Starting a family is a profoundly personal journey, and facing a negative pregnancy test can be emotionally challenging. Unexplained infertility can feel even more disheartening.
The World Health Organization defines infertility as the inability to conceive after 12 months (or 6 months if you’re over 35) of unprotected sex. One in 6 couples experience an “unwanted delay” in conception, making fertility issues relatively common, often with treatable causes.
What is the most common cause of infertility? According to the National Institute of Health, “failure to ovulate” is the most common cause of infertility. Ovulation can be disrupted by factors such as anxiety or hormonal imbalances.
1. Know your ovulation cycle and schedule sex accordingly.
Ovulation occurs when an ovary releases an egg, which then travels down the fallopian tube to be fertilized. In a 28-day cycle, ovulation typically occurs on day 14, but this may vary for those with longer or shorter cycles. An egg usually survives for 12-24 hours after ovulation.
To optimize your chances of conception, identify your fertility window, which is when you’re most likely to get pregnant. According to the American College of Obstetricians and Gynecologists, this window averages about 7 days.
Aim to have intercourse every day for the 5 days leading up to ovulation, the day of ovulation, and the day after ovulation.
Why am I not getting pregnant when my periods are normal? Even with regular periods, various factors could contribute to infertility. Although having regular periods is essential, it’s not the only aspect of fertility to consider.
2. How often are you having sex?
Some couples might not be having sex often enough. If you’re attempting to conceive, it’s recommended to have unprotected sex daily during your fertile window.
A common misconception is that a woman’s fertile window lasts only 3 days: the day before ovulation, the day of ovulation, and the day after ovulation. However, the actual fertile window is approximately a week long.
In a 28-day cycle, the fertile window spans from day 10 to day 17. For reference, “Day 1” starts on the 1st day of bleeding of your period.
3. Avoid getting personal products in your vagina.
Ensure your feminine care products are non-toxic, such as tampons, lubrication, and underwear. Women who douche may be as much as 30% less likely to conceive. Be mindful of what you use.
4. Lubricants can impact sperm motility.
Lubricants can reduce sperm’s ability to travel to the fallopian tubes for conception and may be toxic to sperm. Choose fertility-friendly lubricants such as coconut oil.
5. Certain lifestyle factors affect fertility.
Improving overall health can increase fertility. Assess your habits and make necessary changes. Here are 3 major areas to consider:
A 2022 review reported that an anti-inflammatory diet like the Mediterranean diet “…improves fertility, assisted reproductive technology (ART) success, and sperm quality in men” Therefore, they state that an anti-inflammatory diet may improve fertility partially or fully and reduce the need for interventions.
A 2017 review suggested women should abstain from alcohol when trying to conceive or during pregnancy, as no safe dose has been determined with substantial evidence. (Interestingly, drinking while pregnant may not be dangerous in some cases — but we don’t think it’s worth the risk.)
The FDA states that smoking can harm hormone production, affect the reproductive system, and damage sperm DNA.
As smoking cigarettes and vaping are associated with only adverse side effects, it’s a good idea to stop altogether (not just when addressing fertility problems).
6. Unmanaged stress or anxiety might play a part.
Stress can inhibit your ability to conceive, whether the source is work, a particular relationship, or even the pressure of trying to become pregnant. Not only can it lower your libido, but the stress hormone, cortisol, can get your ovulation schedule off track.
7. Chances of conceiving decrease with age.
It’s true that a woman’s fertility declines with age due to decreasing number and quality of eggs.
A female is born with 1 to 2 million eggs; by puberty, about 300,000 remain. Fewer eggs mean fewer chances to conceive.
Additionally, egg quality affects fertility, with chromosomally abnormal eggs being less likely to implant, potentially causing chromosomal disorders (such as Down Syndrome) or miscarriages.
8. You might be too physically active.
Regular exercise is beneficial, but overworking the body can negatively affect fertility. A 2018 review found that rigorous exercise could lead to irregular periods.
While trying to conceive, consider adopting gentler exercises like walking, yoga, or biking.
9. Body weight can be a factor.
Being underweight or overweight can affect your fertility. A 2022 study found that extreme BMI values “tended to predict infertility.”
A low BMI can cause estrogen levels to drop, while obesity can cause them to rise excessively. Aim for a BMI between 18-24.
And remember: Body Mass Index and other measures of a healthy weight aren’t perfect. Talk to your healthcare provider about what weight, body composition, and BMI are appropriate for your body.
10. If you just stopped hormonal birth control, give your body some time.
Hormonal birth control is 99% effective, according to the NIH. After stopping, give your body time to adjust from preventing pregnancy to promoting it. We tend to recommend that our patients stop birth control about 6 months before they want to start trying to conceive.
11. You may have a reproductive condition.
Reproductive conditions can sometimes go undetected if symptoms are mild. Getting tested for such abnormalities is important if you’re having trouble conceiving.
Polycystic Ovary Syndrome occurs when a woman’s ovaries produce too many androgens or male sex hormones, leading to cysts (small growths) on the ovaries and decreased fertility. One reason this happens is that PCOS creates significant abnormalities in otherwise normal menstrual cycles.
