Having a baby isn’t always as straightforward as it might be, and there can be a number of potential explanations for low fertility.
If you’re reading this, chances are you’ve — or someone you know has — been trying for a while for a baby, but without much luck (so far).
And that’s OK. It’s actually, believe it or not, quite common – infertility affects as many as one in four Irish couples, so you’re far from alone. But obviously, that’s little consolation.
What’s most important is why you’re not getting pregnant, and, of course, what can be done to boost your chances of having a baby.
The human body is inherently complex. And that’s both a good and bad thing. When it comes to your fertility, it means that there are a number of possible reasons, including ovulation irregularities, structural problems in the reproductive system, low sperm count, or an underlying medical problem.
By and large, most couples who have been trying for a baby without success find their infertility can be explained by one of the following eight reasons:-
Not Ovulating
As you’ll no doubt remember from biology lessons, human conception requires an egg and sperm. Remove one of these and the chances of success are nil.
If you’re not ovulating, you won’t be able to get pregnant. Anovulation (the lack or absence of ovulation), as it’s known, is a common cause of female infertility and it can be triggered by many conditions.
PCOS is one possible cause of anovulation. Other possible causes include being over or underweight, primary ovarian insufficiency, a thyroid dysfunction, hyperprolactinemia, and excessive exercise.
Most women who are experiencing ovulation problems have irregular periods. However, regular menstrual cycles are not a guarantee that ovulation is occurring. If you have irregular cycles, talk to your doctor, even if you haven’t been trying for a year yet.
Low Sperm Count
Women may carry the baby, but the man’s role is equally important. Between 20-30% of infertile couples discover fertility factors on the man’s side. Another 40% discover infertility factors on both sides[1].
[1] Leaver RB. Male infertility: an overview of causes and treatment options. Br J Nurs. 2016;25(18):S35-S40. doi:10.12968/bjon.2016.25.18.S35
It’s important to bear in mind that male infertility rarely has symptoms that are observable without a semen analysis, which is a test that measures the health of the semen and sperm. So, when if and when you do make an appointment to see your GP, make sure you are both tested.
Not Trying Long Enough
Assuming you’re ovulating and your partner’s sperm is of a sufficient quality and quantity, it’s worth looking at how long you have been trying to conceive.
It may feel like you’ve been trying forever—and perhaps you have!—but it’s important to know that many couples won’t conceive right away.
Approximately 80% of couples conceive after six months of trying, while this figure rises to 90% after 12 months. This assumes you have well-timed intercourse every month.
Remember, Rome wasn’t built in a day, and nor are babies. If you’re fit and healthy and 35 years or older, it’s worth speaking with your GP about your fertility if you have been trying for a baby for over six months without falling pregnant. If you’re younger than 35, it’s advisable to consult with your GP if you have been trying for a baby for 12 months of over without success.
Age-Related Infertility
Some sobering statistics:-
- A woman’s prime reproductive years are in her 20s.
- Fertility gradually declines in the 30s, particularly after age 35.
- Each month that she tries, a healthy, fertile 30-year-old woman has a 20% chance of getting pregnant.
Age impacts egg (and sperm) quality as well as quantity. Furthermore, if your partner is five or more years older than you are, this can further increase your risk of fertility problems after age 35.4
Blocked Fallopian Tubes
Ovulatory problems accounts for about 25% of female infertility cases[2]. The rest can have problems with blocked Fallopian tubes, uterine structural problems or endometriosis.
[2] Sasaki RS, Approbato MS, Maia MC, Fleury EA, Giviziez CR, Zanluchi N. Patients’ auto report of regularity of their menstrual cycles. Medical history is very reliable to predict ovulation. A cross-sectional study. JBRA Assist Reprod. 2016;20(3):118-122. doi:10.5935/1518-0557.20160027
The Fallopian tubes are the pathway between your ovaries and the uterus. The Fallopian tubes do not directly attach to the ovaries; sperm need to swim up from the cervix, through the uterus, and into the Fallopian tubes.
When an egg is released from the ovaries, hair-like projections from the Fallopian tube draw the egg inside. Conception takes place inside the Fallopian tube, where the sperm and egg finally meet.
If anything prevents the Fallopian tubes from working properly, or if scarring blocks the sperm or egg from meeting, you won’t be able to get pregnant.
There are many possible causes of blocked Fallopian tubes. While some women with blocked tubes experience pelvic pain, many others have no symptoms. Only fertility testing, which can be carried out by your OB/GYN, can determine if your tubes are open.
Endometriosis
Endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Studies have shown that approximately 50% of women with endometriosis will have difficulty getting pregnant[3].
[3] Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012;39(4):535-549. doi:10.1016/j.ogc.2012.10.002
Endometriosis is unfortunately commonly misdiagnosed or simply just missed. It can’t be diagnosed with a blood test or ultrasound. Instead, it requires diagnostic laparoscopic surgery. Because of this, proper diagnosis takes an average of 4.4 years.
Underlying Medical Problems
In addition to the more obvious causes, underlying medical conditions can also lead to infertility in both men and women.
For example, a thyroid imbalance or even undiagnosed diabetes can lead to infertility. While it’s not well understood, depression is also associated with infertility.
Furthermore, some autoimmune diseases, like lupus and undiagnosed sexually-transmitted diseases, such as chlamydia and gonorrhoea, can cause infertility[4].
[4] Hanson B, Johnstone E, Dorais J, Silver B, Peterson CM, Hotaling J. Female infertility, infertility-associated diagnoses, and comorbidities: a review. J Assist Reprod Genet. 2017;34(2):167-177. doi:10.1007/s10815-016-0836-8
Unexplained Infertility
Between 10% and 30% of infertile couples never find out why they can’t get pregnant. Some doctors say this is a lack of good diagnosis. They say there is no such thing as unexplained infertility, but only undiscovered or undiagnosed problems.
The fact remains, though, that some couples don’t get answers. However, not having answers doesn’t mean you can’t be treated. You can (and should) still receive treatment for infertility, even if your diagnosis is unexplained.
In Summary
The reasons for infertility may not always be observable to the lay person.
If you’re having difficulty getting pregnant, it’s important to seek professional advice. The sooner you get help, the more likely fertility treatments will work for you.
