Common Reasons for Not Conceiving & Other Infertility Issues

Almost every couple dreams of building a family. They dream of bearing a child and nurturing it with the best of their abilities. However, at times, medical or lifestyle reasons can hinder the process and stand in the way of conceiving. This article will provide in-depth knowledge of the reasons why one may not conceive.

Major Reasons for Not Getting Pregnant

If you have been trying unsuccessfully for a while and the thought of “why am I not getting pregnant” disturbs you, here are some of the possible reasons behind the problem:

1. Lack of a Healthy Sex Life

Surprisingly, this is one of the main reasons for not conceiving. The timing of intercourse should be such that it is 1 to 2 days before the fertile period of ovulation. It is not enough to just enjoy the act during this window but rather enjoy it every other day. Too much or too little is cutting it too close. While too much sex can lead to burnout and a loss of interest in intercourse during the fertile period, too little sex can also lead to missing the fertile period as you may not always be able to correctly assess when you are ovulating.

2. Being Nervous during Intercourse

If you are not enjoying the act, then your body is stressed and will not go through the natural processes. Somewhere, there may be a glitch, and your body will end up not desiring the act and negating it. It is important that you enjoy and let your instincts take over.

3. Being Stressed

When a body is stressed, it seeks rest and a way to relax. Intercourse, being a physical process, hinders this desire of the body. Rather than relaxing it, it makes you more irritable and exhausted. Under such circumstances, the body is in no condition to receive and aid in growing a baby in the uterus.

4. Using the Washroom Soon After Sex

It is natural to feel the need to wash up once you are done or just relieve yourself. It is important, however, that you don’t rush into this but rather stay in bed for a minimum of 20 minutes. This gives the sperms enough time to stay in your uterus and swim up to find the egg. It increases the probability of multiple sperms reaching the fallopian tubes where the egg is located and fuse with it. If you are running into the washroom soon after sex, the sperms have no time to reach the egg but rather are pulled out of the body due to gravity and during the wash.

5. Smoking or Drinking

Smoking or drinking greatly reduces your ability to produce germ cells (eggs in the females and sperms in the males). Smoking or drinking pulls down the body’s ability to produce healthy germ cells.

6. Working Out Too Hard

When you subject yourself to strenuous workout routines, the uterus goes through a lot of pressure, and this disrupts the natural cycle and lowers the chances of a pregnancy. You can continue your routine but not as extensively. Jog at a lower speed than usual or do a cardio work-out but with fewer repeats and strain.

7. Not Hydrating Yourself Enough

Water flushes out all the toxins in the body, keeps you fresh, and regulates the metabolism to function perfectly. Not being hydrated enough can interfere with your ability to conceive.

8. Medical Conditions

There could also be medical conditions behind problems in conceiving. Either of the individuals in a couple could be affected by conditions that could cause trouble getting pregnant. A few of the factors have been named in the table and discussed in detail in the article.

In Males	Sperm morphology, semen diseases, hormonal imbalance, diseases, previous surgeries, genetic factors, etc.
In Females	Irregular periods, low number of eggs, hormonal imbalance, anatomical abnormalities, previous surgeries, genetic factors, etc.

Causes of Infertility

A couple is considered to have primary infertility only if they are unable to conceive naturally after trying for a year. As mentioned earlier, infertility could be due to various reasons. These conditions can be diagnosed by an andrologist (male) or a gynaecologist (female) and can be corrected accordingly.

In Men

Male infertility happens when:

• They produce sperms which are morphologically abnormal
• They produce a low number of good quality sperms or produce non-motile sperms
• Genetic abnormality leading to sterility
• A sexually transmitted disease (STD) which has caused abnormality
• Lifestyle problems

In order to understand where the problem lies, your doctor will subject you to a physical exam, and ask you personal questions about your sex life, eating habits, and various other questions. In case the need arises, they will ask you to undergo a semen and sperm analysis test. Based on the results, further specific tests will be done.

1. Physical Examination

The doctor checks for any abnormalities in the sexual organs. For example – undescended testicles (a condition where the testicles have failed to enter the scrotum after birth. This could hamper the sperm production), tumours, and abnormal growths which hamper the proper functioning of the organ

2. Hormone Evaluation

Testosterone is the main male sex hormone. This regulates the growth and production of sperms. If the body has an abnormal level of this hormone, sperm production does not follow the normal cycle.

3. Sperm and Semen Analysis

This test checks for the number of sperms, number of motile sperms, the morphology of sperms, amount of semen present in one ejaculate, and consistency of the semen. If these differ from the normal grade, various other tests are done to pinpoint exactly what is causing the issue.

