5 Reasons Why You Are Not Getting Pregnant
By: Dr. Lana Asprey, MD
November 15, 2018
- Not getting pregnant can be an emotionally painful, stressful experience for both you and your partner.
- If you’ve been trying for 6 months to get pregnant, see your doctor. If you’re in your mid- to late-thirties or older, don’t wait as long.
- Reasons why you are not getting pregnant: You’re not tracking your ovulation, you’re having sex at the wrong time, you’re stressed, you’re not eating enough of the right foods, and your thyroid is out of whack.
- It takes about 3 months for your hormones to balance themselves after following the above issues.
- If you still are not getting pregnant, ask your doctor for a full hormonal panel.
You’re ready to have a baby, but after months of trying you’re not getting pregnant. It can be an emotionally painful, stressful experience, for both you and your partner. The good news is, there are things you can do to boost your fertility and increase your chances of conceiving. Read on for the reasons why you may not be getting pregnant, and how to change that.
Reasons you are not getting pregnant
You’re not tracking your ovulation
The first thing I ask my patients is how long they’ve been trying to get pregnant. If you’re in your late-twenties or early-thirties, and you’ve been trying to get pregnant for 6 months without success, see your doctor. If you’re in your mid- to late-thirties and early-forties, you don’t want to wait that long.
The second question I ask is whether you’ve been tracking your ovulation — this is key. Ovulation is the point in your cycle — typically mid-way — when your ovary releases an egg.
There are many misconceptions here, so let’s clarify. An egg lives for 12-24 hrs. Most women release only one egg at a time. However, as you get older and the “clock starts ticking,” it’s more common for more than one egg to get released. That’s why older mothers have a higher chance of twins!
The two eggs could be released on the same day from each ovary, but you could also release one egg and then a second egg a day or two later from either the same ovary or from the other ovary. This can give you a “fertility window” of up to 5 days per cycle. And since healthy sperm can survive up to 5 days in the female reproductive tract, many fertility doctors extend the “window” to 7 days.
Tracking your ovulation so you know WHEN it’s happening is therefore crucial. It’s not unusual for women to miss their ovulation window because they are either not tracking it correctly, or because they ovulate early or late in their cycle. Without a proper tracker and an ovulation kit to test your urine, you won’t know. You can track your cycle using a period tracking app like MyFLO or Period Calendar, and I strongly recommend you buy an ovulation test kit from the drugstore for at least 3 consecutive months. The money spent on the ovulation test kit will be far less than what you might spend on lab tests, supplements, herbs, or fertility treatments.
You’re not timing sex
Given the above information about ovulating, when should you have sex? If you are in your twenties or early thirties, and likely releasing only one egg at a time, you should be having sex every other day, starting 4 days before your ovulation, the day of your expected ovulation, and 2 days later. So if your ovulation happens on day 14 of your cycle, you’d have sex on day 10, 12, 14 and 16.
If you are in your mid-thirties or older, you may be releasing two eggs, at least during some of your cycles, so you want to boost your chances of getting pregnant on the 3 days following your first expected ovulation. So with a 28-day cycle, and possibly ovulating on day 14, and 15 or 16, you would have sex on day 10, 12, 14, 16, 18.
The reason you have sex every other day is because with a “day of recovery”, a man’s sperm count rises. And a higher sperm count means better chances of getting pregnant.
If your cycles are irregular, and/or you have anovulatory cycles, it’s best to consult with a fertility doctor because the simple math above just won’t do it in your case.
You can still bleed every month when it’s your period, and not ovulate. This is typically due to a hormone imbalance — you’re lacking the right mix of hormones to create a healthy egg. Sometimes a hormone imbalance is hereditary — if your grandmother and mother have a history of miscarriages or struggled to get pregnant, it’s possible you might run into similar challenges.
But the biggest reason — other than hereditary hormonal imbalances — for not ovulating properly is stress. When you’re stressed, you don’t get enough sleep, and without good sleep, you produce fewer sex hormones like estrogen and progesterone. Instead, your body ramps up production of other hormones like cortisol (the stress hormone).
Cortisol signals to your body that this isn’t a good time to get pregnant. You can have a woman who is desperate to get pregnant, yet her body is saying “absolutely not.” The human body hasn’t changed significantly in 50,000 years — back then humans were living in caves, or on the savannah. When food was scarce, or your life was at risk, you were less likely to get pregnant — your body needed to know it could support a pregnancy and produce breast milk to feed a baby. Not much has changed — high cortisol tells your body now is not a good time to get pregnant.
So how do you lower stress when life is so busy and you’re under so much pressure? You start small. You don’t need to completely makeover your life, move to the country, and meditate five hours a day. Instead, small changes, over an extended period of time, have a cumulative effect.
Here are some ideas:
- Go to bed earlier: If you are always tired around 8.30-9pm, then listen to your body and allow yourself to begin your bedtime routine even if it seems “too early”.
