Why can’t I get pregnant?

We feel strong sympathy for anyone reading this because they searched for the title. It is easier typed out than done, but please try not to worry too much. Just because you are not pregnant yet does not mean it will never happen or that you’ll never be a mum. Let’s look at some reasons things might be taking longer than you’d prefer.

You could make more conception-friendly lifestyle choices.

As Dr. Shree Datta covers in Unii’s Preconception Journey, the first step you take towards conceiving should be an antenatal checkup. There are proactive steps you can take yourself that may be recommended during the appointment. These include taking your antenatal supplements, especially your folic acid. You should always speak to a doctor before taking any new vitamins, but it’s exceptionally important in this case because, while there are guideline amounts for antenatal supplements that you can find online, you may need to adjust or forgo these to suit your medical or lifestyle circumstances. For example, it is strongly recommended that women with epilepsy take a higher-than-average dose of 5000 micrograms (5 milligrams) of folic acid daily, as soon as they start trying for a baby and for at least the first 16 weeks of their pregnancy. Their doctor may even feel their case warrants taking it for the whole pregnancy; it’s all very patient-specific.

You and the potential father should be eating a balanced diet, exercising regularly, and taking steps to manage your stress. Alcohol consumption harms both female and male fertility. We’re sure you don’t need reminding, but if either of you smokes or use recreational drugs, you need to stop. There is some evidence that caffeine impacts the two of you fertility-wise. You may like to cut consumption as a precautionary measure.

You haven’t been trying to conceive for long enough.

It is not uncommon for completely healthy couples who have regular, unprotected sex to take some time to get pregnant. By regular, we mean 2-3 times a week. It can take up to a year, even if the woman trying to conceive is under 35. If you have been trying longer than that, or you’re over 35 or have known health or fertility problems, and you have been trying to conceive for over six months, it may be time to check in with your doctor about getting some tests.

You are not ovulating.

Anovulation is the absence of ovulation. The most common causes of fertility issues are that a woman is not ovulating or her man has a sperm disorder. These are not pleasant things to think about, but it’s important to emphasise here that if these are your problems, there are many couples who’ve been in your shoes and gone on to conceive and have healthy pregnancies. For example, endometriosis and PCOS might keep you from ovulating, but you may have heard from the many mums brave enough to share their stories that these things can be managed. Other examples of conditions that cause ovulation failure include fibroids, ovarian cysts, obesity, and a range of autoimmune disorders, as well as far less scary-sounding things like the need to foster better lifestyle habits.

Your man has sperm issues.

Another one you probably don’t want to chat about over Sunday lunch is that there may be a problem with the number or quality of your partner’s sperm. Sperm production can be damaged by mumps, untreated sexually transmitted infections, past injuries to the testicles, excessive heat (such as hot baths), tight-fitting underwear, and, as we’ve mentioned, alcohol, smoking, or recreational drugs. Recent studies suggest that there is a worldwide decline in sperm counts, though of course your partner’s individual case should be your starting point. Frustratingly, there may also be unknown causes.

You can conceive, but implantation is a problem.

This can be a heartbreaking one. A sperm’s ability to successfully fertilise an egg is a pretty miraculous thing. If you believe that pregnancy starts at conception (the NHS and ACOG define the beginning as implantation, but it’s not uncommon to disagree), most pregnancy loss happens before implantation. The causes of implantation failure are diverse. Examples include uterine abnormalities, hormonal or metabolic disorders, infections, and immunological factors, as well as other less common ones.

You have (or have had) an underlying health problem that impacts fertility.

Sometimes we don’t know we have a condition that can impede conception until we start trying for a baby. Some examples of this include uterine abnormalities (you would usually need to have had your uterus scanned at some point to know these were a problem) or blocked or damaged fallopian tubes, which are typically discovered only when you have a hysterosalpingogram (HSG) test.

In addition, conditions from which you have completely recovered can impact your fertility, as well as a pregnancy, years after the fact. These include amenorrhoea, eating disorders, and a number of STIs. It is extremely important to be up front with your obstetrician about your entire medical history, especially as some things are very treatable. If you feel that talking about past mental health problems may be an issue, there should be charitable resources available to you, but, as with all these things, your doctor should be the first person you consult.

You are over 36.

Mother Nature is not a feminist! The pregnancies of women over 36 used to be termed geriatric by doctors, though this is changing. Advanced maternal age, elderly primipara, and mature gravida are some other lovely terms you may encounter if you look into getting pregnant that bit older. It really is the case, however, that your age can impact your fertility and pregnancy in a variety of ways if you’re past your 36th birthday. It doesn’t mean it definitely will, but age may be part of the conversation if you have trouble conceiving. The quality of your eggs decreases, your risk of miscarriage increases, and you are more vulnerable to chronic conditions. And on that note...

You have a chronic condition.

A vast number of common and not-so-common chronic conditions can impact fertility. These range from asthma to diabetes, thyroid problems, and even chronic stress. Some are relatively easy to manage, and others require more specialist help, but it’s important to speak honestly to your doctor about how effectively you are managing what you have while trying to get pregnant. How much is your condition disrupting your daily life? Could you try a different medication? Update your plan, if necessary, and stick to it.

Have my years of contraception use made me infertile?

We understand that you may have spent your entire adult life to this point trying not to get pregnant, and your success may have you worried. However, fertility issues arising from contraceptive use are very unlikely, no matter what form you prefer. Fertility returns very quickly after you stop using the combined pill or have devices like an IUD or contraceptive implant removed. It’s true that they’re very effective when used correctly, but this has no bearing on what happens when you stop using them. While the pill won’t cause fertility problems, using it may mask underlying issues that are worth raising with your doctor, such as very irregular periods. Irregular periods can be symptomatic of PCOS or other problems that can impact fertility, and it’s important to seek help.

Why can’t I get pregnant?

Unii looks at some reasons conception might be taking a while.