The time between deciding to try for a baby and finding out that you’re pregnant can be fun and exciting. But it can also leave you anxious or even worried, especially if you feel like a positive test is taking longer than it should.
You’re not alone. Around 1 in 8 couples who are trying to conceive run into bumps along the baby-making path. Here’s a look at some of the most common roadblocks that can get in the way of getting pregnant, plus when it’s time to talk with your doctor.
Reasons why you might not be able to get pregnant
More often than not, issues related to infertility — defined as not being able to get pregnant after 12 months of trying for women under 35, or after six months of trying for women 35 and older — often stem from an underlying cause.[1] The good news is that pinpointing and managing or treating the issue can greatly up your odds of conceiving.
Not having sex at the right time
The "right time" means during ovulation — the 12- to 24-hour period when your ovaries release a mature egg that can be fertilized by sperm. While sex at any time always comes with the potential of getting pregnant, your chances are much, much higher during this small window.
Ovulation generally happens around halfway through your menstrual cycle. But figuring out when that is can sometimes take some detective work, especially if your cycles are irregular. Make sure you understand how to track them, plus ovulation signs to watch for.
Not waiting long enough
Those couples who seem to get pregnant the second they start trying (or maybe even by accident)? They’re the exception, not the norm. While your first negative pregnancy test can be disappointing, most women rack up a few before finally seeing a plus sign.
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At best, the average couple has around a 25 percent chance of getting pregnant during any given cycle. So even though it can be hard, be patient. It’s within the realm of normal to take up to a year to get pregnant if you’re under 35. Still, if you’re concerned about the time it’s taking you to conceive, it’s a good idea to see a specialist.
Male infertility
Baby-making problems can be traced back to the man as often as the woman. Male infertility can have a range of culprits — from anatomical problems, to uncontrolled chronic diseases like diabetes, to infections. Even lifestyle factors like obesity, smoking and alcohol use can come into play.[2]
Pinpointing the root cause usually starts with a semen analysis or a sperm count. So, if you suspect that your fertility problems might be stemming from your male partner, encourage him to see his doctor for a workup. He can try making lifestyle changes to give his swimmers a boost, too.
Endometriosis
An often painful condition where tissue similar to the inside lining of the uterus grows outside the womb, endometriosis affects approximately 15 percent of women of reproductive age. And it can make it harder to get pregnant, since endometrial growths can block parts of the pelvic area (such as the fallopian tubes and ovaries). The condition can make it harder for a fertilized egg to implant, or even trigger immune changes that block an embryo.
Endometriosis doesn’t always cause fertility issues. But if you have it, you should talk with your doctor about your plans for trying to get pregnant. If you run into issues conceiving, surgery or other treatments to remove the endometrial growths can improve your chances.
Uterine fibroids
These growths are common and ultimately harmless, but they can be painful and potentially make it harder to get pregnant. While most fibroids don’t affect fertility, depending on their size and location, it’s possible that they could make it harder for an egg to get fertilized or for a fertilized egg to implant in your uterus.
The good news? Fibroid-related fertility issues can often be solved by treating or removing the growths.
Untreated pelvic inflammatory disease (PID)
A bacterial infection affecting the reproductive organs, PID most often stems from untreated sexually transmitted diseases like chlamydia or gonorrhea.[3] PID is treatable with antibiotics, but if it’s not addressed, inflammation from the infection can cause scarring in the reproductive tract. That scarring can make it harder to get pregnant — and once it occurs, it can’t be reversed.
Polycystic ovary syndrome (PCOS)
PCOS, a condition where you don’t ovulate or ovulate irregularly, is the top cause of infertility in women. The good news is that it’s treatable: Ovulation issues from PCOS are caused by hormonal imbalances, but medications like anti-androgen medications can help.
Irregular periods
At best, periods that are all over the place can make it harder to track when you’re ovulating. At worst, they could mean you aren’t ovulating at all, precluding pregnancy. Abnormal periods can have a number of culprits, including weight loss or gain, hormonal imbalances or thyroid disorders. To get them back on track, start by seeing your doctor to figure out the possible underlying cause.
Diminished ovarian reserve or premature ovarian insufficiency
Diminished ovarian reserve means that the number of eggs or their quality has started to dwindle. It’s something that happens to every woman as she gets older, and is a completely normal part of aging. If the issue occurs sooner than it should, typically before age 40, it’s called premature ovarian insufficiency or premature ovarian failure.
Thyroid disorder
Thyroid problems like hypothyroidism can affect your body’s production of reproductive hormones, and potentially lead to irregular periods and problems with ovulation. But if it’s the root cause of your infertility, treating the thyroid issue (usually, with thyroid hormones) can get your periods back to normal and up your chances of getting pregnant.
Unexplained infertility
In around a third of cases, the reason why a couple is unable to conceive remains unknown. Unexplained infertility is typically only diagnosed after other possible underlying causes — like abnormal ovulation or sperm issues — have been looked into and ruled out.
The news can be hard to process, but it doesn’t mean you can’t have a baby. If you’re under 30, your doctor might recommend taking some more time to try conceive by having sex. But you can also talk about fertility treatments like in vitro fertilization (IVF).
When to seek help if you’re having trouble getting pregnant
There's no downside to reaching out to your doctor any time you or your partner have a concern about conceiving. But in general, experts recommend talking to your doctor if you’ve been actively trying for a full year and are under 35, or if you’ve been actively trying for six months and are over 35. If you’re over 40, it’s worth talking with your doctor right away.
You should also talk with your doctor if you have a health issue that’s known to increase the chances for infertility. These include irregular periods or no periods, periods that are very painful, endometriosis, pelvic inflammatory disease or more than one miscarriage. Your partner should talk with his doctor if he has a history of testicular trauma, hernia surgery, chemotherapy or infertility issues with a previous partner.
Sometimes there’s no good answer for why a couple can’t get pregnant. But very often there is — and treating the issue can make you more likely to conceive. And if addressing the underlying cause doesn’t help or the root reason simply isn’t known, that’s no reason to give up hope. The road to a baby just might be a little longer than you first expected.
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