1.06 Why are we having problems getting pregnant?

In the last two episodes we discussed when and where you should seek help, today we are going to talk about some of the reasons you might have problems falling pregnant.

As we have discussed previously, the first question is do you actually have a problem? If you are under the age of 35 and you stopped contraception more than 12 months ago or if you are over the age of 35 and have been trying to fall pregnant for more than 6 months, you may have a problem. If you or your partner have any known conditions or if you are unable to have sex at the right time in your cycle, you may also have a problem.

Now fertility problems have a lot of causes and even though the end result is the same – that is a problem getting pregnant – the solutions are often quite different.

So what are the causes? In general, we divide these into three: problems with the sperm, problems with the egg or problems with the pelvis.

Problems with the male make up almost half the problems that we see. Male problems, in particular, have few symptoms and you often can’t tell that there are any issues, unless there’s a problem having sex. Unfortunately, problems achieving an erection or ejaculating are often left out of discussions on fertility, but, in fact, the reason we advise couples to have sex every second day is exactly that – to take the pressure of the couple, because the number of people who have problems having sex increases significantly after a few months of timed intercourse.

The second most common problem that we see is a problem with the egg or ovulation. The biggest problem off course is egg quality and the major cause here is age.

As we have discussed previously, it doesn’t matter how healthy you are, your chances of falling pregnant drop after 35, become critical over 40 and it is pretty much all over by 45. Unfortunately, there is little you can do about age.

The other common reason relates to ovulation itself. There are a number of conditions that cause problems with ovulation and the most common is polycystic ovary syndrome or PCOS. PCOS is actually not a condition of the ovary, but rather a problem of metabolism and the consequence of this is that the ovary is frozen in time in a state that is similar to about day 5 of the cycle. Other than PCOS, there are many other causes of ovulation problems, including hormonal causes such as thyroid abnormalities.

The third issue that can cause infertility is the female pelvis. Obviously, sperm actually need to get to the egg, the fertilized egg needs to be transported back to the uterus, needs to implant and establish a pregnancy. Problems can occur in any of these, from women born with abnormalities in each of these areas or conditions like endometriosis, where the lining of the uterus grows in areas outside of the endometrial cavity, or fibroids, where areas of the muscle overgrow or infections. Chlamydia is one of the most causes of infertility worldwide and you may not even know that you have had such an infection.

In the next few episodes, we will be talking about a number of these conditions, how we diagnose these, how they affect your fertility and what we can do to manage them.