Can't Get Pregnant: What Could Be Happening

Understanding normal conception timelines helps put your experience in context:

For most couples trying naturally:

• About 30% conceive in the first cycle
• About 60% conceive within 3 months
• About 80% conceive within 6 months
• About 85% conceive within 12 months

Factors that affect timeline:

• Female age (the most significant factor)
• Male partner's sperm health
• Frequency and timing of intercourse
• Overall health of both partners
• Any underlying medical conditions

When it's considered a concern:

Doctors typically define infertility as:

• Under 35: Not conceiving after 12 months of regular unprotected sex
• 35-39: Not conceiving after 6 months
• 40+: Seeking help sooner is reasonable

Important to remember:

Not conceiving immediately is normal. Each monthly cycle is only a 15-30% chance of conception even under optimal conditions. However, if you're concerned, seeking advice earlier is always reasonable.

About one-third of fertility issues relate to female factors:

Ovulation problems (25-30% of cases)

When ovulation doesn't occur regularly, there's no egg to fertilise.

Signs: Irregular or absent periods, very long or short cycles

Common causes:

• Polycystic ovary syndrome (PCOS)
• Thyroid disorders
• Premature ovarian insufficiency
• Hyperprolactinemia
• Being significantly under or overweight
• Excessive exercise

Fallopian tube issues (25% of cases)

If tubes are blocked or damaged, egg and sperm can't meet.

Causes:

• Previous pelvic infections (including chlamydia)
• Endometriosis
• Previous ectopic pregnancy
• Previous pelvic surgery
• Appendicitis with complications

Uterine factors (10% of cases)

Problems with the uterus can prevent implantation.

Examples:

• Fibroids (benign growths in the uterine wall)
• Polyps
• Uterine abnormalities present from birth
• Scarring from previous surgery

Cervical factors (less common)

Issues with cervical mucus can prevent sperm passage.

Endometriosis

This condition, where uterine-like tissue grows outside the uterus, affects fertility through multiple mechanisms and is found in 25-50% of women with fertility difficulties.

About one-third of fertility issues relate to male factors:

Sperm production problems

Low sperm count or poor sperm quality is the most common male factor.

Causes:

• Varicocele (enlarged veins in the scrotum)
• Hormonal imbalances
• Genetic factors
• Previous infections (including mumps)
• Undescended testicles
• Certain medications
• Excessive heat exposure to testicles

Sperm delivery problems

Even with healthy sperm production, delivery issues can occur.

Causes:

• Blockages in the reproductive tract
• Previous vasectomy
• Retrograde ejaculation (sperm goes into the bladder)
• Erectile dysfunction
• Previous surgery or injury

Lifestyle factors affecting sperm:

• Smoking
• Heavy alcohol use
• Drug use (especially anabolic steroids)
• Obesity
• Excessive heat exposure

Important note:

Male factor issues are present in about 40% of couples with fertility difficulties. A semen analysis is a simple, non-invasive first test that should be done early in any fertility investigation.

Many men feel embarrassed discussing fertility concerns, but male factors are just as common as female factors and many are treatable.

In about 10-30% of couples, standard tests don't reveal a clear cause.

What "unexplained" means:

It means that:

• Ovulation is occurring normally
• Fallopian tubes are open
• Semen analysis is normal
• Uterus appears normal

It doesn't mean there's no cause - rather that current tests haven't identified it.

Possible hidden factors:

Some causes can't be detected with standard tests:

• Egg quality issues (can't be directly tested)
• Subtle sperm function problems (not shown on standard analysis)
• Implantation issues at the molecular level
• Very mild endometriosis
• Sperm DNA fragmentation

What it means for treatment:

Unexplained infertility is frustrating, but it often responds well to treatment. Options include:

• Continued trying naturally (conception still possible)
• Ovulation induction with timed intercourse
• Intrauterine insemination (IUI)
• In vitro fertilisation (IVF)

Prognosis:

Many couples with unexplained infertility do eventually conceive, whether naturally or with treatment. The diagnosis doesn't mean it won't happen.

When you seek help, doctors will investigate systematically:

For women:

Blood tests:

• Hormones on day 2-3 of cycle (FSH, LH, estradiol)
• AMH (ovarian reserve)
• Progesterone mid-cycle (confirms ovulation)
• Thyroid function
• Prolactin

Ultrasound:

• Antral follicle count (AFC)
• Ovarian appearance
• Uterine assessment
• Look for fibroids, polyps, cysts

Hysterosalpingogram (HSG):

• X-ray with dye to check if fallopian tubes are open
• Also shows uterine cavity shape

For men:

Semen analysis:

• Sperm count
• Motility (movement)
• Morphology (shape)
• Volume

Possibly:

• Hormone tests (testosterone, FSH)
• Sperm DNA fragmentation test
• Ultrasound if abnormalities found

Further tests if needed:

• Laparoscopy (keyhole surgery to look inside)
• Hysteroscopy (camera inside uterus)
• Genetic testing
• Specialised sperm function tests

If you're concerned about not conceiving:

Start with your GP:

Your GP can:

• Take initial history
• Arrange basic blood tests
• Refer for semen analysis
• Refer to a fertility specialist if needed

What to bring to appointments:

• Record of your cycle lengths
• How long you've been trying
• Any symptoms you've noticed
• Your partner's medical history too
• List of medications either of you take

While you wait:

Continue trying - Conception can happen while waiting for appointments.

Optimise lifestyle:

• Stop smoking if applicable
• Reduce alcohol
• Take folic acid
• Maintain healthy weight

Track your cycles - This information is useful for doctors.

Seek support - Difficulty conceiving is emotionally challenging. Talk to your partner, friends, or seek professional support.

Don't delay if:

• You're over 35
• You have known conditions affecting fertility
• You have very irregular or absent periods
• Your partner has known fertility concerns
• You've had recurrent miscarriages

Remember:

Most fertility issues are treatable. Seeking help early gives you more options and time.