Why Am I Not Getting Pregnant? Common Causes and Solutions

Introduction

If you have been trying to conceive for several months without success, you are not alone. Many couples face challenges on their journey to parenthood, and the question “why am I not getting pregnant?” can become more concerning with each passing month. The reassuring news is that most fertility issues have identifiable causes and effective treatment options.

Several factors can affect fertility, including timing, lifestyle habits and underlying medical conditions. For women under 35, doctors generally recommend trying naturally for 12 months before seeking medical advice. Women over 35 are advised to consult a fertility specialist after 6 months of trying. It is also wise to seek earlier guidance if you have irregular periods or known health conditions.

This article outlines the common causes of conception difficulties, highlights warning signs that require medical attention and discusses practical solutions to improve fertility. Whether you are just starting your journey or have been trying for some time, this information can help you make informed decisions about your reproductive health.

What Are the Most Common Reasons for Not Getting Pregnant?

While the reasons vary between couples, the leading causes include:

• Ovulation problems
• Male factor infertility
• Blocked fallopian tubes
• Unexplained infertility

Infertility affects men and women almost equally. About one-third of cases are due to female factors, one-third to male factors and the remaining cases involve a combination of both or are unexplained. This distribution highlights why both partners should undergo a fertility evaluation rather than assuming the issue lies with one person.

Common fertility issues in women include irregular ovulation, polycystic ovary syndrome (PCOS), endometriosis, age-related decline in egg quality and damaged or blocked fallopian tubes. However, some women experience regular periods but not getting pregnant, which may indicate subtle ovulation problems, egg quality concerns, tubal issues or unexplained infertility that requires further testing.

In men, fertility problems are often linked to low sperm count, poor sperm motility, abnormal sperm shape or blockages that prevent proper sperm delivery.

Could My Age Be Affecting My Fertility?

Yes, age is a significant factor affecting fertility. Women’s fertility begins to decline gradually after 30 and more rapidly after 35. In men, sperm quality also decreases with age, although the decline in fertility is generally less dramatic.

Female fertility is closely linked to both the quantity and quality of eggs. Women are born with all the eggs they will ever have, approximately 1 to 2 million at birth. This number decreases to about 300,000 to 400,000 by puberty. The decline continues with age, and by 37, the number may fall to around 25,000.

In addition to egg quantity, age affects egg quality and chromosomal integrity. Older eggs are more likely to have chromosomal abnormalities, increasing the risk of miscarriage and genetic conditions such as Down syndrome. Research indicates that women under 30 have about a 20 percent chance of conceiving each month, which declines to around 5 percent by age 40.

Is the Timing of Intercourse Important for Conception?

Yes, the timing of intercourse is crucial because the egg remains viable for only 12 to 24 hours after ovulation, while sperm can survive in the female reproductive tract for up to 5 days.

Your fertile window lasts about 6 days, including the 5 days before ovulation and the day of ovulation. The probability of conception is highest when intercourse occurs in the 2 to 3 days before ovulation, as sperm need time to travel through the reproductive tract and become capable of fertilising the egg.

However, many couples may unknowingly miss this window by trying too infrequently or having intercourse after ovulation has already occurred. Specialists generally recommend having intercourse every 2 to 3 days throughout the cycle, or if tracking ovulation, daily or every other day during the fertile window.

What Lifestyle Factors Can Prevent Pregnancy?

Several lifestyle factors can significantly affect fertility, including obesity or being underweight, smoking, excessive alcohol consumption, high stress levels, poor sleep patterns and exposure to environmental toxins.

• Weight and Nutrition: Both obesity and being underweight may disrupt hormonal balance and ovulation. A body mass index (BMI) outside the healthy range of 18.5 to 24.9 may reduce fertility in women by affecting oestrogen production and the regularity of ovulation. In men, obesity has been linked to lower testosterone levels and reduced sperm quality. Maintaining a balanced diet rich in antioxidants, vitamins and minerals supports overall reproductive health.
• Stress and Sleep: Chronic stress may affect the hypothalamic-pituitary-ovarian axis, disrupting ovulation and menstrual regularity. Poor sleep quality can also interfere with reproductive hormone balance.
• Exercise: Moderate exercise supports fertility, but excessive high-intensity exercise may suppress ovulation in women. It is important to maintain balance and aim for moderate physical activity on most days of the week.

How Do Medical Conditions Affect My Ability to Conceive?

Several medical conditions can directly affect fertility. The most common include PCOS, endometriosis, thyroid disorders and diabetes, all of which may prevent or delay pregnancy.

Polycystic Ovary Syndrome (PCOS)

PCOS affects about one in ten women of childbearing age. It causes hormonal imbalances that may prevent regular ovulation. In addition to irregular periods, women with PCOS often have excess androgens (male hormones) and multiple small cysts on their ovaries.

Endometriosis

This condition is characterised by tissue similar to the uterine lining growing outside the uterus. It can affect the ovaries, fallopian tubes and pelvic cavity. Affecting around 10% of women worldwide, endometriosis may cause pelvic pain, heavy periods and fertility issues. It can interfere with egg release, fertilisation or implantation.

Thyroid Disorders

Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) may disrupt ovulation and menstrual cycles. Thyroid hormones play an important role in regulating metabolism and reproductive hormones.

Pelvic Inflammatory Disease (PID)

PID is usually caused by sexually transmitted infections. It can damage the fallopian tubes, leading to scarring or blockages that prevent eggs from meeting sperm.

What Tests Will Determine Why I'm Not Getting Pregnant?

Comprehensive fertility testing can help identify the reasons you are not getting pregnant.

The following tests are commonly recommended for women:

• Hormone blood tests: These measure levels of hormones such as follicle-stimulating hormone (FSH), luteinising hormone (LH), oestradiol, progesterone and anti-Müllerian hormone (AMH).
• Transvaginal ultrasound: This scan evaluates the uterus, endometrial lining and ovaries.
• Hysterosalpingogram (HSG): An X-ray procedure that uses contrast dye to check whether the fallopian tubes are open and to assess the shape of the uterine cavity.
• Laparoscopy: A minor surgical procedure used to directly visualise the pelvic organs, diagnose endometriosis or detect adhesions.

Common fertility tests for men include:

• Semen analysis: Evaluates sperm count, concentration, motility, morphology and semen volume.
• Hormone testing: Measures testosterone, FSH and LH levels, especially if semen analysis results are abnormal.
• Genetic testing: May be recommended in cases of severe sperm abnormalities.

Conclusion

Asking yourself “why am I not getting pregnant” can feel overwhelming, but it is also the first step toward clarity and action. Fertility challenges are common, and in most cases, there is an identifiable reason that can be addressed with the right guidance.