Why Am I Not Getting Pregnant?
As women (and men) we spent our most fertile years trying to avoid getting pregnant. Sex ed consists of every “how NOT to get pregnant “ tip and visits to our OB-GYN usually start with “what do you use for contraception?”
Yet when we’re finally ready and eager, we find out it’s not always so easy as many of us were led to believe.
Here is why getting pregnant is harder than you think, some of the reasons why—plus what to do about it.
Why getting pregnant can be so hard
One of the most often cited reasons for difficulty getting pregnant is age. It is a fact that women and men are getting married and trying later. In the US, the average age of first time mothers was 26 in 2018 which is up from 21 in 1972. Men went from being first time dad’s at 27 in in 1972 to 31 today.
This may sound pretty young when you consider that women, especially in more urban areas that are college educated, are postponing childbearing until after 35. There is a good reason for this too, as studies show that women who wait till 35 or older to start are more likely to make $50,000 or more and have more clout in the workplace. Without a national federal maternity leave policy and anti-discrimination measures in place for parents, many women are still faced with the unreasonable expectation that they must make a trade-off in their income and career when they have children. And that expectation is true.
A 2018 Princeton study found that women make less after having a baby, but men don’t. I get frustrated when I hear the statement “women just wait too long and that’s why they're stuck with infertility” as if we are all subject to a disease state for safeguarding our future. As if during our peak fertility, we are running through fields laughing without a care in the world.
How does age affect our ability to get pregnant?
Age affects our ability to get pregnant because women have a finite number of eggs in their body. We are actually most fertile in our 20s. Slowly the number and quality of our eggs declines in our 30s and more rapidly in our 40s.
Men might be able to father children late in life, but they are subject to age-related fertility issues, with a decline decline in sperm count and quality as they get older, too.
At any point in time, getting pregnant is dependent on good quality eggs, good quality sperm, a woman ovulating, timed intercourse, and a healthy body to support a successful pregnancy. The older you are, the harder you need to work to keep your existing eggs in good shape.
Is it harder to get pregnant when you get older?
The short answer is yes. The fewer eggs and sperm you have on hand, the odds are less likely that many can make the match to create an embryo. You are also more likely to have chromosomally abnormal eggs or sperm. You have a decline starting in your early 30s and there is a marked drop for an average person (and you don’t have to be average) in the late 30s.
Age matters, but if you know from my prior blogs, age is not the end all be all, in part because there is biological age (how old your body is real time) versus chronological age (your age number in years).
You will have fewer eggs as you age, but you can have better quality eggs that are younger than your years. Thirty five might be a marker for age decline, but it is not the steep cliff that many of us are lead to believe.
Timing sex to get pregnant
Getting pregnant is all about conceiving at the right time—something totally lacking in our sex education.
Timing is one of the easiest things to fix and knowing your own ovulatory pattern is key to getting the timing right.
The ovulatory window shrinks as we age so timing is very important. For this, you can use fertile mucus, ovulation test strips and Basal Body Temperature. Many of my clients aren’t ovulating on day 12 of a 28-day cycle although that is considered the “standard.”
Some women ovulate earlier and some later—something you need to know. I recommend using BBT with fertile mucus or BBT with Luteinizing hormone test strips, but not all three because it can create confusion.
To time getting pregnant, you need to have sex before you ovulate. This is when your temperature dips in the BBT test and your fertile mucus, which is stretchy discharge that looks like egg whites, tells you are about to ovulate.
Sperm can live in a women’s body for up to five days. Therefore, you want to have sex before and during ovulation if you are trying to conceive.
Environmental toxins and estrogen mimics make it harder to conceive
So, what’s up with rapidly declining fertility around the world? A big reason is toxic chemicals in the environment and we are at the cusp of understanding the full impact of endocrine disruptors.
Sperm counts have dropped by 50%. Women also suffer the effects of estrogen mimics, chemicals in our environment that mimic the hormone estrogen, and have been cited in breast cancer, rising obesity, and infertility.
What are estrogen mimics and how can they be harmful?
They change the balance of hormones in your body to favor estrogen, which is a growth promoter. Your hormonal cycle is a carefully orchestrated dance of multiple hormones. When one side of the scale becomes much greater, it knocks the other hormones out of balance, making it harder for you to ovulate and harder for you to conceive.
