman aged 3o years old, just 70% of eggs in the ovarian reserve are of good quality.
What causes infertility?
Most people don’t realize the full array of issues that can lead to infertility. Both women and men can have health conditions that cause fertility troubles. Keep reading below for a comprehensive list of issues that affect both female fertility and male fertility.
Causes of female infertility
- Anovulation: This refers to cycles where you do not ovulate. 40% of women who experience infertility have anovulatory cycles. Several factors could impact your ability to ovulate. These include diminished ovarian reserve, endocrine disorders, or gynecological conditions.
Learn More: Anovulation: Everything you need to know about the #1 cause of infertility - Menstrual irregularities: Irregular menstrual cycles can be either ovulatory or anovulatory. But either way, they can contribute to ovulation problems and infertility. Nearly a quarter of women experience irregular periods. A “normal cycle length” is between 21 – 35 days and 2-8 days long. Irregularities include abnormal cycle length and duration, heavy bleeding, and extreme cramping.
- PCOS: Up to 10% of women in the U.S. have PCOS (polycystic ovarian syndrome). Of those PCOS patients, 80% struggle with infertility. PCOS causes you to produce higher levels of androgens. These hormones interfere with follicle development and ovulation as well as your estrogen and LH levels. Women with PCOS often have cysts that grow in their ovaries.
- Endometriosis: This is when uterine tissue grows in other reproductive organs outside the uterus. Endometriosis can lead to painful sex, blocking of your fallopian tubes, ovarian cysts, poor egg quality, and impaired implantation.
- Fibroids: Uterine fibroids are benign tumors that grow in and around the uterus. They are actually very common and don’t always cause infertility, but they can. Fibroids can also increase your risk of complications like preterm labor or miscarriage.
- Thyroid issues: Thyroid disease affects your body’s production of hormones. This can lead to there being too much or too little of hormones that are vital for reproduction.
- POI: Primary ovarian insufficiency causes your ovaries to stop hormone production prematurely. This would affect your ability to produce and release eggs. 90 – 95% of women with POI use some type of medical intervention to get pregnant.
Medications and drugs: Using certain medications and substances can affect your fertility. Be sure to check with your doctor if you are on any medications while trying to conceive.
Anatomical problems in the reproductive system: You could have structural problems that lead to infertility. This could mean an abnormally shaped uterus or overgrown tissue that blocks the travel of eggs and sperm on their way to the fallopian tubes. Fibroids, scarring, polyps, and endometriosis can all lead to anatomical issues. - Autoimmune disorders: When you have an autoimmune disorder, your body produces antibodies. These may attack your reproductive organs and make it challenging to conceive naturally. This is because the antibodies affect your hormones as well as ovulation and implantation.
- Infections: Untreated infections, such as STIs, can cause inflammation in the pelvic organs. This can lead to scar tissue that could potentially block your fallopian tubes. Chronic infections from HPV can also impact the quality of cervical mucus (CM). This could make it difficult to conceive.
- Failure of eggs to mature: Immature eggs face several issues. These include ovulating on time, making it to the fallopian tube, and being fertilized. Conditions like PCOS and obesity can lead to having immature eggs.
- Implantation failure: Embryos can fail to implant for a variety of reasons. Some include chromosomal abnormalities, thin uterine lining, endometriosis, scar tissue, and progesterone resistance.
Causes of male infertility
- Abnormal sperm morphology: sperm that are abnormal in shape or size
- Low or no sperm count: a lower sperm count or no sperm
- Abnormal sperm motility: sperm with impaired movement
- Medical conditions like diabetes: Insulin resistance or deficiency can alter testicular functions
- Injury to the testicle: Trauma to the testicle can lead to scarring. This will impact sperm production.
- Insensitivity to androgens: Men can have a mutation in the androgen gene receptor. This impairs fertility.
- Impotency: the inability to get or keep an erection
- Infections of the testicles: Infections can cause infertility in men too. This is because they can create scarring that damages sperm and their ability to travel.
- Varicocele: This is when a man has enlarged veins in their scrotum. It’s one of the most common causes of male infertility (2 in 5 cases). Public figure, Hasan Minaj, spoke out about his fertility struggles. 6 weeks after having a varicocele repair surgery, he and his wife were able to conceive their son.
Other factors that affect your fertility
Your age, genetics, and lifestyle also play a big role in fertility. One major fertility factor affected by age is female egg health. As you age, your percentage of healthy eggs declines.
Though you can’t control your age or genetics, you can control certain lifestyle factors. This is why you should make healthy habits a priority when trying to conceive.
Learn More: What Are My Chances of Getting Pregnant by Age? Check Out Our Chart
When to consult a doctor about your fertility?
