Why can’t I fall pregnant?

Infertility for a couple is the inability to get pregnant despite having frequent, unprotected sex for at least a year.

It may be because of issues with you or your partner or a combination of factors that prevent pregnancy.

It is important that both partners are seen and examined to find the cause so it may be treated. Some women with infertility may have irregular or absent menstrual periods. Men with infertility may have other signs of hormonal problems.

Women, consult a doctor if you:

• Are older than 35 and have been trying to conceive for six months or longer;
• Have irregular, painful or absent periods; v Have had miscarriages;
• Have been diagnosed with endometriosis or pelvic inflammatory disease;
•  Have had treatment for cancer

Men, see a doctor if you:

• A history of testicular, prostate cancer or sexual problems;
• A low sperm count or other problems with sperm;
• Had treatment for cancer;
• Small testicles or swelling in the scrotum; and
• If others in their family have infertility problems.

Causes of male infertility

• Genetic defects;
• Chronic health problems such as diabetes. Sexually transmitted infections may cause abnormal sperm production;
• Enlarged veins in the testes (varicocele) can also affect the quality of sperm;
•  Problems with the delivery of sperm due to sexual problems, certain genetic diseases or damage or injury to the reproductive organs.
• Exposure to environmental factors like pesticides, chemicals and radiation. Cigarettes, alcohol, marijuana, anabolic steroids and taking medications to treat bacterial infections. High blood pressure and depression can also affect fertility;
•  Frequent exposure to heat such as in saunas or hot tubs, can raise body temperature and may affect sperm production;
•  Damage related to cancer and its treatment including radiation or chemotherapy. Cancer treatment for cancer can also impair sperm production.

Causes of female infertility

• Hormonal disorders can cause ovulation disorders, which affect the release of eggs from the ovary;
•  Hyperprolactinemia, a condition in which you have too much prolactin – the hormone that stimulates breast milk – may also affect ovulation;
• Too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility;
• Too much exercise, eating disorders or tumours;
• Uterine or cervical abnormalities, including abnormalities with the cervix, polyps in the uterus or the shape of the uterus. Noncancerous tumours in the uterine wall (uterine fibroids) may also cause infertility by blocking the fallopian tubes or stopping a fertilised egg from implanting in the uterus;
•  Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube. This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions;
•  Endometriosis may affect the function of the ovaries, uterus and fallopian tubes;
• Early menopause, when the ovaries stop working and menstruation ends before 40;
• Pelvic adhesions, bands of scar tissue that bind organs that can form after pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery;
• Cancer. Certain cancers – particularly reproductive cancers – can impair female fertility. Radiation and chemotherapy may also affect fertility.

Risk factors

• Age. For women, it drops after 37 and men over 40 may be less fertile than younger men;
• Smoking. Cigarette or marijuana smoking by either partner may reduce the likelihood of pregnancy;
• Alcohol. Heavy drinking can decrease fertility;
• Being overweight. An inactive lifestyle and being overweight may increase the risk of infertility. For men, the sperm count may be affected.
• Being underweight. Women at risk include those with eating disorders and those who follow a very low-calorie or restrictive diet;
• Exercise. A lack of exercise contributes to obesity, which increases the risk of infertility

Prevention

Some causes are not preventable, but several strategies may increase your chances of pregnancy. Having regular intercourse around the time of ovulation will increase your chances. Intercourse beginning at least five days before and until a day after ovulation also improves your chances. Ovulation usually occurs in the middle of the cycle.

Diagnosis

There may usually not be a cause for concern. Just ensuring the couple is having regular sex around ovulation dates may be all that is needed.

Tests for men

Male fertility requires that the testicles produce enough healthy sperm. Male infertility tests will determine if this process is impaired.