Why Can t I Get Pregnant? 11 Possible Reasons

One study found that with every additional drink consumed per week, the IVF success rate decreased.

12 Potential Signs of a Fertility Problem

Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association.

Leyla Bilali, RN is a registered nurse, fertility nurse, and fertility consultant in the New York City area. She works in house at a reputable private clinic in New York City while also seeing her own clients through her concierge fertility consulting and nursing services business.

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Table of Contents

Infertility refers to how long you have been trying to conceive unsuccessfully. While there are possible early warning signs of infertility as well as risk factors (things that make it more likely you’ll have difficulty getting pregnant), some couples don’t have any signs or symptoms of infertility. If you do, it’s important to consult a fertility specialist.

The per capita price of healthcare per year is higher in the United States than in any other nation in the world, according to National Public Radio (NPR). America spends nearly 2.5 times as much per person as the United Kingdom does, despite having comparable wealth and a lower life expectancy.

If you have been trying to get pregnant for one year without success (or for six months, if you’re age 35 or older), then your doctor will likely diagnose you with infertility.

Because of this rule of thumb, many couples wonder if they have to try to get pregnant for a whole year before they would be able to tell if there is a problem. However, there’s no need to wait if you suspect you’re having trouble getting pregnant. Here are some questions you and your partner can consider if you think you might be dealing with infertility. If you answer yes to any of these questions, talk to your doctor.

Signs of a Fertility Problem

If you are actively trying to have a baby, there are some signs to look for that may mean it’s less likely you will get pregnant without help. While some signs of fertility problems are invisible, there are some key risk factors that may make conception more challenging, including the following:

• Irregular menstrual cycles
• Light or heavy bleeding and cramps
• Advanced maternal age (35 or older)
• Male infertility
• Being overweight or underweight
• Recurrent miscarriage
• Chronic illness
• History of cancer
• History of sexually transmitted infections
• Drug, smoking, or alcohol use
• Exposure to toxic chemicals
• Exposure to high temperatures

Irregular Menstrual Cycles

When menstruation begins, having irregular periods can be normal. It takes the body a while to get regulated. However, once you are through your teenage years, your menstrual cycles should be regular. Having an irregular cycle can be a red flag for infertility because it can be a sign of an ovulation problem.

Talk to your doctor if your cycles are unusually short or long (less than 24 days or more than 35 days), they come unpredictably, or you don’t get your period at all.

Irregular periods can have several causes. One of the most common causes of irregular cycles and ovulation-related infertility is polycystic ovarian syndrome (PCOS). Other possible causes for irregular periods include:

• Being overweight or underweight
• Excessive exercise  
• Hyperprolactinemia
• Low ovarian reserves
• Primary ovarian insufficiency
• Thyroid dysfunction

Light or Heavy Bleeding and Cramps

Bleeding between three to seven days can be considered normal. However, you should tell your doctor if your bleeding is very light or extremely heavy and intense. There are also other period-related signs that could indicate a fertility problem, including:

• Severe menstrual cramps
• Significant changes in bleeding heaviness
• Significant changes in the length of bleeding days
• Unusual spotting between cycles

Menstrual cramps that are so intense that they interfere with your daily life can be a symptom of endometriosis or pelvic inflammatory disease (PID). Both conditions can cause infertility.

Endometriosis and PID can get worse over time, so it’s important you do not delay in seeking treatment if you have symptoms of either condition.

Age (Older Than 35)

Both female and male fertility declines with age. The risk of infertility increases at age 35 for women and continues to grow with time. A 30-year-old woman has a 20% chance of conceiving in any given month, while a 40-year-old woman has only a 5% chance. Women over 35 are also more likely to experience a miscarriage and to have a child with a congenital disease.

Male fertility is also affected by age—though not as drastically as it is for women. Research has found that as age increases, male fertility and sperm health decrease (including an increase in DNA-damaged sperm).

Male age has been linked to an increased risk of miscarriage, the passing on of genetic problems, and some congenital conditions. Older male age has also been associated with increased rates of autism and schizophrenia.

Surveys and research studies have found that many people are unaware of how much female fertility declines with age. People frequently overestimate their chances of conceiving at age 40 or 44. They may also assume IVF treatment alone can solve the fertility issues (it may not).

