Getting pregnant should be one of the most fun experiences of your life--in part because you're making a family, and in part because you're hopefully having a lot of fun sex in the process! But when things go wrong and you keep getting periods or failed pregnancy tests, it can be really dejecting.
Trouble conceiving impacts about 11% of women; of these, about half are infertile. About one third of conception difficulties comes from the person that bears the egg; one third comes from the person that gives the sperm; and the final third is undetermined. (Chandra, Copen, & Stephen, 2013)
In other words, for all we know, there may be an equal split between fertility problems in those with ovaries and those with testicles. That said, let's look at what can go wrong in the fertility process from people with ovaries.
All About Ovulation
First, let's give you a quick refresher on how ovulation and fertility work. You become pregnant when sperm enters you at just the right time in your "monthly" cycle to fertilize one of your eggs.
It's easiest to track ovulation by looking at your menstrual cycle. A typical menstrual cycle lasts 28-35 days; when trying to get pregnant, you should keep track of how many days you usually bleed and how much time passes between your bleeding cycles.
If you experience periods much more or much less than once a month, you may have a health condition that is making pregnancy difficult; see below.
Day 1 of your cycle is the first day you start to bleed; you will generally experience "ovulation" (when your ovaries release an egg to be fertilized) at some point between days 11 and 21.
Once your egg is released, it will dissolve in about 24 hours--but sperm can stay alive for 3-5 days, so the timing does not have to be perfect for you to get pregnant. If the egg is not fertilized in time, your body will expel the egg, your uterine lining, and blood, leading back to day one of your menstrual cycle. (Nazario, 2021)
Signs of Ovulation
So how do you know when the time is right to get pregnant? There are a few signs, according to the American Pregnancy Association (2022):
- An increase in cervical fluid. This change in consistency and level of vaginal fluid is hard to accurately describe, as it's different for every woman.
- Heightened temperature. Try taking your temperature every morning when you wake up and tracking the results. On the day when your temperature spikes, you have just passed ovulation, and now you know when it might happen next month.
- Cervix changes. This one may be difficult to discern, but your cervix may seem softer, wetter, and in a higher position while you are ovulating.
- Other changes. Ovulation can look a little different for everyone. You might experience some spotting, light cramping or bloating, and increased senses such as tenderness (especially of the breasts), smell, taste, or vision.
Causes of Infertility
So if you are not ovulating, or not getting pregnant, what could be going on? (NHS, 2018)
Remember the statistic from up above--at least 30% of cases of infertility come from the person who has testicles. It may not be your body at all.
For both you and your partner, lifestyle factors like weight (too low or too high), diet, exercise, and alcohol or drug consumption can all make it more difficult to conceive. Stress can be a huge factor as well, so while it may be tempting to worry about your pregnancy troubles, this may only sabotage your chances! Try to keep your minds and bodies as healthy as possible; this will also establish good habits to make pregnancy and the post-delivery phase easier.
Internal conditions such as endometriosis, fallopian scarring, thyroid problems, and polycystic ovarian syndrome (PCOS) can make it more difficult for you to get pregnant. However, your doctor may be able to prescribe or recommend certain medications or supplements to increase your chances of pregnancy.
Seeing a Specialist
If you already know when you've been ovulating and you don't have any conditions that should hinder pregnancy (or have some that are already being treated), you may be wondering when it's time to see an infertility specialist. If you are under 35, you may want to consider a fertility specialist within one year of trying to get pregnant. If you're 35 or older, you can see an infertility specialist after six months.
The infertility specialist will perform several tests to help you determine why you and your partner are having trouble getting pregnant:
- A physical exam on both partners
- A blood test for both partners
- An ultrasound for you
- A sperm test for your partner
- Less likely - an X-Ray or minor exploratory surgery
Once they have narrowed down the most likely reason for your infertility, you might need to take medications, undergo hormone therapy, commit to certain lifestyle changes, or have surgery to correct the problem. If those options aren't available to you, you might also talk about in vitro fertilization (IVF), intrauterine insemination (IUI), or sperm or egg donations. (Planned Parenthood, n.d.)
If you are struggling to have a baby, don't stress! The best thing you can do is stay calm, keep healthy, and record everything you can in case you need to take things to a specialist later.
Remember that you do still have other options if this does not work out. If you're feeling overwhelmed, please consider talking about this with a therapist; pregnancy troubles can be deeply upsetting, and you deserve help to cope with those feelings however they turn out.
- Chandra, A., Copen, C.E., & Stephen, E.H. (2013). Infertility and Impaired Fecundity in the United States, 1982-2010: Data From the National Survey of Family Growth. National Health Statistics Reports, 67, 1-19. https://www.cdc.gov/nchs/data/nhsr/nhsr067.pdf
- Nazario, B. (Ed.) (2021). Understanding fertility & ovulation: Facts to help you get pregnant. WebMD. https://www.webmd.com/baby/ss/slideshow-understanding-fertility-ovulation
- American Pregnancy Association (2022). Ovulation symptoms. https://americanpregnancy.org/getting-pregnant/infertility/signs-of-ovulation/
- United Kingdom National Health Service [NHS] (2018). How long does it usually take to get pregnant? https://www.nhs.uk/pregnancy/trying-for-a-baby/how-long-it-takes-to-get-pregnant/
- Planned Parenthood (n.d.). Should my partner and I seek testing for infertility? https://www.plannedparenthood.org/learn/pregnancy/infertility/should-my-partner-and-i-get-tested-infertility