Why am I not getting pregnant?

First of all, I would like to talk about infertility. We are talking about infertility when a couple is trying to conceive for more than one year and the woman cannot get pregnant. In such cases, we can start to look for the reason for these failed attempts in conceiving.
To conceive actually we need 4 main points: mature oocyte (egg), sperm, they need to meet in the fallopian tube and finally embryo should implant in receptive endometrium. All the reasons for infertility can be divided into two parts: female reasons and male reasons.
Male is the easiest to be checked. Actually the male partner just needs to check the sperm but female reasons can be caused by many abnormalities on each step of the fertility process.
One of them is obstruction of fallopian tubes which can lead to infertility because natural fertilization is going on inside of the tube. Once the tubes are blocked or their function of the tubes is impaired, sperm and oocyte cannot meet or the embryo cannot reach the uterus cavity. Consequences of such conditions can be infertility or ectopic pregnancy.
Pelvic inflammatory disease and other conditions that lead to adhesion formations inside can lead to these obstructions of fallopian tubes. To evaluate potency you can do some specific examination: it can be ultrasound examination, x-ray and also we can check tubes while performing laparoscopy if a person has another indication for such examination except only checking the tubes.
Infertility can also be caused by ovarian dysfunction like an ovulation. Ovulation problems can be due to PCOS, obesity or weight deficiency, endometriosis, premature ovarian failure or ovarian insufficiency to the natural process like menopause. To clarify if a person ovulates , we can test hormones, do pelvic scan during the ovulation and once we detect ovulatory functions we can try to treat this person: proceed with ovarian stimulation or proceed with assisted reproduction.
I have to say a few words about uterine cavity conditions. You know that embryos should be implanted within the receptive endometrium inside the uterine cavity so the abnormalities of the uterus which affect the womb can also enhance on attempts to conceive.
Some of these pathologies can be seen by ultrasound and then we can decide what will be our next step and how we can treat them.
Finally I would like to say that if a couple tries to conceive for more than one year or if a woman knows about some of her gynecological problems – such a couple needs to come to a fertility specialist and decide if they need some special examinations to find out possible reasons and treat this reasons as soon as possible.

I always go back to the basics, you want to call them ingredients, to have a child which is: good sperm, good eggs, open tubes and a healthy uterus and this is the place where the embryos implant. Any problem, whether it’s anything that affects egg number or egg quality, sperm number or sperm quality. If there’s any problem with the tubes – like blocked tubes or if there’s any problem with the uterus – any of those factors. If there’s any problem in any of those factors that will directly affect fertility and that be one of the reasons why ladies are not getting pregnant.

I suppose that’s the question I’ve been asked probably more than any other over the years. There is no simple answer to that, there can be a myriad of reasons why someone may have been trying to get pregnant and have failed. It can be very simple things, for example, timing of intercourse related to ovulation and that can be as simple sometimes as people not being together physically at the right time of the month. If people walk away and work away for example, the most important point in terms of spontaneous conception would be that you need to have intercourse within about a 24-hour window of ovulation. There’s a very narrow window in terms of the survival of the egg and if live sperm can’t come into contact with that egg within 24 hours of ovulation (usually in the fallopian tube) then you are not going to get pregnant. So, anything that interferes with that process of fertilization will prevent you from getting pregnant. You have to release an egg, the egg has to be able to traverse down the fallopian tube, you need to have intercourse, as I say within that 24-hour window and have to reach the fallopian tube from the top of the vagina and then fertilization and the events that follow that need to occur and anything that interferes with that process will lead to difficulty with conception. All those different factors are broken down when we look at why somebody may be suffering from infertility or struggling to get pregnant, so I think as a summary that’s probably there are many many other things within that but that’s the sort of basic premise of what needs to happen.

The biggest problem I am facing at the moment which I hope will be corrected or somehow dealt with in the future is, lack of awareness. There is a very big lack of awareness so, I may be digressing a little, but we can get women who are slightly older, in their 40’s and because they feel that they are healthy, are non smokers, don’t have alcohol, go to the gym and feel very fit and active You can feel very young in yourself and good about yourself and it is great to look after yourself and to take your vitamins, it does not mean your ovaries will stop growing or that your eggs will stop getting older. There is that concept that whatever we do, whatever we feel from outside, these ovaries everyday are getting older and the eggs are getting older. That’s the kind of information that GP’s should also do as I think it should start from that level and start possibly from university level, but GP’s are also giving this information that you are losing time, you are making them aware of these things. Or looking more into the symptoms that you’ve got such as with endometriosis and especially if it’s a young girl and not thinking of getting pregnant right now but has severe bleeding and severe pain, those symptoms should be picked up and those people should be made aware. At this early age as well, there may be an issue and a problem there that might need attention. So they become aware in their conscious or subconscious, this is helping them be aware that this could be an issue with their fertility. You should not waste too much time. You should get your fertility assessment done so that it is not too late for them.

As we know today infertility is divided into three main causes: female infertility which includes many reasons such as uterine problems which means endometritis, polyps myomas, tube problems when the tubes are not working well or when they do not exist anymore or diseases like hydrosalpinges and biosalvins can be reasons of female infertility. Hormone disorders of a woman can be a reason for female infertility and then genetic reasons that all these reasons are included in female infertility.

As far as male infertility problems in the sperm which means oligospermia meaning low concentration, asthenospermia which means low motility and teratospermia so bad morphology – all these reasons can cause infertility. Also, genetic reasons in male infertility are very important and other less let’s say frequent as a traumatized and cancer can be reasons of male infertility.

Then there’s a large group of as we say unknown or idiopathic infertility although today many of these unknown reasons are let’s say already known and of course, some of these reasons regard the combination of male and female infertility, so it’s a combination of both.

There are so many causes for women not getting pregnant. And to be honest, the most common cause is a problem with ovulation. So we’ll say around 30% of women have difficulty ovulating every month. We call it inconsistent ovulation. So in general, we human beings are a really fertile species. If you take a percentage of around 85% of couples trying to conceive in the first year, they will be successful doing that within 12 months. However, only 15% of these couples will have difficulty conceiving.

Back to our answers about ovulation, ovulation can be delayed or difficult because of many causes. The most common cause in young girls is a condition we call polycystic ovarian syndrome. And this is an imbalance in the hormones due to a condition we call insulin resistance, and that will lead to irregular ovulation occasionally some facial hair. The other possible causes are drugs if you use any or have any medical condition, and occasionally a very rare condition which we call ovarian insufficiency, in which the ovary will become really unable to produce the hormones and ovulate from an early age.

A rather common cause of delay in conception or pregnancy is a problem with the anatomy or the tubes. Simply, the tubes are the canals or the tunnels that transfer the eggs from the ovary to the uterus and fertilization will happen in them. So any problem with the tubes like previous surgery on the tubes, previous infection including pelvic inflammatory disease will make this process more difficult. The other cause for the difficulty to conceive is the male factor. We shouldn’t forget the importance of having adequate semen count, sperm motility, the activity of the sperm, and the shape of the sperm to achieve that. Also, there are many factors from your partner that will lead to difficulty in achieving pregnancy.

We shouldn’t forget psychological factors and we shouldn’t forget other factors. Sometimes, we do everything, we do the test for the couple and we cannot find the cause. This is what we call unexplained infertility. Now, that will constitute around 20% of the couples. Having said that, coming back to the causes of infertility, apart from tubal factors, there is a condition we call endometriosis. Endometriosis can also contribute to infertility which leads to heavy and painful periods and also pain with intercourse and all in all, that will reduce fertility.