For some people, persistence and the tincture of time solve the "problem." For others, difficulty getting pregnant or carrying a baby to delivery can be overcome with medical assistance. If you experience any signs that might indicate impaired fertility, see your doctor or a fertility specialist.
Trying Without Getting Pregnant
According to the American College of Obstetricians and Gynecologists (ACOG), infertility is defined as not conceiving a child after 12 months of trying — meaning regularly having sexual intercourse without use of any form of birth control. As such, trying to get pregnant for a year or longer without conceiving is the most common sign of a possible fertility problem.
Although 12 months without conceiving is typically used as the cutoff to define a possible fertility problem, ACOG recommends an infertility evaluation after six months of trying without getting pregnant for women older than 35. Earlier consultation is recommended for women older than 40, those with irregular menstrual cycles and for men and women with known fertility problems.
Menstrual irregularities can signal an underlying problem that could interfere with a woman's fertility. These irregularities include unusually short, long, variable or absent periods and scant or excessive menstrual flow. Examples of possible underlying medical problems that can cause menstrual irregularities and impaired fertility include:
You can easily determine your menstrual cycle length and regularity by charting your periods with an app or paper or online calendar. The first day of your period marks day one of your cycle. The number of days until the first day of your next period indicates your menstrual cycle length. Charting your periods for at least two cycles will give you an indication of the typical length and regularity of your menstrual periods.
In general, cycles that occur more frequently than every 21 days or less frequently than every 35 days might suggest a menstrual problem that could affect your ability to get pregnant, according to the US National Institutes of Health. Variability in your cycle length of more than 20 days from one period to the next could also indicate an underlying medical problem.
Variable cycle length can also delay getting pregnant due to difficulty predicting what days you're most likely to conceive. And it's important to note that a woman who is not menstruating due to medical problems, delayed puberty, a hysterectomy or menopause cannot get pregnant naturally.
Signs of Not Ovulating
In order to get pregnant, a woman must ovulate roughly midway through her menstrual cycle. During ovulation, an egg ripe for fertilization is released from an ovary. Failure to release such an egg during the menstrual cycle (anovulation) precludes the ability to get pregnant.
Women with anovulatory cycles often experience irregular periods as well as other possible signs, including:
- Excess body weight, difficulty losing weight, persistent acne and/or increased body hair in women with PCOS
- Absence of a distinct increase in basal body temperature during the latter half of the menstrual cycle, which typically indicates ovulation
- A low number of developing eggs or multiple cysts in the ovaries on ultrasound testing
- Abnormal blood levels of hormones that affect fertility
- Lack of clear results when using an over-the-counter ovulation prediction kit
Pelvic, Abdominal or Back Pain
Pelvic, abdominal and/or lower back pain sometimes signals a medical problem that could interfere with getting pregnant. For example, women with endometriosis or uterine fibroids often experience pain in one or more of these locations. Although not all women with these conditions experience difficulty getting pregnant, these disorders increase the risk for fertility problems.
Pelvic and lower abdominal pain can also occur when scarring (adhesions) develops in these sites, potentially distorting the anatomy of a woman's reproductive tract and causing difficulty conceiving a baby. Risk factors for adhesions involving a woman's reproductive tract include:
Signs of Impaired Male Fertility
In medical terminology, a sign is an externally observable or measurable indicator of an underlying disease or abnormality. Unlike women, men with impaired fertility typically don't experience outward signs of their condition unless there are telltale indicators of a prior testicular injury or surgery or abnormal reproductive anatomy, such as small testicles (testicular atrophy).
In most cases, doctors diagnose impaired male fertility with laboratory testing called a semen analysis. This test assesses both the number and quality of sperm in the semen, the fluid a man produces during ejaculation.
Diminished sperm numbers and/or poor quality — such as impaired swimming action or structural abnormalities — typically signals impaired fertility, which can make it difficult to father a baby without medical assistance. And men experiencing sexual problems such as premature ejaculation or erectile dysfunction can also have difficulty getting their partner pregnant.
Other Factors Influencing Fertility
Several factors can influence your fertility — some modifiable and others not. Fertility decreases in both men and women with age. Among women, fertility begins to significantly decrease at about age 32 with a more rapid decline starting around age 37, according to ACOG.
Male fertility begins to decrease around the mid 30s to early 40s but declines more gradually compared to women, as reported in a study published in the October 2013 issue of Fertility and Sterility.
Other factors and conditions that can adversely affect fertility include:
When to See a Doctor
If you're ready to have kids but it seems like you can't have a baby, don't despair. Many medical treatments and interventions can help both women and men overcome fertility problems. See your doctor if you have questions or concerns about your ability to get pregnant.
- Eunice Kennedy Shriver National Institue of Child Health and Human Development: Infertility and Fertility
- Americal College of Obstetricians and Gynecologists: Treating Infertility
- Americal College of Obstetricians and Gynecologists: Evaluating Infertility
- Eunice Kennedy Shriver National Institue of Child Health and Human Development: What Are Menstrual Irregularities?
- The Centre for Menstrual Cycle and Ovulation Research: What Does A "Regular Cycle" Mean?
- American Family Physician: Evaluation and Treatment of Infertility
- Texas Fertility Center: Pelvic Adhesions
- Americal College of Obstetricians and Gynecologists: Female Age-Related Fertility Decline
- Fertility and Sterility: Age Thresholds for Changes in Semen Parameters in Men
- Center of Reproductive Medicine: Diseases Impacting Fertility