Why aren’t we getting pregnant?
If pregnancy is taking longer than expected, there can be many possible reasons, and it is not always down to one partner.
Sometimes there is an identifiable factor affecting fertility. Sometimes several factors are involved. And sometimes initial testing does not find a clear explanation.
Understanding what may be happening is the first step towards deciding whether you need further assessment or support.
Several things need to happen at the right time
For pregnancy to occur naturally, several steps need to come together. A difficulty at any stage may make pregnancy take longer.
An egg needs to be released, sperm needs to reach and fertilise the egg, the fallopian tube needs to allow this process to take place, and the resulting embryo needs to reach the uterus where implantation may occur.
Why might pregnancy be taking longer?
There is no single reason that applies to everyone. Fertility can be influenced by female factors, male factors, a combination of both, or factors that are not immediately clear.
Ovulation and hormones
Irregular or absent ovulation can make conception more difficult. Conditions such as polyendocrine metabolic ovarian syndrome (PMOS), the new name for polycystic ovary syndrome (PCOS), may affect ovulation, while other hormonal factors can also play a role.
Egg number and age
The number and quality of eggs generally decline with age. Age is therefore an important part of understanding fertility, although it is only one part of the overall picture.
Fallopian tubes
Blocked or damaged fallopian tubes may make it difficult for sperm and egg to meet, or affect the movement of a fertilised egg towards the uterus.
Uterus and endometrium
Fibroids, polyps and some other conditions affecting the uterus or endometrium may sometimes affect fertility and may need further assessment.
Sperm
Sperm concentration, movement and shape are among the factors considered in a semen analysis. Male factors should be assessed alongside female factors where relevant.
Endometriosis and other conditions
Endometriosis and certain reproductive or medical conditions may affect fertility in different ways. Your medical and reproductive history can help guide which investigations are appropriate.
Sometimes there is no clear reason
Initial fertility tests can be within expected ranges even when pregnancy has not happened. This does not mean your experience is not real. A doctor can help put the results into context and discuss whether further investigation, treatment or more time may be appropriate.
How long should we keep trying?
How soon to seek fertility advice depends partly on age, how long you have been trying and whether there are already reasons to investigate sooner.
Consider a fertility evaluation after around 12 months of regular, unprotected intercourse without pregnancy, if there are no known concerns.
Consider a fertility evaluation after around 6 months. For women over 40, earlier evaluation may be appropriate.
Is it me or my partner?
Fertility is not just a female issue. Factors affecting either partner, or a combination of both, may contribute to pregnancy taking longer.
Where relevant, fertility evaluation should look at both partners rather than investigating one person in isolation.
What happens if we get checked?
A fertility assessment is about getting information. It does not mean you are committing to IVF.
At IVF(SG), an initial assessment can look at several important factors to help build a clearer picture of your current circumstances.
Your results can then be considered together with your history. Dr Yeong can explain what they may mean and whether further investigation, treatment or simply more time may be appropriate.
Explore our fertility assessmentsDoes having a fertility assessment mean we need IVF?
No. Coming to IVF(SG) for an assessment does not mean you have decided to start IVF.
The purpose of testing is to better understand your circumstances. Depending on the results and your individual situation, your next step may be further investigation, trying for longer, another form of fertility support or, where appropriate, discussing fertility treatment.
Questions you may have
Can everything look normal and we still have difficulty getting pregnant?
Yes. Initial tests can sometimes be within expected ranges even when pregnancy has not occurred. Fertility tests provide useful information, but no single test, or group of tests, can explain every situation or predict whether pregnancy will occur.
Does age affect both female and male fertility?
Age can be relevant to both, although the effects are different. Female age has a particularly important relationship with egg number and egg quality. Male reproductive factors can also change with age, but age alone does not provide a complete picture for either partner.
Do irregular periods mean I am not ovulating?
Irregular or absent periods can be a sign that ovulation is not happening regularly, but there can be different reasons for changes in the menstrual cycle. A doctor can assess your cycle history and decide whether further testing is useful.
Should both partners be tested?
Where both partners are contributing eggs and sperm, assessment of both is generally recommended because fertility factors can involve either partner or a combination of both.
Does seeing a fertility specialist mean we will need IVF?
No. A consultation or fertility assessment is a way to understand your circumstances and discuss possible next steps. IVF is one possible treatment pathway, but it is not the right or necessary next step for everyone.
