The cultural silence around infertility both makes it more difficult to bear and more challenging to know when it is happening to you. Women who try to conceive for months with no success quickly become experts in the human reproductive system and a little-discussed disease: infertility.
If you are concerned about the length of time it is taking you to conceive, know that getting pregnant is often not as easy as portrayed on TV. It is normal for it to take up to 12 months to conceive. If it is taking longer, visit a reproductive endocrinologist to begin identifying the cause of your infertility and to evaluate available treatments.
Read on to learn about the difference between initial failure to conceive and infertility, what to expect when you visit the specialist, different treatments available, and more.
What is failure to conceive?
When trying to conceive, the first negative pregnancy test will be a disappointment. As the months wear on, subsequent ones begin to feel like a terrible dream as you squint to find a second line that never materializes. Failure to conceive is not a technical term, but it does describe the experience of people in the trying to conceive (TTC) community that haven’t seen those two pink lines.
Infertility is the lack of conception after one year of unprotected sex for women under 35, and lack of conception after six months for women 35 and older. For those actively trying to conceive, the journey from month one to twelve in that process is filled with doubt and confusion.
Actually, it is normal not to get pregnant on the first try – or even the second or third. Human reproduction is way more complex than junior high sex ed made it seem. People having unprotected sex around ovulation only have a 30 percent chance of conceiving the first month. That number goes up to 60 percent in three months and 85 percent within one year.
Not all eggs are healthy, nor are all sperm. Even when an egg is fertilized, it may not implant. Sometimes implantation occurs but the blastocyst does not continue to develop, and the only sign is a late period. A phenomenal number of things must go right all at once for a pregnancy to occur.
What causes failure to conceive?
Inaccurate timing is the number one cause behind lack of conception. The length and timing of women’s cycles vary wildly and assuming that you ovulate on the 14th day of your cycle can prevent the all-important meeting of sperm and egg.
Because an egg only lives for about 24 hours, the window of conception is finite, and because every woman’s body is different, the window of conception is very variable. If you aren’t lucky enough to conceive right away, tracking your cycle will be key to helping yourself conceive and identifying whether anything more significant is wrong.
Here are the most common ways to track your cycle and identify ovulation:
Ovulation predictor kits (OPKs)
These kits help you determine your fertile window via testing the LH levels in urine. You will be testing to find your LH surge, which indicates that ovulation has occurred or is imminent.
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Ovulation predictor apps
These apps allow you to input information into the app, and it churns out recommendations for the best days to try to conceive. Information that you input varies from app to app, but may include basal body temperature, cervical mucus observations, photos of your OPK, and any physical symptoms you are having.
Basal body temperature
This is your body temperature when you are fully at rest. A woman’s body temperature slightly rises during ovulation, and then if implantation occurs, it stays elevated. Noting this body temperature rise can help you confirm that ovulation occurred, so, if tracked over a number of months, it can also help you predict when it usually occurs during your cycle.
Your cervical mucus changes throughout the course of your menstrual cycle thanks to the changes in hormones through each phase. Monitoring this cervical mucus can give you another clue to your fertile window; egg-white mucus will be present at ovulation.
Reason for not getting pregnant when everything is normal
Getting pregnant is all the more challenging due to the many non-visible conditions that could be hindering conception.
So many causes of infertility will have no physical symptoms other than a lack of pregnancy:
Structural issues with the male or female reproductive organs can also be the source or contributor to infertility. People live their whole lives without knowing they have any type of organ irregularity.
What to do if you are failing to conceive
If your initial attempts at conceiving are not successful, the most important step to take is careful cycle charting and ovulation monitoring.
By keeping a record of your cycles, you can more accurately time intercourse to improve chances of conception. These records will also be helpful when you are ready to visit your doctor to discuss the next steps.
Whether you use an app to chart your cycle or keep notes yourself, these careful depictions of your cycle may help your doctor quickly pinpoint the source of infertility.
What if you have confirmed ovulation but haven’t gotten pregnant?
While confirming ovulation through hormone testing can narrow down the source of infertility, it in itself is not a guarantee of conception. Sperm and egg health both impact conception, as do the conditions of the uterus.
If you have pinpointed your fertile window and have been having intercourse just before and during it for a few months, you can provide that information to a doctor for further guidance.
The International Committee for Monitoring Assisted Reproductive Technologies notes that intervention can be initiated prior to the one-year mark based on age, findings, and testing. The takeaway is that if you are concerned something is wrong, you can obtain diagnostic testing and pursue earlier treatment.
