You've made up your mind: you're all in for having a baby (or having another one.) So why isn't your body cooperating?
About 11 percent of women of childbearing age have trouble getting pregnant. It can happen to anyone, regardless of the great shape you're in—or how many ovulation trackers you've downloaded on your phone. Studies show that after one year of unprotected sex, as many as 15 percent of couples still aren't pregnant.
"The reasons for not conceiving will depend on where you are in your reproductive life," explains David Diaz, M.D., a reproductive endocrinologist and fertility expert at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. "Younger women tend to have ovulation problems, blocked tubes, and sperm problems in their partners, while older women have more issues with their egg quality."
Get to know the most common reasons for not conceiving yet—and the steps to take next.
Ovulation
A tumor or cyst could keep you from getting pregnant. So could an underactive thyroid, since this gland produces a hormone that tells your body to release an egg during ovulation. If you have an eating disorder or are committed to a super-intense workout, you might stop ovulating altogether.
Tubal Issues
Endometriosis is a condition in which uterine tissue starts growing outside your uterus. It affects 5.5 million women in the U.S. and is one of the top 3 causes of infertility. Pelvic Inflammatory Disease (PID) may also be to blame. The scarring it causes can block your fallopian tubes so your egg and sperm never meet.
Cervical Problems
"Cervical cancer, cervical stenosis [a very narrow cervical opening], and even trauma from an abnormal Pap smear can all cause fertility issues," says Lisa Valle, M.D., an ob-gyn at Providence Saint John's Health Center in Santa Monica, California.
Stress
Experts say that worry and tension play a role in several otherwise unexplainable infertility cases. You don't necessarily need to have a high-stress career. "When people are always thinking about why they're not getting pregnant, they can get anxious and begin to feel inadequate," says Dr. Diaz.
Aging
"As we age, fertility rates decrease," says Dr. Valle. (No judgment! It's a fact of life.) Once you reach your mid-thirties, you're half as fertile as you were in your early twenties.
A Guy Thing
One-third of conception problems stem from your man, not you. "Usually, a low sperm count is to blame," Dr. Diaz says. Your partner's sperm could also have an abnormal shape or not enough forward motion to reach an egg.
While some of these issues are chromosomal, meaning they're present at birth, men who are regularly exposed to environmental toxins, high temperatures, or radiation are at higher risk of fertility issues, says Dr. Diaz.
First Steps When Having Trouble Conceiving
"If you're under 35 and have been having unprotected sex two to three times a week for 12 months, it's time to call your doctor," says Dr. Valle. If you're 35 or older, don't wait that long. Seek counseling after 6 months from an ob-gyn or fertility specialist.
Set up an appointment. Expect lots of questions—your doctor will want to go over your medical history and menstrual history to get a picture of your overall health.
Schedule testing. Blood tests can measure your hormone levels and check your egg count. Your doctor can also do imaging tests to check your uterus, ovaries, and tubes—and will want a semen analysis from your partner.
Seek treatment. There's no "one size fits all" fertility fix. Depending on your reasons for not conceiving, fertility drugs may be all you need to get back on the baby track. (And in some cases, hormones may do the trick, for you or your man.) Surgery's also an option for, say, removing a blockage or repairing your tubes.
Discuss your options. If fertility drugs don't help, there are still plenty of other ways you can get pregnant. With artificial insemination, you'll receive an insertion of specially prepared sperm. Assisted reproductive technology (ART), like in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT), removes some of your eggs to assist with fertilization either in a laboratory or within your fallopian tubes. You could also consider sperm donation, egg donation, or surrogacy —having another woman carry your baby.
Take a deep breath. And try not to panic. "We can diagnose and help as many as 75 percent of all [infertility] cases we see," Dr. Diaz reassures. "Still, try to find out what's wrong sooner than later."