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Why Can’t I Get Pregnant?

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“Why can’t I get pregnant?” is a question asked by many women in their attempts to become a mother. However, medical conditions are often the reason for infertility. Although these conditions can be difficult to diagnose, treatment options are available.

Infertility in women is defined as trying to get pregnant for over a year without success. After a year of unprotected and frequent sex, a woman should seek treatment by an OB/GYN. An OB/GYN can determine if there is a physical problem causing infertility. Likewise, a woman’s male partner should also be tested by a specialist to rule out if he has a medical condition attributing to the infertility.

In women, several factors can disrupt the process of human reproduction at any step in the process.

Infertility Reasons Include:

1. Ovulation Disorders

Infrequent ovulation is the most common cause of infertility. Problems with the regulation of reproductive hormones can cause ovulation disorders.

  • Polycystic ovary syndrome (PCOS) – PCOS causes a hormone imbalance that can affect ovulation, and is the most common cause of female infertility. Along with infertility, women with PCOS are often insulin-resistant, have abnormal hair growth on the face or body, struggle with acne and often have difficulty maintaining a healthy weight.
  • Hypothalamic dysfunction – Irregular or absent periods are the most common signs of hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month. These hormones are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excess stress, a low or high body weight, or a recent weight gain or loss can disrupt production of these hormones and affect ovulation
  • Primary ovarian insufficiency – The condition when your ovaries no longer produce eggs is called premature ovarian failure. It can be caused by an autoimmune response or by premature loss of eggs from your ovary, possibly because of genetics or chemotherapy.
  • Too much prolactin – Some women may have a condition or be taking a medication that causes excess production of prolactin (hyperprolactinemia) in the pituitary gland. This reduces estrogen production and can cause infertility.

2. Damage to Fallopian Tubes

Blocked fallopian tubes or damaged tubes keep sperm from getting to the egg. This can block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

  • Pelvic inflammatory disease – Pelvic inflammatory disease is an infection of the uterus and fallopian tubes due to sexually transmitted infections, such as chlamydia or gonorrhea.
  • Previous surgery – Prior surgery in the pelvis or abdomen can cause infertility. This includes surgery for ectopic pregnancy, in which a fertilized egg implants and develops somewhere other than the uterus, usually in a fallopian tube.

3. Endometriosis

Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places. This extra tissue growth and removing it in surgery can cause scarring. This can block fallopian tubes and keep an egg and sperm from coming together.

Endometriosis can also disrupt implantation of the fertilized egg. This condition also affects fertility in less-direct ways, such as damage to the sperm or egg.

4. Uterine or Cervical Causes

Several uterine or cervical causes can interfere with the egg implanting or increase the risk of miscarriage:

  • Benign polyps or tumors – Found in the uterus, these can block fallopian tubes or interfere with implantation, which can then cause infertility.
  • Born with it – Some women may have been born with a problem with their uterus, such as an unusually shaped uterus. This can cause problems becoming or remaining pregnant.
  • Cervical stenosis – Cervical stenosis is a narrowing of the cervix. This can be caused by an inherited malformation or damage to the cervix, which can result in infertility.
  • A condition in the cervix – Sometimes the condition in the cervix can cause infertility. An example is when the cervix cannot produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.

Infertility Risk Factors

Certain factors may put you at a higher risk of infertility, including:

  • Age – When a woman reaches her mid-thirties, the rate of follicle loss speeds, resulting in fewer and reduced quality eggs. This causes conception to be more difficult and increases the risk of miscarriage.
  • Smoking – Smoking increases your risk of miscarriage, ectopic pregnancy and can age your ovaries and deplete your eggs prematurely.
  • Weight – Being overweight or underweight may affect ovulation. Getting to a healthy body weight should increase the frequency of ovulation and chance of pregnancy.
  • Sexual history – Sexually transmitted infections can damage the fallopian tubes. Having unprotected sex with multiple partners increases your risk of a sexually transmitted infection that can cause fertility problems.
  • Alcohol – Drinking excessive alcohol can reduce fertility.

Tips to Prevent Infertility

For women thinking about getting pregnant, these tips might help prevent infertility:

  • Maintain a normal and healthy weight – Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, follow a diet plan recommended by your doctor and exercise moderately. For those who are underweight, strenuous exercise of more than five hours a week has shown to decrease ovulation.
  • Quit smoking – Smoking has many negative effects on fertility, as well as your health and the health of your baby. If you smoke tobacco or marijuana, stop before trying to become pregnant. Do not smoke while pregnant.
  • Avoid alcohol – Heavy alcohol use may lead to infertility. Any alcohol use can affect the health of a developing baby. Stop drinking alcohol if you are planning to become pregnant, and do not drink alcohol while pregnant.
  • Reduce stress – Added stress in a woman’s life can increase infertility. Reduce physical and emotional stress before trying to become pregnant.

When to Seek Infertility Treatment by an OB/GYN

Women should seek help with infertility, depending on their age:

  • 35 or younger – Testing is recommended if a woman has been trying to get pregnant for at least a year.
  • Age 35 – 40 – Talk to your OB/GYN after six months of trying to get pregnant.
  • 40 or older – See an OB/GYN to begin testing or treatment right away.

Depending on your medical history, your OB/GYN might want to begin testing or treatment right away. Seek an OB/GYN if you have recognized fertility problems, or if you have a history of painful or irregular periods, pelvic inflammatory disease, PCOS (polycystic ovary syndrome), miscarriages, endometriosis or cancer.

Seeking early treatment from an experienced OB/GYN can often be key in finding the root problem. Occasionally, the reason for infertility is not found as it can be a combination of a few factors from both partners. However, in most cases, the sooner treatment is sought, the greater the chances are for a successful pregnancy.