There could be many reasons, but here are 5 of the most common:
1. PCOS (Polycystic Ovarian Syndrome) – this is a common affliction that disturbs hormone levels and ovulation.
PCOS is one of the most common endocrine disorders that can affect women of reproductive age. The diagnosis of PCOS includes oligo-ovulation, signs of hyperandrogenism (excess male hormones), and/or PCO-like appearing ovaries on ultrasound. PCOS most frequently manifests as irregular menstrual periods due to lack of ovulation, or no menstrual periods due to no ovulation. In women with PCOS who are overweight, sometimes losing a small amount of weight may be sufficient to help promote ovulation for a successful pregnancy. Certain medications called ovulation induction medications such as clomiphene citrate can also be used to help a woman ovulate to allow her a chance to conceive.
2. Endometriosis – painful periods, heavy bleeding are hallmarks of this common condition that prevents pregnancy.
Treatment for endometriosis often includes medications such as birth control pills and Lupron, both of which prevent pregnancy. It is challenging for women who are symptomatic from endometriosis to try and conceive since each month that they are not pregnant, their menses will be painful. Additionally, endometriosis has been associated with infertility as it may alter pelvic anatomy, or interfere with oocyte development or peritoneal function. Some women with endometriosis can conceive on their own, but for those who are struggling, a reproductive endocrinologist can work help such patients achieve pregnancy through fertility medications or in vitro fertilization if their fallopian tubes are not functioning properly due to the endometriosis.
3. Low sperm count – Many men are nervous to get tested but a sperm count or mobility issue could be preventing you from conceiving. Simple, easy tests from a infertility clinic can confirm if this is an issue.
4. Over 35? Our fertility decreases drastically as we age. Although many women age gracefully, our eggs do not. If you are over 35 you could be menstruating regularly but you eggs could be “older.” There is little to be done to make our eggs act “younger” than our actual age, but there are lifestyle choices that can impact our eggs’ ability to function properly, such as smoking. In general, maintaining a healthy lifestyle, which includes a normal weight, not smoking and minimal alcohol intake will help keep your chances of conceiving appropriate for your age. However, despite being healthy, some women’s eggs may still not be functioning as well as expected for their age. There are certain tests that can help assess ovarian reserve, including a day 3 FSH level, anti-mullerian hormone level (AMH), and an antral follicle count. These tests are not completely predictive of ovarian reserve (i.e. some women may have good results but still have poor quality eggs), but can be valuable in guiding decisions whether to pursue fertility treatments. Ultimately, if a woman over age 35 has been trying to conceive for 6 months without success, she should seek an evaluation to help determine why she has not gotten pregnant. Fertility treatments may be warranted at that time.
5. Undiagnosed Medical Issue – Often women are unaware they have a thyroid issue or a diabetes. This can lead to infertility. An infertility specialist can run simple tests to tell you if you have underlying problem.
– Dr. Elizabeth Barbieri
Dr. Elizabeth Barbieri is a Board certified specialist in reproductive endocrinology and infertility at Oregon Reproductive Medicine.