Why are we having trouble getting pregnant? — Getting pregnant depends on both the woman and the man. A couple might not be able to get pregnant because of an issue with the man's body, the woman's body, or both.
What are the reasons a woman might have trouble getting pregnant? — A woman can have trouble getting pregnant for different reasons. These include:
●Problems with ovulation – Ovulation is the time in a woman's monthly cycle when the ovary releases an egg into the fallopian tube. Hormones control ovulation. Pregnancy can occur if sperm fertilizes the egg as it travels to the uterus after ovulation. Women have the highest chance of getting pregnant if they have sex 1 to 2 days before ovulation or on the day of ovulation. In some women, ovulation does not happen on a regular basis or at all.
●Problems with the uterus or fallopian tubes – For example, some women have scar tissue in their fallopian tubes from past infections or surgery. This scar tissue can cause the fallopian tubes to be blocked.
●Endometriosis – Endometriosis is a condition that can cause pain in the lower part of the belly. This can also lead to trouble getting pregnant.
●Older age – Once women get into their mid-to-late 30s, it can be harder to get pregnant, so it can take longer. Getting pregnant can be even more of a problem for women in their 40s.
When a couple has trouble getting pregnant, doctors often do tests in both partners to try to figure out the cause. But even with tests, doctors sometimes cannot figure out why a couple can't get pregnant.
When should we see a doctor? — Most doctors recommend that a couple begin having tests if they cannot get pregnant after having unprotected sex for 1 year. But if you are worried, talk with your doctor or nurse. He or she might recommend that you have tests done sooner. Tests are done sooner in women over 35. Tests are also done sooner in women who don't have a period every month.
What tests are done for men? — For men, the doctor will ask him questions about his health and sex history, and do an exam. He or she will often order a test to check how many sperm are being made and how healthy the sperm are.
Other tests that a man might have include:
●Blood tests – Some blood tests check male hormone levels. Abnormal hormone levels can make it hard to get his partner pregnant. Other blood tests can check if there is a genetic condition that can make it hard to get his partner pregnant.
●Ultrasound – This imaging test creates pictures of the inside of the body and can check if a sex organ is abnormal. For example, some men have a block in a structure called the "vas deferens," which is the tube that sperm needs to travel through.
●Urine tests – Urine tests can check if sperm are moving in the wrong direction and going back into the bladder during sex instead of out the penis.
●Biopsy – A biopsy might be done if a sperm test shows that a man has zero or a very small amount of sperm. During a biopsy, a doctor collects a small tissue sample from inside the testicle. Then the doctor can look at the sample under a microscope to check if sperm are present.
What tests are done for women? — For women, your doctor will ask you questions about your health, monthly periods, and sex history. He or she will also do an exam.
Women might then have 1 or more of the following tests:
●Blood tests – Blood tests can check female hormone levels. Abnormal hormone levels can make it hard to get pregnant. Blood tests can also be done to check for genetic problems that can make it hard to get pregnant.
●Ovulation tests – Different tests can be used to check if a woman is ovulating. Ovulation is when an egg is released from the ovary into the fallopian tube. It needs to occur for a woman to get pregnant.
●Tests to check the uterus and fallopian tubes – These tests are described below. Problems with the fallopian tubes and uterus can make it hard to get pregnant. For example, some women are born with an abnormally-shaped uterus. Or women might have blocked fallopian tubes from past infections or surgery.
What tests check the uterus and fallopian tubes? — Doctors can do different tests to check for problems with the uterus and fallopian tubes. These include:
●Ultrasound, X-ray, or other imaging tests – These tests can create pictures of the inside of the body and can check for blockages or other problems. The test most often performed is called a hysterosalpingogram, or HSG.
●Tests that look inside the body – These tests are not as simple as imaging tests, because they involve procedures. A doctor can look inside the body using a small tube with a camera on the end. He or she can put the tube into the vagina, past the cervix, and up into the uterus to look at the inside of the uterus. This is called a hysteroscopy. He or she can also put the tube through a small opening in the skin in the lower part of the belly to look at the outside of the uterus, fallopian tubes, and ovaries. This is called a laparoscopy. These are both outpatient procedures.
What happens after the tests are done? — Test results might show that one or both partners have a problem that can be treated. In that case, treatment will likely be aimed at fixing that problem.
Some people might have a problem that can't be treated. Or the tests might not show what the problem is. In these cases, there are other treatments that doctors can do to help couples get pregnant. Talk with your doctor about different treatment options so that you can choose which treatment is right for you.
What else can we do? — Trying to get pregnant can be tough on couples. People can feel sad, worried, angry, or guilty. It is important to get help for these feelings. You might find it helpful to learn ways to relax, or to go to a support group for people who are trying to get pregnant.
Is there anything I can do on my own? — If you are overweight, losing weight might help you become pregnant. Losing weight can also help you have a healthier pregnancy when you become pregnant.
What treatments are available? — Women who have trouble getting pregnant might choose to have one or more of the following treatments. You and your doctor should discuss which treatment to try first. Treatments can include:
●A medicine called clomiphene (brand names: Clomid, Serophene) – This medicine improves the chances that ovulation will occur. Many times, doctors prescribe this treatment first. Your doctor will tell you how and when to take this medicine. He or she will also tell you when to have sex so the treatment has the best chance of working. If this medicine does not work after a few months, your doctor might recommend trying other medicines to help with ovulation.
●Hormone shots – Hormone shots are often recommended if a woman does not get pregnant with clomiphene. Hormones improve the chances that ovulation will occur. Your doctor will tell you how and when to do this treatment.
●Intrauterine insemination – For this treatment, a doctor uses a tube to place sperm directly inside a woman's uterus. This is done right before ovulation. For some women, this treatment is combined with clomiphene or hormone shots to increase the chance of pregnancy.
●In vitro fertilization, also called "IVF" – IVF is a procedure that is usually done if other treatments have not worked. It involves the following:
•A woman gives herself hormone shots for a few weeks. These hormones get the ovary ready to ovulate.
•Just before ovulation, the doctor uses a thin needle to remove some eggs from the ovaries. He or she does this through the vagina.
•The eggs are put into a test tube with sperm so that the sperm can fertilize one or more eggs.
•After 2 to 5 days, the fertilized egg or eggs are put in the woman's uterus. Hopefully, one of the eggs will attach to the uterus and grow into a pregnancy.
•IVF is usually done in women:
-Whose fallopian tubes are missing or blocked
-With male partners who have too few sperm
-Who have not been able to get pregnant using other treatments
How will I know if a treatment is working? — Your doctor will do tests at different times during treatment to check if it is working. These tests can include blood tests and ultrasound. Ultrasound is an imaging test that creates pictures of the inside of the body.
Do treatments always work? — No. Treatments do not always help a woman get pregnant. The same treatment can work for one woman, but not another.
How do I decide which treatment to have? — Talk with your doctor about the benefits and downsides of the different treatments. To choose the treatment that is right for you, you might want to think about:
●How well your doctor thinks the treatment will work
●Cost of the treatment – Some treatments cost a lot of money. Health insurance does not pay for all types of treatments.
●How long the treatment will take – Treatments might need to be done more than once to work. Getting pregnant can take months to years.
●Side effects and downsides of the treatment
You should also talk with your doctor about other options for having children, such as adoption.
A woman can have a tough time making these decisions. You might find it helpful to talk to a counselor or go to a support group for people who are having trouble getting pregnant.
Content adapted from UpToDate Patient Information.