Why aren’t you pregnant yet? Find out the common causes of infertility

Having a baby, what can go wrong?

It goes without saying that human reproduction is a complex process, and there are lots of things that can go wrong. A small upset at any point in the process can prevent a conception from occurring. Even more frustrating is that when you’re having fertility problems it can take time for doctors to figure out where the problem lies.

Female fertility problems

As a woman you may have to go through a lot of testing to get to the root cause of your fertility problem, which can be physical, hormonal or something else perhaps health or lifestyle related.

Hormonal problems are commonly the cause because an imbalance in the hormones that regulate egg production and ovulation can mean that you don’t produce eggs every cycle, your eggs don’t develop properly, or ovulation may not occur.

Polycystic ovary syndrome (PCOS)

PCOS is a common cause of female fertility problems because it disrupts ovulation.

If you have polycystic ovaries this means that there are undeveloped follicles (or cysts) just under the surface of your ovaries. These cysts are often not accompanied by any other symptoms and they don’t affect fertility.

However, if you have polycystic ovary syndrome, there are other symptoms. For example, your menstrual cycle is usually affected, and ovulation is usually irregular, infrequent or entirely absent which impacts your fertility.

Many women with PCOS are also overweight and have unwanted facial and body hair and skin problems such as oily skin and acne. The hormonal imbalances associated with PCOS mean you may produce higher than normal levels of testosterone and insulin which is the hormone that regulates blood sugar levels.

Early or premature menopause

An early or premature menopause occurs when your ovaries stop functioning well before they should. It can take place when you are still in their twenties, and the causes are not always clear, although they may be genetic or chromosomal.

Women who’ve had an early menopause will usually only be able to become pregnant using donated eggs because once a woman has reached menopause it is irreversible.

Raised prolactin levels

Raised prolactin levels can disrupt ovulation, so if who have high prolactin levels this may cause you to have irregular periods, or no periods at all. This is because prolactin is a hormone that is associated with lactation, it helps prepare women’s breasts for milk production after childbirth. However, prolactin levels can sometimes rise in women who are not pregnant and this can affect their hormonal balance.


Endometriosis is a condition where tissue like the womb lining starts growing outside your womb causing female fertility problems. Many women who have endometriosis can still become pregnant without any difficulty, but other women will find it affects their ability to conceive. Endometriosis may be accompanied by heavy, painful periods and pain in the abdomen, lower back or pelvis.


Fibroids are benign tumours made up of muscle fibre that grow in or around your womb. Fibroids can make it difficult for a fertilised embryo to implant and they are also associated with miscarriage. Many women who have fibroids don’t know they have them, but they may be accompanied by heavy menstrual bleeding, painful periods, bloating or lower back pain.

Problems with the fallopian tubes

Problems with the fallopian tubes are another common cause of infertility. The fallopian tubes lead from your ovaries to your womb and if they are blocked, scarred or damaged this can prevent an egg travelling along them. The tubes can become damaged by infection or by scar tissue if you’ve had surgery in the pelvic area.

One major cause of tubal problems is the sexually transmitted infection, chlamydia. It can lead to pelvic inflammatory disease which damages the fallopian tubes. Chlamydia is very common and there are often no obvious symptoms, so a woman may be completely unaware that she has chlamydia although it may be putting her future fertility at risk.


A hydrosalpinx is the medical term for a blockage in the fallopian tubes. This occurs when one or both of your tubes gets completely blocked due to infection or scarring and then fills up with fluid. Some women who have a hydrosalpinx find it extremely painful and others have no symptoms at all.

If you have a hydrosalpinx, doctors often recommend removing the tube entirely before having IVF, as it is thought to affect the chances of an embryo implanting and may increase the risk of miscarriage.

Physical problems with the womb or ovaries

Physical problems with the womb or ovaries can make it difficult to conceive. Sometimes the outer surface of your ovaries may be scarred, and this can affect ovulation. Perhaps, for example, your womb is unusually shaped, or scarred, which may also lead to fertility problems.

Your age

Age is an important factor in female fertility. Your fertility starts to decline when you reach your mid-thirties and then declines sharply once you reach your forties.

Although some women continue to have periods until they reach their early fifties, their fertility is compromised for some years before their periods stop due to perimenopause which occurs before they officially go through menopause.

Age-related fertility problems are common today as more women are starting families later in life. People often assume that medical fertility treatments will overcome age-related fertility problems. However, the chances of success using assisted conception are directly related to your age in the same way that they are with natural conception.

Secondary infertility

Secondary infertility occurs when you have already had one or more children without any problems then find it difficult to become pregnant again.

Things can change in your body over time, and with age, so a fertility problem that you may have been able to overcome when you were younger may not be so easy to overcome when combined with decreasing fertility due to age.

Couples sometimes put off getting medical help if they’ve already had a child, assuming everything must be ok, but having had children is no guarantee that you will be able to have more.

Unexplained infertility

Unexplained infertility is extremely common, and many couples will never find out why they’re having problems conceiving because all the tests may come back suggesting that everything is normal.

In some cases, unexplained infertility could be linked to age but in most cases it is just that no cause has been found.

Male fertility problems

Most male fertility problems are to do with sperm production. In a semen sample for analysis, there should be at least twenty million sperm per millilitre of semen. If there are fewer than this a man may be told that he has a low sperm count, or fewer sperm than normal in his semen.

It isn’t just the quantity of sperm that is important but also the quality of sperm. Sperm must be able to swim forwards if they are to fertilise an egg. If the sperm are very slow or they swim around in circles for example, this is called a motility problem and it may impact fertilisation occurring because the sperm cannot reach the egg.

Sometimes the sperm aren’t formed properly, or they are abnormally shaped. In this case they are then said to have poor morphology.

It is normal for semen samples to contain some abnormal sperm. It is only a problem if there are a lot of misshapen sperm or sperm unable to swim normally.

Some men have no sperm in the semen at all. This might mean that no sperm are being produced in the testicles, but it often occurs when there is a blockage in the tube leading down to the penis or if the tube hasn’t developed properly.

You can become pregnant. Work with me and let’s get you healthy, fertile and ready for conception and pregnancy.

This is from my program ‘Everything you need to know before starting IVF/ART’.

If you would like to become pregnant or prepare your body for a natural or assisted conception, my natural fertility programs and courses are here.

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