For those actively trying to conceive, once you’ve made the choice to get pregnant, every negative test result can lead to disappointment. Everyday activities, like a stroll through your neighbourhood, can bring reminders of pregnant bellies and seemingly happy smiling families. The same goes for whenever you tune in to your favourite streaming program or social media accounts… Suddenly, there are happy pregnant people everywhere but you. Frustrating to deal with for sure but don’t worry just yet — you are not alone.
Allow me to break down some possible reasons why you might be having trouble conceiving. The key to reviewing this list is for you to remember that more than one of these possibilities can be going on in your body, at the same time :
1. Endometriosis — This condition affects between 10% and up to 20% of persons born with ovaries and often manifests as chronic pelvic pain with periods or during intercourse. Moreover, endometriosis can be overlooked or misdiagnosed in many while causing issues with diminished ovarian reserve (low egg counts) and fallopian tube scarring. This diagnosis is only formally made via surgery but a skilled gynaecologist or fertility specialist can often help you figure out if you fall into this category.
2. No Ovulation — You will not get pregnant if you are not ovulating. While this is a common fact, persons with ovaries experience the absence of ovulation for different reasons. Reproductive conditions such as dysfunctional thyroid, polycystic ovary syndrome (PCOS), prolactin tumours, primary ovarian insufficiency (aka premature menopause) and weight issues (overweight or underweight) can contribute to this type of anovulatory infertility. Seeing a gynaecologist or fertility specialist can help you determine if any of these issues are at play for you.
3. Male (sperm factor) Infertility — 50% of cases of infertility in couples, where one partner makes sperm and the other makes eggs involve something going on with the sperm! Yes, sperm factor infertility is a big deal but most people do not look into it early enough. In fact, many people just assume that sperm is normal because the person making sperm feels healthy or has sired pregnancies in the past.
However, many medical conditions, environmental factors (e.g. smoking) and simply getting older, can have a direct impact on someone’s ability to make healthy sperm.
If this is the case, diagnosis for sperm factor infertility should take place earlier rather than later! The most straightforward first step in evaluating for sperm factor is to have a semen analysis performed to identify potential issues such as low sperm counts, sperm movement issues, and other sexual related problems. There are different and very successful treatment options available to treat sperm factor infertility if it is identified.
4. Blocked Fallopian Tube — Fallopian tubes are the place in the body where sperm and egg are supposed to meet to start an embryo. The tube(s) also help transport the fertilized embryo to the uterus, where it can implant to form a pregnancy. If one or both tubes become blocked, conception can become more difficult, as chances of egg and sperm meeting go to slim or zero. Endometriosis, history of chlamydia infection or pelvic inflammatory disease (PID), and surgeries on the fallopian tubes (e.g. tubal ligation) are the leading cause of blocked fallopian tubes. Getting a hysterosalpingogram (HSG) dye test to help determine if one or both fallopian tubes are open or blocked is important when assessing your attempts to conceive.
5. Your Vices — The fun and recreational things that humans sometimes indulge in can take a toll on your fertility. Drinking alcohol in excessive amounts, smoking/ingesting cigarettes or marijuana (THC) products can directly impact your egg or sperm counts and also negatively affect how they function. Certain foods, certain packaging/storage containers and certain cosmetic ingredients can also negatively impact your hormonal functioning and your egg/sperm counts and quality. Consider talking to your fertility specialist to get more details on this.
6. Age — For the person born with ovaries, age is the BIGGEST determinant of your chances for successfully conceiving and going on to deliver a liveborn baby! This is because you are born with all the eggs that you are destined to have and those eggs age with you, while their total numbers decline with age. If you have ovaries and are under the age of 35, you should speak with a fertility specialist after 1 year of trying to conceive; if you are 35 or older, you should seek out a fertility specialist after 6 months of trying to conceive. For those born with testicles, as mentioned above, you should get a semen analysis to start.
7. Uterine Fibroids (aka Myomas) — When it comes to fibroids, it’s about Location! Location! Location! Knowing the exact location of fibroids is critical to determining if they are impacting your fertility. In fact, a small fibroid sitting within the cavity of the uterus (where a baby is supposed to implant and grow) can have a major negative impact on your ability to get pregnant and stay pregnant while a large fibroid that sits outside of the uterus will have little to no impact. Similarly, a small fibroid pressing against the point where your fallopian tubes meet the uterus can also negatively impact your ability to get pregnant.
8. Stress — Although we do not directly link stress to infertility, we understand that it is hard to relax and calm down when you’re high in emotion due to the frustrations of not being able to conceive. This can in turn lead to behaviours that undermine your efforts to conceive or lead to shifts in hormones, such as cortisol, that do not favour ovulation or implantation. Therefore, we encourage seeking out ways to manage stress while you work on looking into everything else listed above.
If you are struggling to get that positive pregnancy test, the first step to do is to identify if any of the above potential roadblocks exist for you. Start by evaluating your lifestyle habits and your health history. If the months keep passing and the sign of pregnancy is still out of reach, consult a fertility specialist to further address any underlying issues.
All the best!