Why aren’t you getting pregnant when things seem normal?

Infertility is defined as the inability to become pregnant after one year of regular, unprotected sex for women under 35 and six months for women 35 and older. It affects about 10 to 15 per cent of couples. Usually 50 per cent of couples conceive within three months of regular unprotected intercourse and 80 to 85 per cent by the first year. Cases of infertility are about one third male-related, one third female, and the rest a combination of minor factors in both partners or unexplained infertility.

WEIGHT ISSUES: A woman’s weight is one of the most common causes of blocking pregnancy/conception. Whether you are underweight or overweight, both have an adverse effect on your conceiving potential and menstrual cycle. Indulge in regular fitness regimes like walking or yoga. Also, try to stick to a healthy diet as much as possible. Leafy, green vegetables, seasonal fruits and nuts are a must-have for women who are trying to get pregnant.

STRESS: Stress levels, anxiety and depression target your fertility and menstrual cycle. In men too, stress is known as a major factor for lowering sperm count or poor sperm motility. Try to live an anxiety-free, happy life. Practise meditation.

POLYCYSTIC OVARY SYNDROME (PCOS): This is one of the biggest reasons for women finding it hard to conceive these days. In this condition, ovulation (normal egg release from ovary every month) does not occur. Lifestyle modifications with a regular and calorie-restricted diet are the first line of therapy before we start medicines to induce ovulation. Ovulation can also be affected by other hormonal disorders, stress, obesity, diabetes, thyroid disorders and hyperprolactinemia. Ovulatory disorders are present in 15 per cent of couples with infertility.

PROBLEM IN THE FALLOPIAN TUBE: Damaged and blocked fallopian tube might also affect your chances of getting pregnant. A history of pelvic infection, sexually-transmitted diseases, endometriosis, previous surgery on the fallopian tube or ectopic pregnancy increases your risk for fallopian tube obstruction.

There is a test known as hysterosalpingography or sonosalpingography which can be done on the seventh day of your periods to assess the health of the tube. If there are blockages, then some of them can be corrected by laparoscopy and hysteroscopy surgery.

UTERINE FACTOR: An irregularly shaped uterus can make it difficult for a fertilised egg to attach itself to the uterine wall. Abnormalities can be caused by fibroids (non-cancerous growth on the uterine wall), polyps or scar tissue from surgery, infection and congenital anomalies of the uterus. Hysteroscopy is done to treat intracavitary lesions for infertility. Cervical factors are responsible for five per cent of infertility.

ENDOMETRIOSIS: In this disorder, the endometrial lining starts forming outside the uterus instead of inside it and thus blocks the passage of egg and sperm for fertilisation. Even though symptoms vary, majorly the patients endure constant pain in the pelvic region, painful sex, frequent urination, severe pain during periods.

This condition can be treated by medicines or surgery.

There could be primary ovarian insufficiency when menstruation stops before age 40 due to genetic conditions, immunological causes, radiation or chemotherapy.

AGE: As you age, the quality and quantity of eggs that are produced in a women’s body dip. At birth, you have about two million eggs but naturally lose hundreds of thousands of them by the time you reach puberty. Your body continues to lose eggs no matter what you do. And the rate at which women lose eggs accelerates around the age of 37. The quality of eggs stored in the ovaries also declines over time. Remember, the biological clock is ticking. However, the option of egg-freezing is now available.

MALE FACTOR: The poor quality and quantity or low motility of a man’s sperms can delay or stop you from getting pregnant. Alcohol, smoking, drugs, stress have a negative impact on the release and production of sperms in a man’s body. Male factor infertility can be due to a number of reasons including local trauma, medical conditions like diabetes, mumps, sexually transmitted diseases besides unhealthy habits such as heavy drinking and smoking. Frequent exposure to heat can affect sperm production too. So male partners must maintain a healthy lifestyle. Visit a doctor to get your sperm count tested.

UNEXPLAINED INFERTILITY: In many cases, even though everything comes out to be normal, couples face the problem of not being able to conceive. In such cases, lifestyle modification and intrauterine insemination may help you conceive.

The first step after 12 months of trying to conceive (six months if you’re 35 or older) is to schedule an infertility evaluation. This multipart assessment includes:

History and physical examination
Pelvic ultrasound and assessment of ovulation
Blood work including hormonal profile and AMH
Semen analysis after three days of abstinence
Evaluation of the uterus and fallopian tubes (by specialized X-rays or ultrasounds)
Laparoscopy and hysteroscopy when indicated
Treatment is cause-specific and tailor-made for each couple with good success rates.