It can feel like a cruel game each month waiting for that positive pregnancy test only to be met with disappointment and frustration. While infertility is defined as the inability to conceive after having regular, unprotected intercourse for 1 year, it is considered “normal” for an average fertile couple under 35 years of age to try for 1 year before conception occurs. But for those individuals who are older than 35 that timeframe for conception becomes smaller. So what happens, if I have not conceived during this timeframe based on my age? What is the reason I am not getting pregnant?
US News & Health Report turned to fertility expert, board certified reproductive endocrinologist, Dr. Eric Levens of SGF’s Fairfax, VA office to discuss the reasons for possible infertility in couples.
1). Maternal Age
Age is one of the initial indicators used to determine a woman’s chances of getting pregnant. From ages 30 to 35, there is a gradual decline in a woman’s ability to become pregnant; after age 40, there is a sharp decline in conception. One reason fertility declines as maternal age increases is because women are less likely to ovulate regularly as they age. But, the most important reason relates to the condition and decreasing number of the woman’s eggs. As the eggs age, they become more resistant to fertilization, resulting in lower pregnancy rates. More of the eggs also tend to have chromosomal abnormalities, making miscarriage more likely.
Most people know that smoking can have an effect on their health. However, many don’t realize this includes their reproductive health. Compared to non-smokers, smokers can experience up to a 54 percent higher chance that conception will take 1 year or longer. This delay in conception correlates with the daily quantity of cigarettes smoked. Smoking can also increase the rate of follicular depletion and reduce the levels of estrogen in the body.
3). Extra Body Weight
A woman’s BMI is strongly connected to her fertility potential. While not every woman who is overweight or obese will have difficulty conceiving, there are many that do. Weight becomes an issue at the very outset for some women due to irregular menstrual cycles and ovulatory dysfunction. In overweight women, an increase in insulin levels may cause the ovaries to reproduce male hormones and stop releasing eggs making conception very difficult.
4). Under Weight
While being overweight has its implications on fertility, an appropriate amount of fat is actually a necessary tissue for the reproductive system. Too little fat can cause absence of periods and ovulation. “Our bodies preserve ourselves at the expense of fertility,” says Dr. Levens. “Long distance runners, ballerinas, and women with eating disorders are among those who may need to increase their body fat before trying to get pregnant,” Levens adds. If you aren’t having regular menstrual cycles, this is an early indicator to seek help quickly.
5). Medical Conditions
With nearly one-third of all infertility diagnoses in women, polycystic ovary syndrome, or PCOS, is the most common ovulatory disorder in women of reproductive age. Polycystic ovary syndrome (PCOS) is caused by hormonal imbalances that curtail or prevent ovulation—the body’s process of producing and releasing eggs from the ovary. Endometriosis is also a common cause of infertility in which endometrial tissue (tissue that lines the inside of the uterus) grows outside the uterus. This type of infertility can often go undiagnosed as many people don’t have noticeable symptoms.
6). It’s Not You
While infertility is generally perceived as a female issue, the reality is 40 to 50 percent of infertility is the male. “There’s a fairly equal distribution between male and female factors,” Levens says. For example, erectile dysfunction, ejaculatory issues, spinal cord injuries, tumors, and undescended testes are all fairly common (and often treatable) culprits of male infertility. Because basic testing for these problems is relatively simple and inexpensive, a semen analysis is performed as part of a couple’s routine testing to determine the underlying cause of the infertility.
There are three simple tests for fertility: semen analysis, bloodwork and ultrasound, and a hysterosalpingogram (HSG) that checks if your Fallopian tubes are open and functioning properly. If all of the testing comes back normal, you may have a diagnosis of unexplained infertility. This can be a very frustrating diagnosis as there is not a real “reason” for the infertility. “Still, it’s important for clinicians to know what the problem is not before counseling patients on options like medications to stimulate egg growth or assisted reproductive technology like in vitro fertilization (IVF),” says Levens.
If you have been trying to conceive and are not getting pregnant, it might be time to see a fertility specialist. When it comes to fertility, time is of the essence. Don’t wait any longer to seek the help you need. There are now treatments available to help nearly everyone conceive.
If you’ve been wondering why you are not getting pregnant and would like to learn more, please call our New Patient Center at 1-877-971-7755 or click here to schedule an appointment.