The CDC states “PCOS is one of the most common causes of female infertility, affecting 6% to 12% (as many as 5 million) of US women of reproductive age.”
Endometriosis is a disorder where tissue that typically lines the uterus grows outside of it, potentially hindering fertility. This tissue can grow on the ovaries, the bladder, and even the bowels.
This abnormal tissue growth can cause significant pelvic pain during intercourse, menstruation, and even bowel movements.
Fallopian Tube Blockage
Blocked fallopian tubes can prevent eggs from reaching the uterus. Blockages can be caused by:
- Scarring from ectopic pregnancies or surgeries
- Uterine fibroids
Irregular Uterine Shape
An irregular uterine shape due to scar tissue, uterine fibroids, or genetics can make it challenging for a fertilized egg to implant within the uterine wall.
History of STIs
A 2017 study showed that untreated sexually transmitted infections can cause inflammation and scarring in the reproductive system, affecting fertility.
12. Other medical conditions can lead to fertility issues.
- Diabetes or prediabetes
- Kidney disease
- Thyroid disease
Is it a bad idea to try to get pregnant if I have a chronic illness? If you have a chronic illness, consult with your healthcare provider to determine the best course of action based on your current health, medical history, and unique needs.
13. It might be your partner’s health or habits.
Women aren’t the only ones who can experience infertility. A 2015 review found that 40-50% of infertility cases are caused by male infertility, which can be due to low sperm count, poor sperm mobility, or low semen quality.
Chronic conditions like diabetes, heart disease, and high blood pressure can also contribute to erectile dysfunction and conception difficulties.
Treatment for infertility will differ depending on your personal medical history, lifestyle, how close you are to menopause, and many other factors. Here are a few options you can discuss with your doctor:
- Fertility treatments: Modern medicine offers various options, such as intrauterine insemination (IUI), in vitro fertilization (IVF), egg freezing, and fertility medications. However, these options can be costly — talk to your partner and healthcare provider to determine if these options are appropriate for you.
- Lifestyle changes: Optimize your health by eating well, incorporating moderate exercise, sleeping 7-8 hours a night, and reducing stress.
- Herbs: In combination with lifestyle changes, certain herbs like Vitex and Maca can also help with balancing hormones and inducing ovulation.
- Acupuncture: Acupuncture for both the male and female partner has been shown in some studies to improve the chance of conception.
- Visit your gynecologist/obstetrician (ob-gyn) or see a fertility specialist: These doctors can help identify possible reasons for infertility through physical exams, fertility tests, and advising on your chances of pregnancy.
When to Seek Help
In general, you should consider speaking to your physician about unexplained infertility that lasts for 12 months or more. You may want to make an appointment earlier if you have diagnosed medical conditions that might interfere with your ability to conceive.
If you’re concerned about your reproductive health and live in the Denver, CO area, schedule a free consultation with us. PrimeHealth members gain access to our entire team of specialists, offering care ranging from dietary recommendations to mental health support to medication management and more!
- Taylor, A. (2003). Extent of the problem. Bmj, 327(7412), 434-436.
- Baird, D. D., Weinberg, C. R., Voigt, L. F., & Daling, J. R. (1996). Vaginal douching and reduced fertility. American Journal of Public Health, 86(6), 844-850.
- Alesi, S., Villani, A., Mantzioris, E., Takele, W. W., Cowan, S., Moran, L. J., & Mousa, A. (2022). Anti-Inflammatory Diets in Fertility: An Evidence Review. Nutrients, 14(19), 3914.
- Van Heertum, K., & Rossi, B. (2017). Alcohol and fertility: how much is too much?. Fertility research and practice, 3(1), 1-7.
- La Vignera, S., Condorelli, R. A., Cannarella, R., Duca, Y., & Calogero, A. E. (2018). Sport, doping and female fertility. Reproductive biology and endocrinology, 16(1), 1-10.
- Zhu, L., Zhou, B., Zhu, X., Cheng, F., Pan, Y., Zhou, Y., … & Xu, Q. (2022). Association between body mass index and female infertility in the United States: data from national health and nutrition examination survey 2013–2018. International journal of general medicine, 1821-1831.
- Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American journal of obstetrics and gynecology, 216(1), 1-9.
- Kumar, N., & Singh, A. K. (2015). Trends of male factor infertility, an important cause of infertility: A review of literature. Journal of human reproductive sciences, 8(4), 191.
- Antoine, E., Chirila, S., & Teodorescu, C. (2019). A Patented Blend Consisting of a Combination of Vitex agnus-castus Extract, Lepidium meyenii (Maca) Extract and Active Folate, a Nutritional Supplement for Improving Fertility in Women. Maedica, 14(3), 274–279.
- Zhu, J., Arsovska, B., & Kozovska, K. (2018). Acupuncture Treatment for Fertility. Open access Macedonian journal of medical sciences, 6(9), 1685–1687.