One fascinating study looked at what age a couple should start trying to have a family based on how many kids they eventually want to have and whether they are open to IVF treatment:

• Begin by age 32 for one child (90% chance)
• Begin by age 27 for two children
• Begin by age 23 for three children

• Begin by age 35 for one child (90% chance)
• Begin by age 31 for two children
• Begin by age 28 for three children

IVF treatment is also impacted by the male partner’s age. One study found that each additional year of paternal age had an 11% increased odds of not achieving pregnancy and a 12% increase in the odds of not having a live birth.  

While younger couples statistically have greater chances of getting pregnant than older counterparts, young men and women can also experience infertility.

Male Infertility

Male factor infertility isn’t always obvious, as there are rarely symptoms (though sexual dysfunction can be an infertility red flag). Usually, low sperm counts or inhibited sperm mobility is determined by a sperm analysis. In other words, you’ll need to go through fertility testing to discover the problem.

Weight

Your weight plays a major role in your fertility. Being overweight or underweight can lead to trouble conceiving. In fact, obesity is believed to be one of the most common causes of preventable subfertility.  

Research has found that losing 5% to 10% of your body weight can jump-start ovulation for women with obesity.

Being overweight or underweight can also have an adverse effect on male fertility. A meta-analysis suggested that men with a BMI below 20 might be at risk for lower sperm concentration and sperm counts. Obese men have been found to have lower levels of testosterone and lower sperm counts.  

Body Mass Index (BMI) is a dated, biased measure that doesn’t account for several factors, such as body composition, ethnicity, race, gender, and age.

Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.

If you are having difficulty losing extra weight, talk to your doctor. Some hormonal causes of infertility can lead to weight problems. For example, PCOS increases a woman’s risk of obesity and is also a cause of infertility.

Recurrent Miscarriage

Infertility is usually associated with the inability to get pregnant. However, a woman who experiences recurrent miscarriages may also need help getting pregnant.

Miscarriage is not uncommon, occurring in nearly 20% of pregnancies.   That said, repeated or recurrent miscarriage is not common. Only 1% of women will miscarry three pregnancies in a row.   If you’ve had two successive miscarriages, talk to your doctor.

Chronic Illnesses

Chronic diseases, as well as their treatments, can also lead to fertility problems. Diabetes, untreated celiac disease, periodontal disease, and hypothyroidism can increase your risk for infertility.  

Sometimes, treatments for chronic illnesses can negatively impact fertility. Insulin, antidepressants, and thyroid hormones may lead to irregular menstrual cycles.

Tagamet (cimetidine), a medication used to treat peptic ulcers, as well as some hypertension medications can cause male factor infertility.   These medications can also cause problems with sperm production or the sperm’s ability to fertilize an egg.

History of Cancer

Some cancer treatments can lead to fertility problems. If you or your partner has gone through cancer treatments (especially radiation therapy that was near the reproductive organs), talk to your doctor about the potential effect these treatments could have on your fertility.

History of STIs

Sexually transmitted infections (STIs) can also cause infertility. Infection and inflammation from chlamydia or gonorrhea can cause blockage of the fallopian tubes.   Not only can this make unassisted pregnancy impossible, it also places a woman at an increased risk for an ectopic pregnancy.

If untreated, chlamydia and gonorrhea can lead to a condition called pelvic inflammatory disease (PID). According to the Centers for Disease Control and Prevention (CDC), about 1 in 8 women with PID experience infertility.

Untreated sexually transmitted infections can also cause fertility issues in men. Scar tissue in the male reproductive tract can make semen transfer ineffective or even impossible.

Chlamydia and gonorrhea do not usually cause noticeable symptoms in women, which is why screening for STIs is important. Many sexually transmitted infections are symptomless in women, yet silently affect the reproductive organs.

If you have any symptoms of an STI, see your doctor right away. If you’re at risk of contracting an STI, make sure you get regular checks—even if you are asymptomatic.

Smoking and Alcohol Use

While most people are aware of the risks of using tobacco and alcohol while pregnant, smoking and drinking while trying to get pregnant can also cause problems.

Smoking negatively affects sperm counts, sperm shape, and sperm movement—all of which are important factors for conception. IVF treatment success has also been found to be poorer in couples with male smokers, even when IVF with ICSI (taking a single sperm and directly injecting it into an egg) is used.

Smoking has also been connected to erectile dysfunction. Quitting cigarettes might be able to reverse the effect.

