Dear Fertility Doc: Why Am I Not Getting Pregnant?

Millions of people are impacted by infertility. Studies indicate that after one year, only 85% to 88% of couples trying to conceive will be successful, which means 12% to 15% will not^[2]How common is infertility?. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Accessed 11/23/2021. .

While the struggle is common, it’s also normal to feel alone, especially if you have family members and friends who are announcing their pregnancies or family-building journeys.

The first step in understanding infertility is removing any guilt you may feel from the equation. It isn’t you or your partner’s fault—Mother Nature designed a flawed system that hasn’t evolved alongside us as our lifespans extend decades beyond our 20s and 30s. Fortunately, assisted reproductive diagnostics and technologies have improved significantly, helping more individuals and couples overcome infertility and build healthy families.

Still, we recognize there’s a big emotional component—including a lot of stress—to any fertility journey. As such, there is a need for continued awareness for those experiencing infertility and even more so for those who aren’t but need to support those who are.

The time to see a reproductive endocrinologist, also known as a fertility specialist, is different for everyone. For you, Frustrated With Fertility, as you’re in your early 30s and haven’t gotten pregnant after a year of unprotected sexual intercourse, now is the appropriate time to seek help.

With that said, someone 35 years or older should see a fertility specialist after six months of actively trying. And for those 40 and older, a fertility evaluation is recommended before you even try to get pregnant.

There are many causes of infertility, but three of the most common factors include female factors (33% of cases), male factors (33% of cases) and those that cannot be explained (the remaining 33% of cases).

Female Factors

For women, age, tubal problems and hormone imbalances—sometimes known as ovulatory dysfunction like polycystic ovary syndrome (PCOS)—are the most common causes.

• Age affects both egg quality and egg quantity. Unfortunately, as the number of available eggs drops year by year, so does the ability of each egg to produce a chromosomally normal embryo or pregnancy. While there is no stopping, fixing or reversing age-related fertility decline, options like egg freezing—a viable method of fertility preservation—can give women more freedom to decide when to have a baby. For those with a severely diminished ovarian reserve, eggs from another person, also called donor eggs, can help them experience pregnancy and have a healthy baby.
• Tubal problems account for up to 30% of cases and often happen when a blockage occurs in the fallopian tubes that doesn’t allow the egg and the sperm to meet, preventing fertilization^[3]Tubal Factor Infertility (Fallopian Tube Obstruction). Columbia University Irving Medical Center. Accessed 11/23/2021. . They most commonly result from pelvic inflammatory disease or sexually transmitted infections (STIs). Tubal problems can also be caused by endometriosis, a disease in which the tissue that normally lines the inside of the uterus (called the endometrium) develops in other places in the pelvis or abdomen like the fallopian tubes, which can cause scarring and blockages. For those whose fallopian tube damage is severe and can’t be corrected with surgery, in vitro fertilization (IVF) usually offers women the best chances of a successful pregnancy because it bypasses the fallopian tubes, as the embryo is transferred directly into the uterus.

• Polycystic ovary syndrome (PCOS) is a hormonal imbalance that can impact a woman’s ability to ovulate, in turn reducing her chances of conceiving naturally. Signs of this condition include irregular or heavy menstrual cycles, acne and weight gain. A full fertility workup can diagnose PCOS. From there, your doctor can guide you to the best treatment options.

Male Factors

Male-factor infertility (MFI) can also be attributed to STIs or damage caused by injury or diseases affecting the testicles, such as hormone imbalances or blockages in male reproductive organs. Low sperm count, abnormal or malformed sperm, or a complete lack of sperm—known as azoospermia—are all components of MFI. A semen analysis is an important first step in understanding a male’s reproductive health.

Unexplained Causes

The third most common diagnosis—and arguably the most frustrating one—is unexplained infertility. This classification means all test results are normal and a “cause” or reason for infertility is not identifiable.

Unexplained infertility is also common—it accounts for approximately 30% of infertility cases—and can be due to a combination of factors^[4]Sadeghi MR. Unexplained infertility, the controversial matter in management of infertile couples. J Reprod Infertil. 2015;16(1):1-2. . For instance, couples with unexplained infertility may have problems with egg quality, tubal function or sperm function that are difficult to diagnose and treat. In these cases, your doctor may recommend fertility drugs or treatments such as IVF or intrauterine insemination (IUI), which can be successful for unexplained infertility.

How to Cope with Infertility

I can’t stress enough, Frustrated With Fertility, how important it is to recognize that infertility is not your fault. But even so, facing infertility—and the unknowns that come with it—can be emotionally, physically and financially draining.

Fortunately, there are online and in-person support groups where people struggling with fertility can lean on one another to discuss their feelings and experiences, which can help you realize you’re not alone. There are financial programs available as well that make accessing fertility care easier.

Becoming aware of your fertility can also be empowering. After all, knowledge is power, and cultivating skills, strategies and a community can help you navigate the tough questions you may get from family members and friends whose intentions are good but commentary and “advice” likely lacks awareness and education.

Most importantly, give yourself grace and create space for you and your partner to feel sad, grieve or experience any other feelings that come with this process. It’s your experience, your journey, and there’s no right or wrong way to travel this road—the most successful way is the route that’s best for you. Just remember to have hope, because fertility treatments have improved tremendously over the past few decades, helping more families bring home babies than ever before.

“Dear Fertility Doc” is for informational purposes only and should not substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health providers with any questions about a medical condition. By submitting your letter, you’re agreeing to let Forbes Health use it in part or in whole, and we may edit the letter for length and clarity.