- Protect yourself from too much blue light exposure: When you work on your laptop at night or scroll through Instagram on your phone, you’re exposing yourself to blue light. Too much blue light suppresses melatonin — the hormone that tells your body when it’s time to sleep. Shut down all electronic devices two hours before bed, and switch to a red bulb in your bedside lamp. Read here for more ways to protect yourself from junk light.
- Learn to say no: If you’re someone who likes to say yes to everything, especially to helping others, you may want to pull back a little. If you volunteer every weekend, volunteer every other weekend, at least while you’re trying to get pregnant.
- Get support: If you already have another child, look into getting some support. You could hire a mother’s helper — typically young babysitters who can help you run errands or play with your older children so you can get things done, or simply rest. The bonus? They’re typically more affordable than nannies. Or arrange for another parent to pick up your child from daycare once or twice a week, so you can use that time to meditate, do yoga, or go for a walk
Making some simple tweaks to your day can have a huge impact on your stress levels overtime.
You’re not eating enough good fats and protein
You need good fats and high-quality protein to build hormones.
Fats like omega-3s and saturated fat help your body produce sex hormones like testosterone and estrogen — these hormones keep you fertile. The best sources of fat are:
- Grass-fed butter
- Coconut oil
- Olive oil
- Raw nuts
- Grass-fed beef and lamb
- Wild-caught fish (avoid species high in mercury like fatty tuna — too much mercury and other environmental toxins can hurt your fertility.)
- Krill oil supplements
Protein is also key to creating quality eggs. One study looked at women undergoing IVF at the same clinic. Those who ate a moderate amount of protein (more than 25% of their daily calories) had more embryos to transfer and two times the pregnancy rates than those eating less than 25% of protein. Cutting down on carbs also boosted fertility. The women with the highest pregnancy rate (80%) ate more than 25% protein and ate less than 40% of carbs.
If you’re a vegetarian — and a lot of women are — it’s likely you aren’t getting enough fat and protein. Vegetable protein isn’t as efficient as animal protein at building hormones. Animals eat grass — they take the plant and convert it into a more a sophisticated protein. Humans aren’t so good at doing this. Same goes for omega-3 fats from fish, versus from plant sources like flaxseed oil and chia seeds.
If you’re vegetarian, you want to supplement with digestive enzymes and probiotics and prebiotics — anything that will help you better digest vegetable protein.
Your thyroid is out of whack
If you are not getting pregnant, you want to check your thyroid levels. Your thyroid produces hormones that regulate almost all of your bodily systems, including your menstrual cycle and mood.
Ask your doctor for a full thyroid panel. You want to get the TSH (thyroid stimulating hormone), T3, and T4 tests. TSH is secreted by the brain, and its job is to tell the thyroid gland to make the right amount of thyroid hormones. A lot of physicians will only test for TSH — if the test comes back normal, doctors assume your levels of thyroid hormones must be normal.
But I see more and more clients whose TSH is fairly normal, yet their actual thyroid hormones are low. That’s why I test TSH along with T3 and T4 so I can get a full picture and I know for sure whether the thyroid is producing what’s needed for pregnancy. A lot of health care plans won’t cover expanded thyroid tests. T3 and T4 each cost around $30 each. Women will spend a lot of money on supplements, herbs, and ovulation kits, yet they often don’t think, “Am I getting the right tests?”
Most women walk around with levels of T3 and T4 that are too low. Even if your tests come back with a “low normal”, you should start supplementing with thyroid medication. If your doctor isn’t onboard with doing the extra tests, find another doctor. Even very small doses of supplemental thyroid hormone can make a huge difference.
You can boost your thyroid with iodine — a mineral that’s necessary to make thyroid hormone. Make sure you supplement under the supervision of a doctor or a naturopath, since too much iodine can also cause problems. To test your iodine levels at home, put two drops of liquid iodine on the inside of your forearms and let it soak in. You should see a dark brown stain on your skin. Let that dry, and check back after 12 hours.
If it’s more pale or completely gone, you have an iodine deficiency, and it’s time to supplement. If it’s completely gone after 24 hrs, your levels are low but not dangerously so. Even then you should have a blood test to see what your actual iodine levels are and see if supplementation is needed.
Another healthy activity that “steals” iodine is exposure to strongly chlorinated water. If you swim in a public pool even once a week on a regular basis, it is slowly lowering your iodine.
What to do next
It takes about 2 to 3 months for your hormones to balance themselves, when following the above guidelines. If you still haven’t become pregnant after 4 months or so, take the next step and order a full hormonal panel.
At a minimum you want your estrogen, progesterone, testosterone, LH, FSH, vitamin D levels, DHEA, CRP, homocysteine, ferritin, iron, and iodine levels checked. Your best chance, however, to have the correct lab tests done and save time and money is to work with a fertility doctor who will guide you through this process and monitor your results. Someone should be in charge of fitting the pieces of the puzzle together. Otherwise it’s much more difficult to understand what the obstacles might be that are keeping you and your partner from realizing your dream of having a family.
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