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It can feel like a cruel game of hide and seek: Many women spend years actively avoiding pregnancy, but when they welcome it, it evades them. If that sounds familiar, take heart: “It can be totally normal to try for 11 months and not achieve a pregnancy,” since infertility is defined as having unprotected sex consistently for a year without getting pregnant, says Dr. Stephanie Romero, an OB-GYN and assistant professor at the University of South Florida Morsani College of Medicine. Even if something is wrong, you can take comfort in company — about 1 in every 6 U.S. couples faces infertility at some point. Among the (often treatable) reasons:
You’re old(er).
Ready or not, here the truth comes: Female fertility hits a significant tipping point around age 35, and declines most drastically after 40. “Mother Nature wanted us to have our 10 kids by the time we were 25 and maybe drop dead by exhaustion at 40,” says Dr. Serena H. Chen, a reproductive endocrinologist and OB-GYN in Livingston, New Jersey. “That really is our biology.” But choices like egg freezing are increasingly available for women who want to delay pregnancy. “We can’t solve the age-related issue,” says Chen, who serves on the medical and scientific advisory board for Progyny, a company that offers fertility solutions including egg freezing, “but we can give people options.”
You smoke.
It’s all fun and games until you want to get pregnant. “Smoking and drinking and drug use can all have a significant impact on your health, and especially your reproductive health,” Chen says. Smoking can cause women’s eggs to die off faster; in fact, up to 13 percent of female infertility is caused by cigarette smoking, the American Society for Reproductive Medicine reports. The good news is that changing your lifestyle habits can make a big difference. Quitting smoking, for one, “will improve your fertility, lower your miscarriage risk and improve your chances of having a baby,” Chen says, “but it doesn’t stop the biological clock.”
You’re carrying a lot of extra fat.
Obesity affects all body systems, and the reproductive system is no exception. “[Fat] is not a passive tissue — it’s an inflammatory organ [that’s] damaging our bodies,” Chen explains. What’s more, obesity can lead to hormonal changes that compromise fertility by, for example, leading to irregular periods and ovulation — when an ovary releases an egg to be fertilized. Women who are obese are also at higher risk for medical conditions that can compromise fertility, such as thyroid disease and diabetes. The American Society for Reproductive Medicine recommends talking to a provider about whether you should try to lose weight before trying to get pregnant.
You’re underweight.
Fat is also a very necessary tissue for the reproductive system; too little can weaken your chances of pregnancy by altering or even halting your period and ovulation. “Our bodies preserve ourselves at the expense of fertility,” says Dr. Eric Levens, a reproductive endocrinologist at Shady Grove Fertility’s Northern Virginia location. Long-distance runners, ballerinas and women with eating disorders are among those who may need to increase their body fat before trying to get pregnant. If you’re not having regular cycles, “seek care very quickly,” rather than wait 12 months, Levens says, since there’s already a problem and time is of the essence to determine a cause and treatment.
You have a medical condition.
A top cause of female infertility is a condition that many women don’t know they have and many more have never heard of: polycystic ovary syndrome, an endocrine disorder that can cause follicles to collect on ovaries and lead to irregular periods and other symptoms. “Your ovaries aren’t getting the hormonal input from your brain and you’re not ovulating when you should,” Romero says. Endometriosis, too, is a top cause of female infertility that often goes undiagnosed. Genetic conditions, thyroid problems, fibroids, chlamydia and blocked fallopian tubes may also be to blame. “If you’re worried, seek counsel,” Leven says, since most conditions are treatable. “You don’t have much to lose.”
It’s not you.
While infertility is often bucketed as a women’s issue, about 40 percent of the time, a couple’s problem can be traced at least in part to the man, ASRM says. “There’s a fairly equal distribution between male and female factors,” Levens says. For example, erectile dysfunction, ejaculatory issues, spinal cord injuries, tumors and undescended testes are all fairly common (and often treatable) culprits of male infertility. Because basic testing for these problems is relatively simple and cheap, Levens typically begins with the man when narrowing down why a couple might be having trouble getting pregnant. “Treatment is based on history, underlying medical issues and these test results,” he says.
No reason.
If male factors are ruled out and a woman’s workup — which might include a medical history, blood and imaging tests to evaluate egg supply, and a hysterosalpingogram, which can reveal blocked fallopian tubes — comes up normal, you may be slapped with “unexplained infertility.” “That’s probably one of the more frustrating categories because there’s not that ‘aha’ moment,” Levens says. Still, it’s important for clinicians to know what the problem is not before counseling patients on options like medications to stimulate egg growth or assisted reproductive technology like in vitro fertilization. “You should at least make an informed decision,” Chen says, “instead of just hoping things will work themselves out.”
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