Estrogen mimics are found in your household cleaners, your beauty products, plastic bags, plastic tupperware, herbicides, nonstick cookware, and antibacterial soap, for example. Here is a handy list. I highly recommend using the Environmental Working Group’s Skin Deep Database to assess the safety of your personal care products.
To help reduce environmental toxins that impact fertility, avoid:
All herbicides on your garden or plants
Non-stick cookware
Antibacterial soap or sanitizer with triclosan (alcohol based products are better)
Bleach and conventional laundry detergent
Food with additives such as propyl gallate, 4-hexyl resorcinol, (if it doesn’t sound like a food - don’t eat it).
Canned foods including sparkling water in cans (the cans are lined with BPA)
Plastic bottles
Store receipts—the sheen that makes the receipt shiny has BPA
Eating and microwaving food in plastic containers
Instead, use personal and homelceaning care products that are listed as Paraben free, Phthalate-free and BPA-free and recognized as safe (See EWG’s Skin Deep Database linked above); stainless steel or aluminum cookware; chemical-free laundry detergent; and stainless steel water bottles.
It takes time to do your initial research, but once you’ve discovered clean brands that perform well, you’re set—not only for yourself, but for the health of that baby you are dreaming of and the child, teen, and adult they will become.
How does stressing about not getting pregnant impact my fertility?
Have you ever heard the saying, “If you just relaxed, it would just happen.” It’s so annoying! Especially when people are giving advice for problems they don’t experience.
My clients typically experience a LOT of day--to-day stress. COVID-19, caring for other family members, demanding jobs, working from home, relationship stress, trying to manage providers and figure out solutions on your own can be overwhelming. And then sex, usually a great stress reliever, is stressful when you can’t get pregnant.
How does stress impact fertility? Day to day stress does impact fertility when we measure the marker in saliva. Stress can interfere with your ability to ovulate. You may have experienced missing a period during stressful periods in your life (my PhD was one for me). Stress can imbalance your hormones—yes, that chin acne is related. It also can set off inflammation in the body, which is negatively associated with fertility. Stress can impact egg quality with increased oxidation leading to more chromosomally abnormal eggs and sperm.
I had a prospective client tell me “I am 37, my AMH is low, and I’m told I have very little time. My acupuncturist told me not to do anything else other than acupuncture and the IVF clinic told me not to do acupuncture. I am so stressed that I am doing the wrong thing, but everyone’s advice conflicts.”
I find many of my clients are very stressed in the fertility healthcare setting and often don’t feel guided or heard. This takes a toll.
However, the good news is that support groups, therapy, reduced isolation and a sense of community can lower stress and improve pregnancy rates.
Can medication I take impact fertility?
There are a number of medications that can impact fertility and also should not be taken in pregnancy (unless under strict supervision and approval from your physician). Antidepressants have been found to reduce the chances of conception. There is evidence that antidepressants can impact male infertility. However, antidepressants are not something to just stop taking. Talk with your doctor or therapist. Most recommend a tapered approach gradually weaning off antidepressants to avoid withdrawal side-effects. You should be under the supervision of a clinician when doing so.
There are certain medications you want to avoid during pregnancy and before getting pregnant. If you are on medication, do your research to check whether it is something that is safe in pregnancy, whether it interferes with fertility, and if there is an option to change or go off the medication. Then talk to your prescribing clinician.
We will continue other causes for not getting pregnant and what to do next week.
In my practice, we don’t just cover nutrition; we cover greening your home and personal care routine to reduce your exposure to chemicals that interfere with fertility while optimizing your nutrition, exercise, sleep and mental health. If you want to learn more, book an appointment today even if you aren’t ready to get pregnant or you can’t get pregnant or if you are pregnant.
It’s never too early or late to start being healthier.
Schedule a free 15-minute call
Annina is a PhD, Registered Dietitian, Licensed Dietitian Nutritionist and Board Certified in Functional Medicine specializing in nutrition and functional medicine for fertility, pregnancy and new mom and baby. She has 7 years of practice experience and has co-authored several books on infant, child nutrition and obesity prevention.