Reasons you might have trouble getting pregnant or staying pregnant

If you’re embarking on your first steps to try for a baby, congratulations! It’s a life changing pursuit. Because of that it’s normal to feel a range of emotions. I remember the feelings. There was excitement, anticipation and then a flood of uncertainty and a bit of fear mixed in. Everyone’s different and however you feel is normal and valid.

Part of my nervousness came from the many unknowns ahead. You may feel the same even if you had success in the past, and especially if you’ve experienced loss like a chemical pregnancy. Personally, I wish I knew what I know now because there are so many more options and possibilities than I realized. I wish I’d had more knowledge about navigating the healthcare system and had connected with others sooner, to name a few. That’s true for most people, regardless of whether there are indications that they’ll have trouble or not, or whether they have the biology to first try at home or not.

You can take steps to better prepare yourself for getting and staying pregnant. There may be more in your control and, on the other hand, there may be less and you want to temper your expectations.

Let’s dive in.

Here is a list of reasons that indicate you may have trouble getting and/or staying pregnant when you first start.

• Age. With advanced age and especially advanced age of the woman/the eggs and/or gestational carrier, there is an increased likelihood of fertility challenges. Age isn’t everything but it can be an indication. Egg quantity decreases over time and quality too, but in particular at age 35 and then more rapidly at age 40 (in general). For men/sperm, age can affect fertility outcomes starting at around age 40.
• Periods that are irregular, short or long in duration, and/or cycles that last longer than 35 days or that are shorter than 21 days, or are non existent. It could mean there is no ovulation or decreased number of chances for ovulation, and/or a sign of Polycystic Ovary Syndrome (PCOS) and/or may make it more challenging to get pregnant. It could be female hormone imbalance, fibroids, polyp, PID or endometriosis (see below), or premature ovarian failure or another cause.
• Pelvic inflammatory disease (PID). This could be indicated by periods as seen above.
• Complications from previous childbirth. This may include PID or from c-section scarring or anatomical change.
• Complications from a dilatation and curettage (D&C) or known as abortion. The cause may be PID or scar tissue or other type of infection.
• Complications from an abortion. The cause may be PID or scar tissue.
• Endometritis. This inflammation of the uterus usually doesn’t have any symptoms but a common cause of repeated pregnancy loss. Treatment is usually antibiotics.
• Known diagnosis of Polycystic Ovary Syndrome (PCOS). See above regarding periods that are irregular or non existent and/or hormone imbalances.
• Known diagnosis of endometriosis. Endometriosis is a disorder where fragments within the uterus start to grow outside and can cause scar tissue on the ovaries or fallopian tube ends that blocks the sperm from getting in. More severe cases can lead to organs sticking together and making conception more challenging. It is also known to affect egg quality.
• Painful period cramps. It could be a sign of endometriosis. Severe period pain is not normal.
• Painful intercourse. It could indicate endometriosis (see above) or infection.
• Menopause.
• Shift work and heavy lifting. Working night shifts, shift work and heavy lifting at work has shown to increase risk of fertility issues.
• Certain cancer treatment. Some cancer treatment can affect fertility for women/egg supplier and/or gestational carriers and for men/sperm carriers.
• Anatomical issues. An unusually shaped uterus, vagina or fallopian tube(s) or damage to or removal of reproductive parts may or inevitably will cause infertility.
• Known blocked tubes. If both tubes are blocked then it would require reproductive assistance to achieve pregnancy such as IVF, donor eggs in conjunction with IVF and/or through surrogacy or using embryo donation. If one tube is blocked, that decreases your chances of conception.
• Trauma to the testicles. Having had blunt trauma to one or both testicles could harm semen.
• Varicocele. For males, this is a condition where there are dilated scrotal veins in one or both testicles. Since it can raise the temperature in the testicles and negatively affect sperm production, it has been known to cause low sperm count.
• Changes in sexual drive or performance. For males, decreases in drive or inability to sustain an erection may a barrier to conception.
• Family history of early menopause, fibroids or translocation such as your biological mother or sister may indicate you might as well if you’re the one with the ovaries or womb.
• Sexually transmitted diseases. Having chlamydia and/or gonorrhea, if untreated, can lead to scarring or damage of the fallopian tubes in women/gestational carriers/egg suppliers. In men/sperm carriers, these STDs may lead to scarring and blocking sperm from releasing. Sometimes there are no symptoms present for individuals who have these diseases.
• Prostatitis. Chronic infections may affect male fertility.
• Klinefelter syndrome, the genetic condition of being male at birth but have XXY chromosomes. You could know or not know you have this syndrome. It doesn’t always cause infertility or sterilty but it could.
• Some medication. Talk to your doctor about medication you’re using and how it might affect your fertility.
• Excessive caffeine intake. Drinking too much may increase chances of miscarriage for women/gestational carrier/egg supplier.
• Excessive alcohol intake. Women and/or men drinking more than the low risk guidelines may have decreased fertility.
• Smoking cigarettes. Kicking this habit could improve the quality and quantity of sperm and egg quality as well as chances of implantation and gestational success.
• Social drug use. Cocaine may reduce sperm count, motility, and quality. There may be fertility risks to smoking marijuana and it may be specific to smaller subset of the population.
• Hypothyroidism. It may prevent the woman/gestational carrier from getting or staying pregnant. Medication can usually treat the condition and restore your fertility if the right type and dosage needed is maintained.
• Use of saunas or hot tubs. For men/sperm carrier, excessive use of heating sources to the groin such as using saunas or hot tubs or lap tops on the groin may decrease sperm quality and/or quantity.
• Diethylstilbestrol exposure in your own gestation. Diethylstilbestrol is a drug that was widely used decades ago to prevent miscarriages. Children whose mothers or gestational carriers took the medication may have reproductive system abnormalities if they are women (or gestational carrier and/or egg supplier). For men/sperm suppliers whose mothers or gestational carrier took the medication in pregnancy, there may be a risk of low sperm count or high proportion of abnormal sperm.
• Hepatitis B or C. If you had or have either type then it may negatively affect sperm quality.
• Genetic issues. There are too many to list but genetics can play a role.

This list might be daunting to you. I get it. Remember that it doesn’t include the possibilities for what can go right. There are so many ways it could. It might be with a little assistance, but there are more options than there ever were.

Talk to your doctor if you think you need tests or a referral to a fertility doctor or other specialist.

Please feel free to book a call with me if you need any support, mentorship, or a light hearted talk about next steps.