Early detection and treatment are two key factors in beating infertility. Fertility decreases with age, and for some people and conditions, even six months can make a significant difference in chances of success.
What is infertility?
Infertility is the lack of conception after one year of unprotected sex for women under 35, and lack of conception after six months for women 35 and older.
One in eight women has difficulty conceiving, but the number is likely higher due to the lack of comprehensive data gathering on the subject of infertility. This statistic does not include single people who experience infertility on their quest to have a child on their own. Additionally, it is believed that infertility is widely underreported by certain demographics due to shame or feelings of hopelessness due to the cost of treatment.
The formal definition of infertility also fails to capture the experience of families who have recurrent miscarriages.
What is primary infertility?
Primary infertility describes the condition of not becoming pregnant after one year of trying with no birth control.
Women with primary infertility have never been pregnant before.
What is secondary infertility?
When someone has a child but then cannot become pregnant again within one year of trying to conceive, they are experiencing secondary infertility.
Secondary infertility can happen to those who experienced primary infertility and then conceived with medical assistance. It also describes the journey of people who had their first child with no issues but find themselves unable to conceive a second child.
Twelve percent of women ages 15-44 in the United States report difficulty getting and staying pregnant. Six percent of married women report an inability to conceive after one year of trying. These numbers are likely underreported as many women do not seek treatment.
Of couples dealing with infertility, about one-third are having difficulty due to female factor infertility.
Common signs of infertility in women
Women with infertility may show no signs other than lack of pregnancy. Even those with clockwork periods may struggle to conceive thanks to conditions like Diminished Ovarian Reserve.
Other women may have clues that something is not quite right. Irregular or painful periods, too-short luteal phases, or very long or very short cycles can indicate underlying factors that contribute to difficulty conceiving.
Infertility brings so much challenge because it can target those you least expect. Women in their 20s may be diagnosed with infertility, just as regular gym-goers and healthy eaters may be.
Infertility is far from a women’s only problem. In fact, about 30 percent of couples with infertility also have male-factor infertility. About one-third of infertility cases are caused by a combination of both male and female infertility or are unexplained.
Common signs of infertility in men
Just like with women, everything may seem perfectly normal until a man runs into difficulty when trying to conceive. Your doctor can order a lab test of the semen to examine the sperm. These tests measure the quantity of sperm, the shape and structure of the sperm, and the way they move. All of these characteristics impact the ability of the sperm to infiltrate the egg and fertilize it.
The predominant sign of infertility in men is a lack of children or partners with pregnancies.
Other signs of male infertility include abnormalities of the scrotum or testicles like lumps; pain and swelling; difficulty ejaculating; and an unusually small volume of ejaculate.
What to do if you are struggling with infertility
If you think that you are having trouble conceiving, there are several medical options available.
The type of doctor who specializes in infertility and reproduction issues is a Reproductive Endocrinologist (RE). Your RE will also specialize in Assisted Reproductive Technologies (ART).
You can visit your regular OBGYN for a referral to a RE, or you can search online for clinics in your area.
What to expect when you visit a reproductive endocrinologist
If you think you want to meet with a RE, call to schedule your appointment right away. Many clinics have months-long waiting lists. You can continue to try to conceive and chart your cycles in the interim.
The first appointment, usually called a consultation, is the doctor’s chance to learn about your concerns and reproductive history. Unless you have already had testing done elsewhere, the RE will refer you for a number of tests.
Some common tests include:
- Blood draws to check hormone levels. Sometimes, multiple draws are needed throughout your cycle to gauge hormone levels at key points.
- A hysteroscopy is the inspection of your uterus via a tiny scope. This can catch any structural irregularities.
- A sperm sample from the male partner is usually needed to determine whether he has sufficient sperm quantity, quality, and motility to fertilize an egg.
After your doctor has a better idea of the functioning of some key bits, she may be able to recommend a course of action right away.
Some common causes of infertility include:
- Diminished Ovarian Reserve
- Polycystic Ovarian Syndrome (POCS)
- Decreased sperm count
- Decreased sperm mobility
- Lack of ovulation
- Luteal phase defect
- Abnormalities of the uterine structure
Sometimes the test results may all come back perfectly normal, in which your doctor may give you the unhelpful label “unexplained infertility“. Your doctor will talk to you about the options for intervention and hopefully, give you an idea of the feasibility and chances of success with each option.
