It’s natural to start worrying if you have been trying to get pregnant for a few months without success. Remember, however, that it often takes about a year of unprotected sex to get pregnant. But once you approach the one-year mark (or the 6-month mark, if you are 35 or older) you should go see your gynecologist or a reproductive endocrinologist (a doctor that specializes in infertility) to determine whether you may be facing fertility issues.1
What it Takes to Get Pregnant
To get pregnant, four steps need to happen:
- An egg must be released from one of the woman’s ovaries (ovulation)
- The egg must move through the fallopian tubes towards the uterus
- The egg must be penetrated by a healthy sperm (fertilization)
- The fertilized egg must implant into the wall of the uterus (implantation)
Running into a problem at any of the four steps can cause a woman to be infertile and unable to get pregnant without medical intervention.
Causes of Infertility in Women
Ovarian Function
Women of reproductive age generally have a menstrual period every 24-32 days. Regular periods are a good indication that a woman is ovulating, or releasing an egg each month from one of her ovaries. If you want to confirm whether you are ovulating or track your cycle, you can use an over-the-counter ovulation predictor kit.
A woman with irregular periods is at higher risk for not ovulating. According to the Centers for Disease Control and Prevention, any of the following medical conditions can cause a woman of childbearing age to not ovulate:1
- Polycystic Ovary Syndrome (PCOS) – PCOS is a hormone disorder that can cause a woman to not ovulate. Symptoms include irregular or prolonged menstrual periods, excess hair growth, acne, and obesity.2 PCOS is the most common cause of female infertility.
- Excessive physical or emotional stress – Stress, especially prolonged and intense can cause a woman to stop menstruating.
- Diminished ovarian reserve (DOR) – The ability of the ovary to produce eggs is reduced because of congenital, medical, surgical, or unexplained causes. Ovarian reserves naturally decline with age.
- Premature ovarian insufficiency (POI)– POI occurs when a woman’s ovaries fail before she is 40. This condition is sometimes referred to as premature (early) menopause.
Absence of Healthy Sperm
About 20% of infertility is caused solely by a problem with the male partner, and it can be a contributing factor in another 30 to 40%.3 One of the first tests that should be done when a couple is not able to conceive is a sperm analysis to rule out male fertility issues. This is a relatively easy and inexpensive test to examine sperm number, shape, and movement.
Blocked Fallopian Tubes
A blocked or swollen fallopian tube will prevent the sperm from reaching the egg and the fertilized egg from reaching the uterus.1 Risk factors for blocked fallopian tubes include a history of pelvic infections, abdominal surgery, a ruptured appendix, gonorrhea or chlamydia, or endometriosis.1
Uterine Receptivity
Certain conditions in the uterus, such as fibroids or structural abnormalities, can interfere with the ability of the embryo to implant.1
What Increases a Woman’s Risk of Infertility?
Any number of factors can increase the risk of infertility in women, including:1
- Age
- Smoking
- Excessive alcohol consumption
- Drug use
- Being significantly overweight or underweight
- Excessive physical or emotional stress
If you have questions about your own fertility, speak with your physician, gynecologist or a reproductive endocrinologist to determine which steps you should take to help you begin your fertility journey.