In women, smoking can speed up the process of ovarian aging, bringing on earlier menopause. If you quit early enough, you might be able to reverse some of the damage.

Heavy alcohol use can also lead to fertility problems for men and women. While most studies have found that a few drinks a week don’t typically cause harm to fertility, excessive drinking has been linked to lower sperm counts, poor sperm movements, and irregular sperm shape.  

One study found that with every additional drink consumed per week, the IVF success rate decreased.

Quitting smoking and reducing alcohol use may positively impact fertility and will have a positive impact on health, but research has shown that some of the damage to the body (including the reproductive system) caused by smoking might be reversible—particularly in men.  

Toxic Chemical Exposure

If your job involves close contact with toxic chemicals, you might be at greater risk for infertility and decreased sperm health. Farmers, painters, varnishers, metal workers, and welders have all been found to be at risk for reduced fertility. If your job involves toxic chemical contact or high heat conditions, ask your doctor about steps you can take to protect yourself.

High Temperatures

You might have heard the claim that high temperatures are bad for sperm in relation to the “boxers or briefs” argument. The thinking was that because boxers are less restrictive and have more airflow, it leads to cooler testicular temperatures and healthier sperm.

While the research isn’t clear on whether boxers or briefs matter, what is known is that wearing extremely tight shorts or underwear (especially when made from a non-breathable fabric) might have an impact on sperm health.

There are also other sources of heat that can be troubling for sperm health:  

• Heated car seats
• Hot tubs and long hot baths
• Sitting for prolonged periods of time with your legs together (like at a desk job or while driving long distances)
• Sitting with a laptop on your lap

In most cases, the heat damaging effects are reversible. Evidence suggests that wet heat (such as hot tub exposure) does not cause infertility. That said, removing heat exposure has been shown to improve sperm motility.

In one small study of infertile men who used a hot tub at least 30 minutes a week, the researchers asked them to stop for six months.   While sperm motility counts measurably improved, the men in the study remained infertile. About half of the men were also heavy smokers, suggesting that infertility may arise from multiple lifestyle factors that need to be addressed simultaneously.

A Word From Verywell

About 80% of couples will conceive within six months of beginning to try to get pregnant. About 90% will be pregnant after a year if they are having well-timed sexual intercourse.  

If you don’t get pregnant after one year of trying, talk to your doctor. If you’re 35 years old or older, you should see your doctor after six months of trying without success to get pregnant.

If you have a possible sign of infertility before the one-year mark, your doctor can run some basic fertility tests. If everything comes back normal, you can continue trying on your own. If there is a problem, you will have caught it much sooner and your odds of successful fertility treatment will be higher.

18 Sources

Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012;85(1):35-43.
2. American Society for Reproductive Medicine. Age and Fertility: A Guide for Patients Revised.
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8. Lainez NM, Coss D. Obesity, neuroinflammation, and reproductive function. Endocrinology. 2019;160(11):2719-2736. doi:10.1210/en.2019-00487
9. Guo D, Xu M, Zhou Q, Wu C, Ju R, Dai J. Is low body mass index a risk factor for semen quality? A PRISMA-compliant meta-analysis. Medicine. 2019;98(32):e16677. doi:10.1097/md.0000000000016677
10. Gaskins AJ, Rich-Edwards JW, Hauser R, et al. Maternal prepregnancy folate intake and risk of spontaneous abortion and stillbirth. Obstet Gynecol. 2014;124(1):23-31. doi:10.1097/AOG.0000000000000343
11. Duckitt K, Quereshi A. Recurrent miscarriage. BMJ Clin Evid. 2015;2015:1409.
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14. Centers for Disease Control and Prevention (CDC). PID Statistics.
15. Kovac JR, Khanna A, Lipshultz LI. The effects of cigarette smoking on male fertility. Postgrad Med. 2015;127(3):338-341. doi:10.1080/00325481.2015.1015928
16. Sheynkin Y, Welliver R, Winer A, Hajimirzaee F, Ahn H, Lee K. Protection from scrotal hyperthermia in laptop computer users. Fertil Steril. 2011;95(2):647-651. doi:10.1016/j.fertnstert.2010.10.013
17. Shefi S, Tarapore PE, Walsh TJ, Croughan M, Turek PJ. Wet heat exposure: A potentially reversible cause of low semen quality in infertile men. Int Braz J Urol. 2007;33(1):50-56. doi:10.1590/s1677-55382007000100008
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Additional Reading