What are the different types of fertility treatments?
When you step into the world of infertility, the names and abbreviations can make your head spin.
We can categorize the most common treatments from least to most invasive and expensive.
Clomiphene Citrate, or Clomid, is the first step for many people. The drug can be administered by an RE or by some OB/GYNs.
Clomid induces ovulation, and the doctor will advise when to have intercourse for the best chances of success. There are also a variety of injectable medications doctors can try to induce ovulation.
Intrauterine Insemination (IUI)
Intrauterine insemination is a treatment in which the RE directly places the sperm into the uterus using a tiny catheter.
IUI may be done with or without injectable medications to stimulate the growth and/or release of an egg at a particular time.
In Vitro Fertilization (IVF)
In Vitro Fertilization is a much more complicated process, but some people’s only chance at conceiving a child.
During IVF, a woman injects herself with a variety of hormones to stimulate the growth of ovarian follicles, and then more to trigger the release of eggs from those follicles at a specific time. Throughout this stimulation phase, a woman will have several appointments with the RE to track the growth of the follicles via transvaginal ultrasound. The eggs are moved via a surgical procedure under general anesthesia. Sperm is introduced to the eggs in the lab. The fertilized eggs will be monitored and permitted to grow before being returned to the woman’s uterus.
IVF opens the door to treat many more complicated issues causing infertility. When doing IVF, families have the opportunity to genetically test their embryos prior to having them transferred. This can increase the odds of pregnancy by identifying embryos with genetic problems that can cause implantation failure, miscarriage, and severe disease.
Families can choose to use donor eggs, donor sperm, or both, to further increase their chances of getting pregnant.
Multiple IVF cycles may be needed before the procedure is successful, especially if the family wants to plan for multiple children and bank embryos for the future.
Financial basics to know regarding infertility treatment
One of the greatest challenges of infertility is paying for it. Only 13 states have laws in place regarding insurance coverage for IVF. Even in states that have laws mandating insurance coverage for ART, many employer-sponsored plans may not qualify. For example, in some states, state and local governments do not have to provide coverage.
Most insurance plans do cover appointments and procedures that diagnose infertility. This includes initial appointments with the RE, blood work, and diagnostic tests. Remember, “covered by insurance” does not mean no cost. Instead, these costs will be applied to your deductible until it is met.
Many insurance plans also cover treatments that correct the cause of infertility, such as the removal of uterine fibroids or the correction of a uterine septum.
When it comes to the procedures to actually treat infertility and help you conceive, like IUI or IVF, insurance coverage becomes spotty, if it even exists at all. Always review your insurance plan documents that detail the specific benefits covered.
Some employers, such as Starbucks and Bank of America, are known for their insurance plans that offer employees that specifically provide infertility coverage.
The cost of treatment will vary from clinic to clinic and from person to person. The reason for this is that the medications used in ART are very expensive, and usually not covered by insurance in non-mandated states. The amounts of medication needed vary based on the root cause of infertility. Some patients also respond more slowly to medications, meaning that they need significantly higher dosages.
The average cost of one IVF cycle in the United States is $23,474. Some women require more than one cycle before they have a living baby. The cost of treatment also varies wildly between cities; usually, the cost is lower in cities with multiple clinics.
Other costs of infertility are less obvious. IVF cycles in particular require many appointments, often with very short notice. RE’s customize the treatment to your body’s response, so you may find your retrieval pushed back to give your ovaries more time to respond. All of these things can gravely impact work schedules and whittle away the time off you are probably hoping to save for maternity leave.
Can infertility be cured naturally?
Most types of infertility are treatable rather than curable. This means that procedures or medications can be administered to mitigate infertility, but they do not permanently solve the problem that prevented you from conceiving.
Some people experience infertility due to structural issues of their reproductive organs, and if that issue can be resolved, then they could be described as cured. Likewise, if the infertility stemmed from a health condition that could be cured, so too could the infertility be cured.
There is no medical evidence that infertility can be cured, or even treated, naturally. Natural remedies and interventions may increase the likelihood of conceiving and carrying a full-term pregnancy with a live birth.
Generally, the wisdom is that the healthiest version of you has the best chance of conceiving, and to that end, natural interventions can help you have the best chance.
For an in-depth guide regarding diet and lifestyle changes to reduce chemical exposure, the best starting place is It Starts with the Egg by Rebecca Fett. Here are some additional lifestyle changes to enact as soon as possible:
- Stop smoking – Smoking adds 10 years to the fertility age of both men and women.