You may feel disappointed if you’re not pregnant after 4 months of trying. Or even just one or two months of trying. It can be so frustrating when you feel like everything is normal and it’s still not working.
But here’s a guideline for when you should consult a doctor about not getting pregnant:
- If you’re a female under 35 and you’ve been trying to conceive for a year
- If you’re a female over 35 and you’ve been trying to conceive for 6 months
- If you’ve experienced more than two back-to-back pregnancy losses
- If you know that you have a condition that known to cause fertility issues
Any of these descriptions match your situation? Then definitely make an appointment with a fertility specialist or reproductive endocrinologist ASAP. They can do a physical exam and order diagnostic labs for you and your male partner to get done. This infertility evaluation will give you a better picture of your reproductive health.
If you find out that you or your partner have a condition causing your infertility, don’t despair. There is a bright side though! There are so many types of assisted reproductive techniques these days. ART and other medical interventions can help you with your fertility journey.
How do I know if I have infertility?
Experts define infertility as failure to conceive after regularly having unprotected sex for a year. If you are over age 35 though, you should look for help if you’ve been trying for 6 months with no success.
Your best bet is to make an appointment with your doctor or a fertility specialist. There are a lot of diagnostic tests that they can run to give you and your partner a better picture of your overall fertility.
What is unexplained infertility?
15 – 30% of couples struggling to get pregnant will not have any clear reasons for their difficulties. If diagnostic tests don’t reveal any underlying causes, you have unexplained infertility.
Now, that may sound scary but don’t lose hope. There are many couples with this “diagnosis” that go on to have a healthy pregnancy. However, it will likely require looking into fertility treatments or assisted reproduction options.
Tests that can diagnose female fertility issues
Seeing a doctor can help diagnose potential conditions affecting your ability to conceive. Here are possible tests that your healthcare provider (HCP) may have you undergo:
Preliminary exam
Your physician will go over your detailed medical history. This will give them an idea of your overall health and any potential infertility factors. They will also do an overall physical exam and pelvic exam.
More invasive exam
Your doctor may perform additional tests to get even more data about your fertility. This could include a pap test and blood tests for your overall health or to check progesterone levels. They may order FSH or AMH tests to get data on your ovarian reserve.
Here are some more tests that your doctor may suggest you undergo:
X-ray hysterosalpingogram or laparoscopy to examine fallopian tubes
Transvaginal ultrasound, hysteroscopy, or saline sonohysterogram to examine uterus and follicle growth
Tests that can diagnose male fertility issues
Want a better overview of male reproductive health? Male partners may need to get the following tests and procedures done.
Preliminary exam
Your doctor will go over your detailed medical history to gather data about your health and fertility. They will also do a physical exam of the testes and penis to see if there are any obvious issues that could impair sperm production or fertility.
More invasive exam
Another layer of examination may be necessary. For example, you may get a semen analysis to test overall sperm health and sperm count. Your doctor can also do a blood test to check for hormone levels, an ultrasound of the scrotum, or a biopsy of the testicle to assess any abnormalities.
Takeaways
- Having unprotected intercourse in your fertile window plays a key role in conception.
- Implantation failure can occur for two main reasons. These are poor endometrial receptivity and chromosomal abnormalities.
- Hormonal problems can lead to you experiencing infertility.
- Egg quality impacts your ability to conceive.
- Infertility is when you have failed to conceive after a year of trying. Unexplained infertility is rather common.
- There can be many causes of infertility on both the male and female side.
- Some female infertility factors include menstrual irregularities, conditions like PCOS or endometriosis, and immature eggs.
- Some male infertility factors include poor sperm health, medical conditions like diabetes, and varicoceles.
- Consulting your physician is helpful for better understanding your infertility problems. They can also help you get treated (if possible) or recommend a fertility treatment so you can still conceive!
- In the meantime, try your best to lead a healthy lifestyle to give yourself the best chance possible.
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- Diagnosis and Treatment of Unexplained Infertility – PMC
- What are some possible causes of female infertility? | NICHD
- https://www.pnas.org/doi/epdf/10.1073/pnas.0530162100
- Fertility and Egg Quality – Age and Testing
- What are menstrual irregularities? | NICHD
- How is infertility diagnosed? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development
- Significance of Mutations in the Androgen Receptor Gene in Males with Idiopathic Infertility1 | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic
- Hasan Minhaj Reveals He and Wife Had ‘Fertility Problems’ for Years: It Was ‘Really Tough on Us’
- Diabetes Mellitus and Infertility: Different Pathophysiological Effects in Type 1 and Type 2 on Sperm Function.
