Why am I not getting pregnant?

Conceiving is commonly thought to be a straightforward task, but there is much more to it. Women are only fertile for approximately six days each month[1]. Some people go through months or even years of planning without success. In recent studies, 9% to 18% of the global female population have trouble getting pregnant[2] so if you’re having trouble conceiving, know that you’re not alone.

The term “infertility” tends to have a negative connotation but don’t let it discourage you. Infertility is characterized as the inability to conceive after a year of trying, for women under the age of 35, and six months for women that are 35 years old and above[3]  Actively trying means having sex 2 – 3 times per week, according to fertility specialists. In this article, we will discuss and explore the possible reasons that could be hindering your chances of conceiving.

  • Unclear of the ovulation period and “fertile window”
    If you are trying to conceive, it is crucial that you learn to calculate and identify both your ovulation period and fertile window[4]. A regular cycle will last between 26 to 35 days. Your fertile window starts precisely three to five days before ovulation and ends one to two days after ovulation. This is the time when your body is most ready for a successful implantation of the embryo[5].

This may look like a lot of work to do but it is ideal for those who have been actively trying to conceive. Read this article  to find out how women identify their fertile window, especially if you have irregular periods.

  • Underlying medical conditions
    There may also be some undiagnosed medical issues causing your infertility, such as:
  • Common underlying medical issues for women
    • Endometriosis

Endometriosis is a disease impacting women of adolescent and reproductive age, characterized by the presence of tissue resembling endometrium (the lining of the uterus) outside the uterus chronic pelvic pain, pain during intercourse, painful bowel movements and urination, fatigue as well as abdominal bloating and nausea[6]. This condition is extremely common, but often not diagnosed early[7], and affects 10% to 15% of females who are of reproductive age and 70% with chronic pelvic pain. Approximately 30% to 50% of females with endometriosis are infertile which also presents as a common symptom[8].

    • Fibroids

Uterine fibroids are benign (noncancerous) tumors of muscle tissue in the uterus. Fibroids appear when a muscle cell in the wall of the uterus multiplies and develops into a benign tumor. It could change the shape or size of the uterus and occasionally the cervix. Studies have shown that 5% to 10% of women who have fibroids are infertile[9].

    • Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a condition where there are elevated androgen levels, menstrual irregularities, and/or small cysts on the ovaries. In fact, research has shown that PCOS affects 5% to 10% of females aged 18 to 44, and is especially common amongst infertile women[10].

  • Common underlying medical issues for men
    • Varicocele

This is a very common condition where the veins become enlarged inside the scrotum (the loose pouch of skin that holds your testicles). This condition could lead to decreased sperm quality and quantity from increased temperature. It is one of the most common male infertility problems affecting 40% of men[11].

    • Hormonal defects

The male reproductive hormone axis is also called the hypothalamic-pituitary-gonadal axis. This is made up of three components: the hypothalamus, pituitary and testicular glands. This axis provides the appropriate concentration of hormones for male reproductive development and function. A slight irregularity in the axis would lead to infertility[12].

  • Managing a healthy environment and lifestyle
    • This is the most important aspect for couples who are trying to have a healthy environment and lifestyle. There are several environmental factors, such as cigarette smoke, alcohol, occupational exposures, and environmental contaminants, that could increase chances of infertility[13].

    While this information may seem alarming, do keep in mind that you are not alone in this journey. If you are looking for more information regarding your fertility, a great place to start is with our fertility questionnaire.

1. Yi, Y. C., Wei, T. Y., Chang, T. C., & Cheng, C. M. (2017). Detection of ovulation, a review of currently available methods. Bioengineering & Translational Medicine, 2(3), 238–246. https://doi.org/10.1002/btm2.10058
2Johnstone, E., Dorais, J., Silver, B., Peterson, C. M., & Hotaling, J. (2016). Female infertility, infertility-associated diagnoses, and comorbidities: a review. Journal of Assisted Reproduction and Genetics, 34(2), 167–177. https://doi.org/10.1007/s10815-016-0836-8
3American Society for Reproductive Medicine (ASRM), (2012) Age and Fertility [Booklet]. American Society for Reproductive Medicine. http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf.
5Yi, Y. C., Wei, T. Y., Chang, T. C., & Cheng, C. M. (2017). Detection of ovulation, a review of currently available methods. Bioengineering & Translational Medicine, 2(3), 238–246. https://doi.org/10.1002/btm2.10058
6World Health Organization (WHO). (2021). Endometriosis [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Endometriosis%20is%20a%20disease%20characterized,other%20parts%20of%20the%20body
7 Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current Obstetrics and Gynecology Reports, 6(1), 34–41. https://doi.org/10.1007/s13669-017-0187-1
8Female causes of infertility. (n.d.). Retrieved November 7, 2022, from https://www.fertility.com/en/understanding-fertility/female/causes-of-infertility.html
9ReproductiveFacts.org. (2015). Fibroids and fertility [Fact Sheet]. https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/fibroids_and_fertility_factsheet.pdf
10Uche Anadu Ndefo, Angie T. Eaton, & Monica Robinson Green. (2013). Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P & T : A Peer-Reviewed Journal for Formulary Management. https://pubmed.ncbi.nlm.nih.gov/23946629/
11 Baigorri, B., & Dixon, R. (2016). Varicocele: A Review. Seminars in Interventional Radiology, 33(03), 170–176. https://doi.org/10.1055/s-0036-1586147
12 Babakhanzadeh, E., Nazari, M., Ghasemifar, S., & Khodadadian, A. (2020). Some of the Factors Involved in Male Infertility: A Prospective Review. International Journal of General Medicine, 13, 29–41. https://doi.org/10.2147/ijgm.s241099
13Hruska, K. S., Furth, P. A., Seifer, D. B., Sharara, F. I., & Flaws, J. A. (2000). Environmental Factors in Infertility. Clinical Obstetrics and Gynecology, 43(4), 821–829. https://doi.org/10.1097/00003081-200012000-00014


SG-NONF-00250 | 6 Jan 2023 | 7 Jan 2023

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