4. Anti-Sperm Antibodies

In some cases, the body makes abnormal antibodies which attack sperms once ejaculated. These antibodies kill the sperms and do not allow them to penetrate and fertilise the egg.

5. Varicocele

This is a common condition which occurs mostly in the legs of those who continue to stand throughout the day. Veins swell up and cause obstructed blood flow leading to muscular damage to that area. This also occurs in the veins present in the testis. A varicocele in the testis lowers the sperm quality. This condition can usually be reversed.

6. Tumours

Tumour growth in the reproductive tract can damage the functioning of the system. These malignant tumours can affect the glands that release the sex hormone, affect the production of cells, or obstruct the passageway. Sometimes, this condition can be corrected through chemotherapy. However, chemotherapy may also cause the organs more damage, and the germ stem cells may acquire genetic flaws.

7. Abnormal Sperms

There are various factors that affect sperms, rendering them abnormal and losing their ability to fertilise an egg.

• Oligozoospermia

In this case, there is a lowered level of sperm production. On a broad spectrum, this condition is caused due to hormonal anomaly, poor health, or anatomical irregularity.

• Asthenozoospermia

This is a condition where the sperm motility is hampered. Sperm cells need to be highly active and motile in order to swim through the vast distance to reach the egg cell and fertilize it. If these sperms are “lazy” or not active enough, they are unable to do so and fail to aid in pregnancy.

• Teratozoospermia

This term refers to morphologically hampered sperms. If there are any damages to the structure of the sperm cell, it gets naturally aborted or the viability gets drastically reduced.

• Azoospermia

This is where the semen contains no sperms. It has varied forms, most of which can be medically corrected.

• Pretesticular

In this case, due to hormonal imbalance, the testicles do not receive a healthy dose of testosterone to produce sperm cells.

• Testicular

Here the organ itself is abnormal, damaged, or the sperm production is fully absent or not up to the optimum level.

• Post-Testicular

In this case, sperm cells are produced but are not ejaculated into the semen. The main underlying cause is due to an obstruction or absence of a tubule. This condition is pretty rare and can be surgically corrected.

• Leucocytospermia

This condition defines a semen sample which contains a high number of white blood cells. There are cases of asymptomatic conditions which have an increased production of white blood cells in the semen. According to research, this could be due to an unhealthy lifestyle or an actual bacterial infection. Rarely, sperms from such samples have had a high probability of fertilization during artificial reproductive techniques but when it comes to the archaic way, such samples have been associated with borderline infertility. The condition can be fully reverted to antibiotic treatment.

• Aspermia

Here, men experience a “dry ejaculate” where the semen with the sperms is not released from the penis but reverts to the bladder. This happens due to retrograde ejaculation or an obstruction. Both of these can be surgically corrected.

• Necrozoospermia

This is a condition where the sperms are non-motile. It refers to dead sperms in the ejaculate.

8. Retrograde Ejaculation

In this case, the ejaculate moves back into the bladder instead of exiting through the penis. This occurs either due to a previous pelvic surgery or when the vans deferens (tube connecting the testis to the penis) is missing because of a genetic condition.

9. Obstruction

There can be an obstruction anywhere from the testes till the penis, and this does not give a clear passage for the sperms to move out.

10. Problems with Sexual Intercourse

This occurs due to various reasons such as:

• Erectile dysfunction – The erection is not maintained for a sufficient amount of time
• Premature ejaculation – Where the orgasm is reached before semen and sperm cells are mixed
• Anatomical anomalies – Where the parts of the anatomy are not how they are supposed to be
• Physiological or relationship problems that interfere with the act

11. Celiac Disease

It is basically a digestive disorder due to sensitivity to gluten. One of the symptoms happens to be infertility. Adopting a gluten-free diet can reverse the condition.

12. Certain Medications

Some medications can disrupt sperm production and lead to infertility. A few of them are –

• Testosterone replacement therapy
• Long-term anabolic steroid use
• Cancer medication
• Certain antifungal medications
• Some ulcer drugs

13. Prior Surgeries

Infertility could be a side-effect of surgeries previously undertaken by the individual. These can always be corrected through another corrective surgery. Some of the surgeries which could lead to such an effect are –

• Inguinal hernia repairs
• Scrotal or testicular surgeries
• Prostrate surgeries
• Cancer surgeries on testicular or rectum
• Vasectomy

14. Idiopathic Infertility

In common terms, this refers to a condition where the causal factor cannot be pinpointed to a particular trait or a missing element.

15. Genetic Anomaly

Due to some genetic factors, men are rendered sterile. The chromosome gets silenced or it goes missing or in some cases a microdeletion in the Y chromosome causes the testis to produce abnormal sperms. This being a birth defect has no cure or treatment course.