- Reduce or eliminate alcohol use – Alcohol alters estrogen levels in women and impacts sperm quantity and quality for men.
- Eat well – Some doctors recommend a high-protein, low-carb diet. Be sure to take in as many vitamins and nutrients as possible.
- Consider supplements – Some doctors also recommend the implementation of a wide array of supplements for optimal fertility.
- Try acupuncture – Studies indicate that acupuncture can support male and female fertility. Some infertility centers even recommend acupuncture to their patients’ overall care plans or refer patients to particular providers.
How to cope with infertility and failure to conceive
If you find yourself surprised by the emotional toll your conception battle is taking, you are not alone.
In one study, 50 percent of the women surveyed at an IVF clinic said that infertility was the most upsetting experience of their life. It has long been observed that women facing infertility report the same levels of stress as women diagnosed with cancer or recovering from a heart attack.
How to deal with the disappointment and grief of not getting pregnant?
Month after month of negative pregnancy tests pack a large emotional toll with few forms of respite. Each month initiates a new cycle of hope followed by grief. As those months turn to a year and more, disappointment quickly becomes an understatement.
If you are able to transition to ART, the disappointment and grief only grows as your body becomes a pincushion that you barely recognize from hormones and invasive procedures. The stress may seep across all areas of your life, leaving nothing untouched. Work becomes an ordeal thanks to frequent, short-notice appointments. Friends are no longer sources of joy, but rather ticking time-bombs apt to spring pregnancy or birth announcements at any minute. Treatment may restrict your diet and exercise, and soon it may feel like there is nothing left.
This will be one of the most challenging phases of your life, and unfortunately, there is no guarantee that it will end with a take-home baby. The lack of social knowledge and awareness of the issue makes it worse. Offhand comments can destroy a day. When those around you fail to recognize your agony, infertility becomes a crushing, silent burden.
Most women struggling through infertility won’t find peace until the journey is done, but they can find some coping mechanisms to make the process more manageable.
If you are already paying for IVF out of pocket, another medical bill probably seems like the last thing you want to take on. However, if you lack a support system that can really comfort you, therapy can be a crutch to get you through.
Many infertile people have well-meaning friends or family members who try to say the right thing, but just don’t understand. Therapy will give you somebody who does.
Therapy can also help you process any feelings of trauma, depression, or anxiety that you may be feeling. Processing events and the resulting feelings can leave you feeling better now, and prevent a snowball of negative feelings in the future.
Join a Support Group
Support groups are usually free and give you access to a like-minded community. You can find a great selection of infertility support groups online through Facebook, Instagram, and Reddit.
Support groups are especially helpful for people who lack friends or family who are familiar with infertility.
Having a place to vent, ask questions, and feel seen can help make the days easier.
Whatever your time and budget allows, find something that brings you joy and gives your mind a break from the worry. When the above options are not available, the next best thing is self-care.
To get through this, you will need small things that bring you comfort and give you something to look forward to.
Self-care can be as simple as a hot bath or a favorite TV show. It can be more involved like a yoga class or getting a facial.
How to support a loved one experiencing infertility
Friends, family, and co-workers can take a few steps to support their loved ones who are experiencing infertility.
People experiencing infertility may feel added stress, anxiety, or isolation if they don’t have a support system they can turn to during this time.
To help support a loved one who is experiencing infertility:
- Research the treatment that your loved one is trying. When you are having a conversation with them, this will free them up to share their feelings and their personal experiences rather than teaching you about infertility.
- Be sensitive about your own pregnancy announcement. Never spring a surprise pregnancy announcement on someone you suspect to be having trouble conceiving. Ideally, let them know via text prior to any announcement they may be at so that they can excuse themselves from the event if they wish. Similarly, group texts with running updates about pregnancies and babies can also be very painful.
- Don’t minimize their feelings or give false reassurance. Your loved one may feel as if they are in the midst of the most significant crisis of their life and need a safe place to talk and receive comfort.
- Know that the trauma of infertility does not vanish upon pregnancy. Your friend who went through fertility treatments may experience heightened anxiety during her pregnancy. After the baby is born, the grief of infertility may still linger over her and cloud her perception of how her family was created or her ability to expand her family.
For further resources regarding supporting a loved one through infertility, RESOLVE offers an excellent set of resources that are a quick but informative read.