After a lifetime of condoms and birth control pills, it can be a shock if your first few months of unprotected sex don’t lead to pregnancy. For most couples, the answer is just patience—80 percent of couples who have sex two or more times a week will get pregnant within a year on their own.
But what about those who don’t? If you’re under 35 and you’ve been trying for a year (or are over 35 and have been trying for six months), it might be time to see your doctor and investigate possible reasons why you’re not getting pregnant. The answer often comes down to age (because as you get older, you have fewer eggs, and they are more likely to have defects, so they won’t implant in your uterus) or an issue with your partner’s sperm. But there are also common medical issues that cause infertility. The good news is, most are reversible with treatment. Here are five common health problems that might be keeping you from getting pregnant.
1. Polycystic ovary syndrome (PCOS)
PCOS causes a hormonal imbalance that interferes with your body’s ability to release eggs, and it’s the most common cause of infertility, says Yaakov Bentov, a reproductive endocrinologist and research director at Toronto’s Anova Fertility. You might have it if you have irregular periods, and facial hair or acne (which can indicate the presence of higher than normal levels of the male hormone androgen). The good news is, PCOS can be treated by a family doctor with an oral medication like letrozole, which helps you ovulate. “The treatment is very cheap, people can get it outside of a fertility clinic, and unlike with in vitro fertilization (IVF), they’re more likely to only have one baby and a healthy pregnancy,” says Jeff Roberts, a reproductive endocrinologist and co-director of the Pacific Centre for Reproductive Medicine in Burnaby, BC.
Problems getting pregnant? It could be PCOS
If you have severe pain every month around the time you get your period, endometriosis might be to blame. It’s a result of the type of tissue that should be growing inside your uterus growing—and bleeding—into your abdomen instead. Though, for many people, it doesn’t affect fertility, in others endometriosis can cause chronic inflammation, which reduces the chances of an embryo successfully implanting in the uterus. In more severe cases, it can also lead to the fallopian tubes being scarred and blocked. Treatment is different for pain than it is for fertility: surgery might be performed to remove the extra endometrial tissue to relieve pain, whereas IVF is most commonly used to bypass any issues with the fallopian tubes to help women get pregnant.
3. Uterine fibroids
Fibroids are non-cancerous tumours that grow in your uterus and cause heavy periods and abdominal pain. They are found in about one-third of women, says Bentov, and you’re more likely to have them if you’re of African descent. Most often, they don’t affect fertility, though one subtype, known as submucosal fibroids, grow in the lining of your uterus, making it harder for the embryo to implant, and easier to miscarry. “That’s why when we test women [at our fertility clinic], we always look into the uterine cavity for fibroids,” says Bentov. The fix is most often a simple day surgery that shaves off the fibroids through the cervix.
Feeling tired and more prone to weight gain than usual? In some people, that’s a sign of hypothyroidism, which occurs when your body doesn’t make enough of the hormones produced by your thyroid—triiodothyronine (T3) and thyroxine (T4). Along with making you feel sluggish and put on extra pounds, hypothyroidism can also interfere with the hormonal signals that make your ovaries release eggs. The good news is hypothyroidism is usually easy to treat with a synthetic thyroid hormone called levothyroxine.
5. Pelvic inflammatory disease
Some sexually transmitted infections, including chlamydia and gonorrhea, often have no symptoms so they go untreated, which can lead to pelvic inflammatory disease. “Pelvic inflammatory disease occurs when bacteria from these diseases track up the vagina, into the uterus and the tubes, which are normally sterile environments,” says Roberts. That can create scar tissue that blocks the fallopian tubes. In some cases, surgery can help with scar tissue, but the procedure doesn’t yield very good pregnancy rates. Still, many women with pelvic inflammatory disease can still get pregnant with IVF, which bypasses the fallopian tubes.