• Garolla A, Torino M, Sartini B, et al. Seminal and molecular evidence that sauna exposure affects human spermatogenesis. Hum Reprod. 2013;28(4):877-85. doi:10.1093/humrep/det020.
• Mac Dougall K, Beyene Y, Nachtigall RD. Age shock: Misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40. Hum Reprod. 2013;28(2):350-356. doi:10.1093/humrep/des409

By Rachel Gurevich, RN
Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. She is a professional member of the Association of Health Care Journalists and has been writing about women’s health since 2001. Rachel uses her own experiences with infertility to write compassionate, practical, and supportive articles.

Why Can’t I Get Pregnant? 11 Possible Reasons

Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association.

Brian Levine, MD, MS, FACOG, is board-certified in obstetrics-gynecology, as well as reproductive endocrinology and infertility (REI). He is the director and founding partner of CCRM New York and was named a rising star by Super Doctors from 2017 to 2019.

Table of Contents
Table of Contents

If you’ve been trying unsuccessfully to get pregnant, you may be wondering, “Why am I not getting pregnant?” You could be worrying that you never will. However, there are many possible reasons why you aren’t conceiving, including ovulation irregularities, structural problems in the reproductive system, low sperm count, underlying medical problems, or simply not trying enough.

While infertility can have symptoms like irregular periods or severe menstrual cramps, most causes of infertility are silent. Male infertility, for example, rarely has symptoms. Here are 11 possible reasons you haven’t conceived yet.

11 Reasons You May Not Be Getting Pregnant

You might not have been trying long enough.

You might not be ovulating.

Your male partner may be experiencing infertility.

You may be experiencing age-related infertility.

You may have blocked fallopian tubes.

You may have endometriosis.

You may have underlying medical problems.

You may be on medications that impact fertility.

You may have lifestyle factors that impact fertility.

You could have unexplained fertility.

You may need to seek fertility treatments.

Read on for more on each of these factors.

Not Trying Long Enough

The first thing to consider is how long have you been trying. It may feel like you’ve been trying forever—and maybe you have—but it’s important to know that many couples don’t conceive right away.

About 80% of cisgender, heterosexual couples conceive after six months of trying. Approximately 90% will be pregnant after 12 months of trying to get pregnant. These rates assume you have well-timed intercourse every month.

When to Call a Doctor

See a healthcare provider about your fertility if

• You’re 35 years or older and have been trying for at least six months
• You’re younger than 35 and have been trying for at least one year

If either of these situations matches your experience, seek medical advice, even if you have no symptoms of a fertility problem.

Not Ovulating

Human conception requires an egg and sperm. If you’re not ovulating, you won’t be able to get pregnant. Anovulation is a common cause of female infertility and it can be triggered by many conditions.

Polycystic ovary syndrome (PCOS) is one possible cause of anovulation. Other possible causes include being overweight or underweight, primary ovarian insufficiency, thyroid dysfunction, hyperprolactinemia, and excessive exercise.

Most people who are experiencing ovulation problems have irregular periods. However, regular menstrual cycles don’t guarantee that ovulation is occurring normally. If you have irregular cycles, talk to your doctor, even if you haven’t been trying for a year yet.

Male Infertility

Unless you are using medical interventions like sperm or egg donation. it takes both partners to conceive. Fertility issues do not just happen to the person intending to carry the baby. In 20% to 30% of infertile male-female couples, the male partner has a fertility problem. Another 40% of couples have infertility factors in both partners.

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. Make sure both partners’ doctors know you’re trying to get pregnant, and that you are both tested for fertility issues.

Age-Related Infertility

For women after age 35, it can take longer to get pregnant. Many people assume if they still get regular periods, their fertility is fine, but this isn’t necessarily true. Age impacts egg quality as well as quantity. Men after age 40 may also face problems conceiving.

Blocked Fallopian Tubes

Ovulation problems account for about 25% of female infertility cases. In other cases, women may experience blocked fallopian tubes, uterine abnormalities, or endometriosis .

The fallopian tubes are the pathway between the ovaries and the uterus. When an egg is released from the ovaries, hair-like projections from the fallopian tube draw the egg inside.

