You’re tracking your menstrual cycle, you know when you’re ovulating, and you’re doing the deed at all the right times. But, month after month, the pregnancy tests are negative. First, you’re not alone — many couples find it takes longer than they expected to start a family. And second, there are many factors that affect fertility, and a good doctor can help to figure out what’s happening in your body (or your partner’s) that is preventing pregnancy.
There are common causes of infertility that you’ve probably already considered: age and polycystic ovarian syndrome, for example. But there are some lesser-known factors that could be making it harder for you to make a baby.
“Once your doctor has ruled out common causes of infertility, he or she must dig deeper,” says Draion M. Burch, a sexual health advisor for Astroglide, maker of sperm-friendly lubricant. “If you are not satisfied as a patient, choose another provider for a second opinion.”
The fertility industry is big business, and you have many doctors to choose from. Make sure yours is up to date on the latest research, so he or she can identify the specific cause of your infertility.
“Google them to see if they are doing research themselves, speaking at scientific conferences on infertility, or in the media as an expert on infertility,” Burch says. “Doctors who are more public about infertility updates are usually reading the current literature. It’s their responsibility.”
Here are 12 lesser-known causes of infertility that you may want to discuss with your healthcare providers.
1. Your doctor doesn’t have all the facts. Burch says things such as diet, drugs, autoimmune disorders, stress and environmental toxins can all contribute to infertility. “These factors are often missed because patients may not provide enough information for the doctor to probe into the issue or the doctor may not have asked the appropriate questions for the patients to relay the information,” Burch says. Bottom line: Even if you don’t think a particular issue is affecting your fertility, discuss it with your doctor, so he or she can give you the best possible treatment.
2. You have undiagnosed endometriosis. While endometriosis is commonly associated with infertility, Dr. Shahab Minassian, chief of reproductive endocrinology and infertility at Reading Hospital in Pennsylvania, says women with less severe cases may not experience pain, and the condition could go undiagnosed as a result.
3. Your doctor can’t see your endometrial polyps. Carolyn Givens, a board-certified reproductive endocrinologist at Pacific Fertility Center San Francisco, says endometrial polyps are common and benign. But, catching them can be tricky. “Endometrial polyps are commonly missed because they often cause no symptoms and an endo-vaginal ultrasound must be properly timed to the patient’s monthly cycle in order to be able to see them,” Givens says. “The ultrasound needs to be done zero to four days prior to ovulation. Too early and the polyp may be too small to see. Too late and the uterine lining normally becomes whited out on ultrasound, obscuring the presence of a polyp.”
4. Your partner is older. We all know that a woman’s age is a critical factor in fertility. But, Dr. Edward Marut, medical director at Fertility Centers of Illinois’ Chicago IVF Center, says the man’s age also impacts the couple’s chances of getting pregnant. “We now know that there are effects on the men aging as well — men who are procreating in their 70s and 80s, those are outliers,” Marut says. “Even though a guy’s production never comes to end, the quality of his sperm takes a downturn in mid- to late-30s, and in the mid-40s, we start to see some unpredictable sporadic genetic mutations.”
5. Your partner has erectile dysfunction. In addition to the decline in sperm quality as men age, Marut says older men may also start to experience erectile dysfunction, and may avoid sex as a result. Since the window during which the egg is available to be fertilized is short, a couple needs to have sex frequently to achieve pregnancy.
6. Your weight isn’t in a normal range. Of course, you don’t need a perfect figure to get pregnant, but Marut says that for every 10 pounds a woman is overweight, there is an incremental decrease in egg quality. Likewise, being too thin can also impact fertility by suppressing ovulation or causing abnormal hormonal fluctuations. “If you’d like to get pregnant without treatment, get your weight into normal range and do moderate exercise,” Marut says. “There is no magical diet for pregnancy — it all comes down to the Mediterranean diet that we are all supposed to eat.”
7. Your partner is overweight. Guys aren’t off the hook when it comes to weight and fertility. Marut says extra weight in men can cause testosterone to convert to estrogen, which suppresses the pituitary gland function needed for sperm production. Overweight men are also more likely to experience erectile dysfunction.
8. Your partner smokes marijuana. You know how bad cigarette smoke is for anybody trying to become a parent. But, Marut says men should not smoke anything while trying to conceive. Marijuana acts like estrogen on the brain, Marut says, and can negatively affect testicular function. The good news? Moderate amounts of caffeine and alcohol have not been shown to hurt fertility in men or women.
9. You take certain OTC drugs. If you’re having trouble getting pregnant, make sure your doctor knows about all of the drugs you take. Marut says even seemingly harmless over-the-counter painkillers like aspirin or ibuprofen could block ovulation.
10. You have a negative attitude. The science here is not totally clear, but Marut says research has shown that patients who maintain an optimistic outlook about fertility treatments tend to be more successful — possibly because they stick with it even after initial failures, where more pessimistic people might give up sooner.
11. You’re taking the wrong vitamins. While there are many vitamins and supplements on the market that promise to improve fertility, Marut says most of them aren’t effective. One exception, he says, is the enzyme CoQ10, which has been shown to slow the decline of ovarian reserve and improve sperm quality in men.
12. You haven’t had a hysterosonogram. This procedure flushes water and dye through the fallopian tubes, and is often part of the initial workup for people who want to undergo fertility treatments. But, Marut says many women don’t need any further treatment after this procedure. “People will go through all of the testing and after having flushed the tubes, they are pregnant that cycle [without any other fertility treatments],” he says. “I have this woman who comes in every time she wants to have a baby just to have that done.”
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