Trying to fall pregnant can begin with excitement and expectation. But when month after month passes without a positive pregnancy test, it is natural to start wondering why.
Pregnancy depends on several factors working together. Ovulation needs to occur, healthy sperm need to reach the egg, fertilisation needs to take place, and the resulting embryo needs to develop and implant in the uterus.
A difficulty at any stage can affect the chances of conception. Sometimes there is an identifiable female fertility factor, sometimes a male fertility factor, and sometimes both partners contribute. In other cases, fertility investigations do not identify an obvious cause.
Importantly, difficulty falling pregnant does not automatically mean that you need IVF. The first step is understanding what may be preventing pregnancy.
How long should it take to get pregnant?
It is normal for pregnancy not to happen immediately.
In general, women under 35 should consider seeking fertility advice after 12 months of regular unprotected intercourse without becoming pregnant. From age 35, it may be appropriate to seek advice after six months.
If you are over 40 and would like to become pregnant, it is worth discussing your fertility with a specialist sooner.
You should also consider seeking advice earlier if you have irregular or absent periods, known or suspected endometriosis, previous pelvic or reproductive surgery, or concerns about male fertility.
What can cause difficulty falling pregnant?
There are many possible reasons, and fertility difficulties are not exclusively female.
Factors can include:
- problems with ovulation;
- age-related changes in fertility or diminished ovarian reserve;
- blocked or damaged fallopian tubes;
- endometriosis or PMOS;
- conditions affecting the uterus or reproductive system;
- sperm count, movement or morphology;
- other male fertility factors; or
- a combination of factors.
Having regular periods does not necessarily mean that there are no fertility concerns. Regular cycles may suggest that ovulation is occurring, but they do not provide information about factors such as the fallopian tubes, uterus, egg quality or sperm.
Similarly, having conceived previously does not guarantee that another pregnancy will happen easily. Difficulty conceiving after a previous pregnancy is known as secondary infertility.
What about male fertility?
Male fertility should be considered alongside female fertility when investigating why pregnancy has not occurred.
A semen analysis can provide information about sperm concentration, movement and morphology. Depending on the results, further investigation may be recommended.
Assessing both partners from the outset can provide a more complete picture and avoid focusing on only one possible cause.
What is unexplained infertility?
Sometimes standard fertility investigations do not reveal an obvious reason why pregnancy has not occurred. This is referred to as unexplained infertility.
It does not mean that the fertility difficulty is not real or that there are no options available. Rather, it means that the investigations performed have not identified a clear cause.
Your fertility specialist can consider factors such as age, how long you have been trying, previous pregnancies and your investigation results when discussing what may be appropriate next.
What happens at a fertility assessment?
A first fertility consultation does not mean that you will immediately begin fertility treatment or IVF.
The purpose is to understand your medical and reproductive history and identify factors that may require further investigation.
For a female patient, assessment may include a transvaginal ultrasound and investigations relating to ovarian reserve, ovulation and reproductive anatomy. Male fertility can be assessed with a semen analysis. Further tests may be recommended depending on your individual circumstances.
The aim is to answer three important questions:
- What may be preventing pregnancy?
- Does anything need to be done about it?
- If so, what is the most appropriate next step?
Does seeing a fertility specialist mean I will need IVF?
Not necessarily.
IVF is one fertility treatment; it is not automatically the first step when someone has difficulty conceiving.
Depending on the findings of your fertility assessment, management may involve monitoring or medication, ovulation induction, intrauterine insemination (IUI), IVF or ICSI.
The appropriate approach depends on the reason for the fertility difficulty as well as individual factors such as age, reproductive history and previous treatment.
What is the difference between IUI, IVF and ICSI?
Artificial Insemination / IUI (intrauterine insemination) involves preparing sperm and placing it directly into the uterus around the time of ovulation. Fertilisation takes place inside the reproductive system.
IVF (in vitro fertilisation) involves stimulating the ovaries, retrieving eggs and fertilising them with sperm in the laboratory. Embryos are monitored before an embryo is selected for transfer to the uterus.
ICSI (intracytoplasmic sperm injection) is similar to IVF, however the fertilisation process is slightly different. A laboratory technique in which a single sperm is injected directly into an egg. It may be recommended in particular circumstances, including certain male fertility factors.
One treatment is not inherently better than another. What matters is whether it is appropriate for the individual fertility circumstances.
What should I do if I am worried about my fertility?
You do not need to know what is wrong before asking for help, and seeking fertility advice does not commit you to treatment.
If you have been trying to conceive without success, a fertility assessment can help identify factors that may be affecting conception and determine whether further investigation or treatment is necessary.
At Aevitas Fertility Clinic in Cape Town, the starting point is understanding the individual patient or couple before considering treatment options.
If you are concerned about your fertility, you can book a consultation with an Aevitas fertility specialist to discuss your reproductive health and the appropriate next steps.