Sperm must swim up from the cervix, through the uterus, and into the fallopian tubes. 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 people with blocked tubes experience pelvic pain, many others have no symptoms. Only fertility testing can determine if your tubes are open. A hysterosalpingogram (HSG) is a specialized X-ray used to determine if the fallopian tubes are open. An OB/GYN can order this test (you don’t need a fertility specialist).

Endometriosis

Endometriosis is when endometrium-like tissue (which is the tissue that lines the uterus) grows outside of the uterus. It’s estimated that up to 50% of people with endometriosis will have difficulty getting pregnant.

The most common symptoms of endometriosis include painful periods and pelvic pain at times besides menstruation. However, not everyone with endometriosis has these symptoms. Some people only discover they have endometriosis as part of an infertility work-up.

About 10% to 15% of women have endometriosis, but it is commonly misdiagnosed or simply missed. Endometriosis can’t be diagnosed with a blood test or ultrasound. It requires diagnostic laparoscopic surgery . Because of this, proper diagnosis can take 4 to 11 years from when symptoms being.

Underlying Medical Problems

Underlying medical conditions can lead to male and female infertility. For example, a thyroid imbalance or undiagnosed diabetes can cause infertility. Some autoimmune diseases, like lupus, can cause infertility, as well. While it’s not well understood, mental health conditions like anxiety and depression are also associated with infertility.

Also, an undiagnosed sexually transmitted infection (STI) can cause infertility. Note that you may not have any symptoms of an STI but still have one.

Certain Medications

Some prescription medications that may impact fertility. For example, research has shown that taking some antidepressants makes it harder to get pregnant. In one 2016 study, researchers concluded: “Our data suggest that antidepressants may reduce the probability of a woman with a history of depression to conceive naturally.”

However, never stop taking a medication without talking to your doctor first. If you have concerns that a drug you’ve been prescribed may be interfering with getting pregnant, consult a healthcare provider. They may need to put you on another medication, have you try a different type of treatment, or reassure you that the medication isn’t an issue.

Lifestyle Factors

Marijuana, whether taken recreationally or for medicinal purposes, may also impair fertility. Likewise, studies show that smoking tobacco, excessive alcohol use, and illicit drug use, such as cocaine, ecstasy, ketamine, and amphetamines, can contribute to fertility issues.

Additionally, living with extreme or chronic stress, experiencing trauma, or having insomnia and other sleep issues may reduce fertility.

Being significantly overweight or underweight is also known to disrupt fertility. Exercising excessively or not at all can also cause problems getting pregnant. Following a program to reach a healthier weight and physical activity level often increases rates of conception.

Unexplained Infertility

Between 10% and 30% of infertile couples never find out why they can’t get pregnant. This is called unexplained infertility, or more accurately, lack of good diagnosis. Many doctors make the point that there really 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 still receive treatment for infertility even if your diagnosis is unexplained.

Not Seeking Fertility Treatment

If you’re having difficulty getting pregnant, know that there is help available. The best way you can know if you have fertility issues is to consult an OB/GYN. Whether you are trying to get pregnant for the first time, you’re hoping to conceive after a miscarriage, or you’ve been pregnant before but are having difficulty conceiving now. your doctor can evaluate you for fertility problems and treatment.

Many couples put off testing and treatment, thinking they should just “try a little longer” first. This is a mistake. Many causes of infertility are silent and worsen with time. The sooner you get help, the more likely fertility treatments will work for you.

Another reason couples sometimes delay testing is they feel and seem to be in perfect health. But many people who have infertility issues do not have outward signs or symptoms of a fertility problem. You may have a textbook 28-day menstrual cycle, but that doesn’t mean you’re guaranteed fast and smooth results when trying to get pregnant, and it doesn’t mean you may not have a fertility problem.

A Word From Verywell

While the majority of people conceive naturally if they continue trying for 6 to 12 months, some people have more difficulty getting pregnant. There are a variety of causes for fertility issues—and the reasons for infertility aren’t always observable to the layperson. If you’ve been trying to conceive for one year (or six months if you’re 35 years or older), please get help. Don’t wait.

14 Sources

Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Rachel Gurevich, RN
Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. She is a professional member of the Association of Health Care Journalists and has been writing about women’s health since 2001. Rachel uses her own experiences with infertility to write compassionate, practical, and supportive articles.