Many couples have difficulty conceiving naturally and the most common fear when you don’t get pregnant is that there may be an issue of infertility with one or even both partners. However, whilst there may, of course, be medical reasons for not getting pregnant that could be affecting your ability to conceive, it is important not to worry about this prematurely. The amount of time it can take for couples to conceive can vary significantly. If you have only been trying for six months to a year and if there are no known contributory factors, then generally there should be no cause for concern. If you do discover that there are medical reasons for not getting pregnant, such as conditions including amenorrhea, PCOS, endometriosis or low AMH levels for women, low sperm motility or testicular varicocele for men, there are fertility treatments available to help you still conceive.
Medical reasons for not getting pregnant
There are many medical and health-related issues that can affect fertility and ability to conceive. If you have concerns then the first step would be to go to your general practitioner (GP) who can run the necessary tests and try to find a cause for your difficulties conceiving. Anyone who already has known medical conditions that might affect infertility should visit their GP as soon as they decide to start trying for a baby. Otherwise, we would recommend that couples under 35 visit their GP after a year of trying and couples over 35 after six months.
Once you have been to see your GP, some of the medical conditions that might be identified could include:
Amenorrhea is the absence of menstruation. Women will obviously experience this at some point in their life, either due to certain types of contraception, pregnancy or menopause. However, some women will experience this as a side effect of other medical complications. Some lifestyle factors such as stress, intense exercise (such as that undertaken by athletes) or low body weight can result in amenorrhea. It can also occur due to hormonal imbalances that can be a result of thyroid conditions, premature menopause or polycystic ovary syndrome (PCOS).
Lack of menstruation is indicative of the fact that ovulation is not occurring, without which it will be impossible to become pregnant naturally.
A common cause of amenorrhea and other fertility issues is polycystic ovary syndrome (PCOS). This is a condition that affects the way your ovaries work. Your ovaries may have lots of small cysts or follicles on them, which are underdeveloped ova (eggs) that don’t go on to pass through the fallopian tubes but remain on the surface of your ovaries. Other symptoms may include ovum being released irregularly or not at all and a hormone imbalance that results in a higher level of testosterone than normal. The causes of PCOS are several and complex reasons can cause this.
PCOS can affect different women to varying degrees but, in general, fertility treatments are still very successful in helping women with this condition to conceive.
There is a known medical link between endometriosis and fertility. Endometriosis is when the lining of the womb (the endometrium) is found outside of the womb, for example in the fallopian tubes and ovaries. It is again not clear what causes endometriosis to occur and its extent, symptoms and complications can be varied. Some women will experience minor discomfort and others can experience debilitating symptoms. One of the possible effects of endometriosis can be difficulties getting pregnant.
The Anti-Müllerian Hormone (AMH) is a protein that is released by cells in a women’s growing follicles as they develop into ova. AMH levels can therefore be a good indicator of the ovarian reserve (how many eggs are left in the ovaries). AMH levels naturally decrease with age and can also be affected by other genetic conditions or environmental factors.
Whilst low AMH levels are not a sign of infertility, they do indicate a decreased egg reserve and therefore an increased likelihood that a couple might struggle to conceive. Getting your AMH levels tested can help you to be more aware of your chances of conceiving naturally and the timeframe within which you might like to think about assisted fertility treatments.
Common causes of male infertility
For men, problems with semen production represent the most common reason for infertility. A decrease in sperm quantity and quality can happen naturally over time, as the result of other health conditions or environmental factors, or can simply be genetic.
Low sperm motility is one factor that can affect many couples trying to get pregnant. Sperm motility describes the way that a sperm moves. This is important as sperm needs to be able to move efficiently and effectively through the female reproductive tract in order to reach and fertilise an egg. Low sperm count can also make it less likely that a sperm will successfully fertilise an egg; a higher sperm density will of course increase the chances of getting a partner pregnant.
At IVI, men undergo to a semen analysis at their first consultations to measure, not only its quantity and quality, but also sperm motility and morphology, in order to find the most adapted fertility treatment to help you conceive.
A common factor that can contribute to low semen quantity and quality is testicular varicocele. This is where the veins within the scrotum become enlarged due to improper blood flow. They are usually harmless and don’t present any symptoms but are always worth getting checked out, especially if you are trying to have a baby as this condition has been known to affect sperm production.
For a small percentage of men, azoospermia (which is the complete lack of sperm in the ejaculate) can be the cause of infertility. This could either be a problem with sperm production or a blockage in the genital tract and there are azoospermia treatments available. If it is the case that you are unable to produce any sperm, then you could look into sperm donation.
If you do find that any of the above – or any other – medical reasons for not being able to get pregnant are affecting you, there are lots of different options for assisted fertility treatment available to help.
One of the most straightforward assisted fertility treatments, IUI (Intrauterine insemination) is when sperm is prepared in the laboratory and then placed directly into the woman’s uterus to increase chances of fertilisation. This is a good first option for couples where reasons for difficulty conceiving are unknown or where the woman has ovulation problems.
A well-established technique, in vitro fertilisation (IVF) creates an embryo in the laboratory by fertilising the sperm with an egg before then transferring this to a woman’s uterus. This is a recommended treatment for patients who’ve undergone other unsuccessful treatments or where there is a problem with ovulation or with the fallopian tubes.
For men who are experiencing problems with sperm quantity and/or quality, there is a technique called ICSI that can be used in conjunction with IVF in order to improve chances of conception. ICSI (Intracytoplasmic Sperm Injection) is an assisted reproductive technique where embryologists individually select the best sperm, which are then used to fertilise the eggs directly to give the best possible chance of fertilisation.
For women who are unable to get pregnant using their own eggs, it is possible to use an egg donor. A healthy egg will be inseminated with sperm – either from a partner or donor – in the laboratory and then transferred into a woman’s uterus for possible pregnancy.
Find out more
The common fear when you don’t get pregnant right away is, of course, that there could be some infertility issues. It is important to stay patient and positive and to first give yourselves time to conceive naturally. However, as detailed above, there are a lot of options available to assist conception, should this be required.
To find out more information or to talk with someone about any of the above assisted fertility treatments, you can call or use the online contact form and an IVI specialist will get in touch to talk to you with no obligation.