Certain environmental factors can also bring about infertility in males. These factors influence the traits with a force equal to that of genetic characters. Some of these are –

• Exposure to industrial chemicals can lead to low sperm count. e.g.: Benzene, Toluene, etc.
• Radiation or X-rays cause DNA damage leading to abnormal cells which are killed inside the body.
• Increased temperate can kill the sperms in the testicles.
• Prolonged exposure to fertilisers, herbicides and pesticides like nitric oxide reduces sperm motility and viability and impairs the ability of the sperm to penetrate the oocyte. Dichlorodiphenyltrichloroethane (commonly called DDT) affects sperm count.
• Low-grade plastics can enter the body when used to store food, get mixed in the bloodstream, reach the male reproductive system, and affect the sperm count, motility and viability.

In Women

A woman’s body needs to be in good health in order to conceive since it has to undergo the physical changes to nourish a growing, healthy baby. Thus, your health needs to be checked if you are having problems in conceiving. Some issues women face may be because of the following reasons:

• Ovulation problems due to hormonal imbalances, tumours or cysts, eating disorders, thyroid gland problems, excess weight, stress or extremely brief menstrual cycles
• Pelvic inflammatory diseases, endometriosis or fibroids, scar tissue or adhesion
• A previous ectopic pregnancy, previous birth defects, etc.

All these factors affect the working of a woman’s body towards a healthy pregnancy. The main factors that contribute to causes of infertility in females are –

1. Disruptive Menstrual Cycles

In this case, the cycles are either too long (35 days or more), too short (less than 21 days), irregular, or not occurring. Under such conditions, a mature egg is not being released for pregnancy to occur.

2. Ovulation Disorders

This is related to the above disorder. This condition persists due to either of the factors stated below –

• PCOS (Polycystic Ovarian Syndrome)

Due to hormonal imbalances, an egg is not released but rather persists inside the ovaries in the form of fluid-filled cysts.

• Hypothalamic Dysfunction

Follicle stimulating hormone (FSH) and leutanizing hormone (LH), which are produced in the hypothalamus, are responsible for regulating the growth, maturation, and release of an egg every month. If there are any disruptions to these hormones, the proliferative stage gets disrupted.

• Premature Ovarian Failure

This is a disorder where the premature eggs are lost in the ovary without ever maturing due to an autoimmune disorder, genetic factors, or hormonal causes.

• High Levels of Prolactin

A high amount of prolactin in the body reduces the production of oestrogen which is responsible for the maturation and proliferation of eggs. This could be caused due to a medication or an anomaly in the pituitary gland.

3. Tubal Infertility

This condition refers to a physical obstruction or damage to the fallopian tubes which connect the ovaries to the uterus. Fertilisation occurs in these tubes after which the zygote travels down into the endometrium. Some of the reasons for this problem are:

• Pelvic Inflammatory Disease: Chlamydia, gonorrhoea, or any other STD can cause inflammation of these tubular cells leading to a blockage
• Previous surgery in the abdomen or the pelvis
• Pelvic Tuberculosis

This is a bacterial pelvic infection. Once the bacteria infect the lungs, it reaches the bloodstream and gets transported to various parts of the body. Fallopian tubes form the perfect area for these bacteria to reside. This causes inflammation and blocks off this segment of tissue from various other forms of response from the body.

4. Endometriosis

This is a condition where the tissue growth occurs in sites other than where it is supposed to grow. It tends to outgrow into the surrounding area. Upon correction through surgery, the healing process leaves scars. These scars, if in the fallopian tubes, tend to block them. If in the uterus, they can disrupt the implantation of a zygote in the endometrium.

5. Uterine or Cervical Causes

Several factors can disrupt the process of implantation or increase the chances of miscarriages.

• Fibroids or tumours in the uterus which can block the fallopian tubes
• Endometriosis scarring
• Uterine abnormalities present from birth
• Cervical stenosis: where the uterus is narrow and cannot support pregnancy
• Inability to produce the optimum amount of mucus which aids in the travel of sperms into the fallopian tubes

6. Not Enough Healthy Eggs

A woman is born with a particular number of eggs in her ovaries. As she ages, these eggs mature every month and get reduced in number. If there are not enough premature eggs present in the body, the chances of pregnancy reduce drastically.

7. Chronic Medical Illnesses

These conditions are those which persist in the body for a long time and disrupt the functioning of the other organ systems in the body.

• Chronic liver and kidney diseases impact the functioning of pituitary glands leading to infertility.
• Cystic fibrosis causes the production of thicker cervical mucus which makes it harder for the sperms to penetrate the cervix and enter the uterus.

8. Thyroid Disorders

Thyroid problems can cause unintentional weight loss leading to no ovulation.

