Why Am I Not Getting Pregnant
Delay in pregnancy
Having difficulty in conceiving is not uncommon. Approximately 1 in every 7 couple worldwide would have experience some form of subfertility. The term subfertility is used, as the inability to conceive may not be absolute. When a couple is unable to conceive, the female has often been singled out as the cause for this failing. Even with the advancement in medicine, we are unable to identify the cause in up to 30% of subfertilities. However, in cases where the cause can be identified, only approximately one third of subfertility is due to female factor, the other one third due to male factor and the final one third involves both parties.
Causes of subfertility in women:
- Damage to fallopian tubes
During ovulation, your ovaries release a mature egg that will travel along the Fallopian tubes to reach the uterus where it may be fertilized by a sperm. Some women may have inborn deformities or deformities caused by scarring from a previous infection, surgery or tubal pregnancy (fertilized egg attaches at the tubes instead of the uterus lining ). Since the tubes are damaged, fertilized eggs are unable to reach the uterus to be fertilized causing infertility. All women have 2 fallopian tubes, even if one tube is damage and the other is normal, the chance of conception is lower than that of a someone with 2 normal tubes as the ovary releasing the mature egg varies between cycles.
- Ovulatory problems
In order for conception to take place, a matured egg must be released from the ovary each cycle, this phenomena is called ovulation. Ovulation is controlled by hormones that are released from multiple sites in our bodies at specific times. Malfunction in any one of these systems can affect ovulation. If you do not have menstrual periods for several months or years, or if your menstrual periods are very irregular ( having period only few times a year), you might be having an underlying condition causing ovulatory problems.
- Conditions affecting the uterus
Once a matured egg is fertilized, it will need to latch itself unto the lining of the uterus. A woman may have a septate uterus (band of tissue or muscles divide the uterus into two sections), bicornate uterus ( having two smaller cavity instead of one large cavity) or unicornate uterus (half of a uterus) which can complicate conception. These conditions usually do not give off any symptoms and are detected incidentally. Some uterus lining may have scar tissues due to previous cesarean section or abortion making it unfavourable for attachment by a fertilized egg. The other common uterine abnormality is fibroid formation. Fibroids are benign growths of muscle tissue in the uterus. If the fibroid is large enough, it may affect fertility. Some of the telltale signs of a having a fibroid include heavy periods, discomfort over your lower abdomen or pain during sexual intercourse. Most of these conditions can be detected from an ultrasound scan and corrected with simple surgical procedures.
- Medical conditions and medications
Certain conditions like diabetes mellitus, epilepsy or thyroid disease affects the hormone regulating system in your body which in turn affects ovulation and fertility.
- Extremes of body weight
Fat cells produces estrogen hormones in significant amount as to affect a woman’ ovulation. In those who are severely underweight or do physical exercises excessively tend to be anovulatory, which means that they do not ovulate and also do not or seldom have menses. Those who are overweight tend to have irregular periods due to hormonal imbalance. They also tend to have PCOS (polycystic ovarian syndrome) causing infertility.
- Lifestyle factors
Emotional and physical stress can impact the hormones in your body. Infertility can also be due to exposure to chemicals or radiation on a regular basis
- Age and early menopause
After the age of about 35, fertility declines due to normal age related changes of the ovaries. As a woman age, the quality and quantity of matured eggs released from her ovaries will decline. Although the average age for menopause is 50, some women achieve menopause at an earlier age. Fertility does not cease at the point of menopause, women become less fertile years before they achieve menopause as the quality and quantity of matured eggs released declines. Therefore, early menopause can be the cause of infertility.
Causes of subfertility in males:
- Sperm production factor
The majority of male infertility is due to defective or ineffective sperm production in the testis. Either he has low number of sperms and or the sperms made are not working properly. This may be due to an underlying chromosomal or gene mutation (such as Klinefelter’s syndrome or chromosome Y deletion), history of testis not descending at birth (common in baby boys born premature), hisotyr of testicle infection, regular exposure to radiation/chemical/heat, previous event of torsion (testis twisting in the scrotum) or low level of testosterone.
- Sperm transportation factor
After sperms are produced in the testis they travel through the epididymis and the urethra during ejaculation. Any previous infection, surgery, radio/chemotherapy near or over these tracks may cause scarring and therefore affect transportation of sperms.
- Problems during sexual intercourse
Problems during sexual intercourse includes inability to ejaculating, retrograde ejaculation, premature ejaculation, erectile dysfunction or spinal cord injury. This could be caused by a defect along the transportation track, or a nerve injury or certain medications. A thorough assessment by your fertility specialist will help to identify the underlying issue.
- Medical conditions and certain drugs
Some medical conditions and drugs can affect the testosterone level in your body affecting your testis’ ability to produce sperm. Some drugs can also cause erectile dysfunction and therefore please inform your doctor of any medications you are taking, including recreational and performance enhancing drugs
- Lifestyle factors
Smoking and stress are known causes affecting fertility. The good news it that these are easily reversible causes. It is estimated that the negative effect smoking has on fertility is reversed a year after smoking cessation. And sometimes, a good break from work or a holiday could be the solution some couples need.
If you and your spouse are having trouble conceiving, it is advisable to visit a gynecologist or fertility specialist together to rule out these causes. Not all couples will require medical intervention to be able to conceive. Many times simple lifestyle modification might be the only change you will need to be able to conceive. It is important to know that about 80% of couples will conceive in a year if they are under the age of 40 years and are having regular sexual intercourse. 50% of the remaining couples conceive within the 2nd year of trying. Therefore, do not hesitate to visit a fertility clinic if you and your spouse are having difficulty conceiving as many cases can be treated effectively.