9. Chemotherapy

Due to the reverberated chemical factors in the body, the eggs get affected and are killed off in this duration. Women can freeze their eggs before undergoing chemotherapy so as to implant them after for a pregnancy.

10. Lifestyle

Different factors of your lifestyle greatly influence your fertility.

• Age: After the age of 30, follicle loss increases, resulting in a lower number of good quality eggs.
• Smoking: This damages the fallopian tubes and the uterus. The risk of miscarriages and chances of an ectopic pregnancy also increase.
• Weight: An increased or decreased BMI greatly influences your body’s ability to support a pregnancy.
• Alcohol: It decreases healthy egg production.

11. Diabetes Mellitus

It has been observed that women with Type 1 Diabetes have an increased risk of delayed puberty, menstrual irregularities, hormonal imbalances, PCOS, low number of live births, and early menopause.

12. Coeliac Disease

This is an autoimmune disorder triggered by gluten in the diet. Non-gastrointestinal symptoms of this disease are observed to be late puberty, menstrual irregularities, and a higher risk of pregnancy complications.

13. Drugs/Medication

The drugs used to treat diseases also have the ability to cause infertility. A few of them are:

• non-steroidal anti-inflammatory drugs
• neuroleptic medicines (used to treat psychosis)
• spironolactone (a medicine taken to reduce fluid retention)

14. Stress

This is a factor that mostly results in a hormonal imbalance which leads to irregular periods.

15. Xenohormones

These are substances present in the environment which are absorbed by the body through the skin. Once absorbed, they decrease the level of progesterone which reduces fertility. These substances are mostly present in car exhausts, plastics, pesticides, emulsifiers in soaps and cosmetics, etc.

16. Prolonged use of Birth Control Pills

The birth control pill (also prescribed for fertility issues such as PCOS or endometriosis) has been linked to fertility issues in some women.

17. Unexplained Infertility

Unexplained infertility is where the cause is never found. It could be due to several minor factors or a culmination of factors present in both individuals of a couple.

18. Genetic Factors

This is where the genes encode for abnormal anatomy, abnormal hormonal levels, etc., leading to sterility in an individual.

Health and Other Causes of Infertility

1. Drug Abuse

Anabolic steroids which are taken to increase body mass have been observed to shrink the testicles and lower sperm production

2. Alcohol Use

Alcohol lowers testosterone production which causes erectile dysfunction and sperm production

3. Emotional Stress

Stress hampers the normal hormonal cycle which in turn affects the sperm production

4. Wearing Tight-Fit Clothes

This has also been linked to problems in fertility due to reduced sperm production

Fertility Tests

Fertility tests help identify the issues that could be triggering problems in conceiving. They must be taken by both the man and the women if conception is taking time. Here is a list of the tests you may need to go for if you detect any signs that you can’t get pregnant.

1. For Men

These tests are used to image the anatomy of a man to deduce the anomaly present.

Semen analysis	Tests for sperm abnormalities, sperm count, sperm number, sperm mobility
Hormone tests	Test for testosterone, FSH, LH, and prolactin
Urinalysis	Test for presence of white blood cells indicating infection
Vasography	X-ray exam to determine blockage or leakage of tubes
Ultrasonography	Exam used to detect blockages in the reproductive tract, prostrate duct, seminal vesicles, ejaculatory ducts
Genetic testing	A DNA analysis to determine any genes causing infertility

2. For Women

These female infertility tests are used to image the anatomy of a woman to deduce the anomaly present.

Ovulation testing	Detects the surge of ovulation-inducing hormones to analyze a menstrual cycle
Hysterosalpingography	Detects the abnormalities in the uterine cavity. X-ray contrast in injected and observed under X-ray exposure
Ovarian reserve testing	Detects the number of good quality eggs present in the ovaries
Hormone testing	Hormones related to ovulation, pituitary and thyroid are checked
Laproscopy	Invasive technique where using a thin incision an optical tube is inserted to clearly view uterus, endometrium and fallopian tubes
Ultrasound	Uterine and fallopian tube anomalies are deduced. This test may be conducted if the woman is ovulating but not getting pregnant
Genetic tests	A DNA analysis to determine any genes causing infertility

How Long Can I Try to Conceive Before Seeing a Doctor?

The duration for which you should try to conceive before consulting a doctor depends on your age. If the mother is less than 35 years old, the couple should speak to a doctor after 1 year of trying, but if she is older, it is advisable to see a doctor after 6 months of trying.

Advancements in science and applied medicine have resulted in synthesizing techniques of treatments to solve the above issues. If you are facing problems in conceiving, consult your doctor to get help through these rough patches.

Also Read: Fertility Treatment – Assisted Reproductive Technology