Why am I not getting pregnant?
First: how long has it been?
If it is under a year and you are under 35, this is common rather than a problem. The chance of conceiving in any given month is roughly one in five even with everything working well.
See a specialist after 12 months, or 6 months if you are 35 or over — sooner with irregular cycles, known endometriosis or PCOS, previous pelvic surgery or infection, two or more miscarriages, or a known concern in either partner.
The causes, roughly in order of frequency
Ovulation problems. PCOS is the commonest — now renamed polyendocrine metabolic ovarian syndrome (PMOS), with clinical content unchanged. Also thyroid disorders, raised prolactin, premature ovarian insufficiency, and functional hypothalamic amenorrhoea from low energy availability.
Male factor. Involved in a substantial proportion of cases, and typically symptomless. A semen analysis is quick and inexpensive and should be among the first tests — male assessment is still routinely delayed.
Tubal damage. Often from previous infection — chlamydia in particular is frequently asymptomatic while causing tubal damage.
Endometriosis. Average diagnostic delay measured in years, because severe period pain gets normalised.
Uterine factors. Polyps, fibroids distorting the cavity, adhesions.
Age-related decline in egg quality.
Unexplained — a real and common outcome. It means standard tests found nothing, not that nothing is wrong or nothing can be done.
Things that matter less than you might think
Timing precision. Sex every one to two days across the fertile window is enough. Daily is not necessary, and intensive tracking often adds stress without adding much.
Position and lying down afterwards. No evidence.
Stress. Severe sustained stress can suppress ovulation. Ordinary stress does not prevent pregnancy — and "just relax" is unhelpful and largely inaccurate.
Lubricants. This one does matter — many standard lubricants impair sperm motility, as does saliva. Use one labelled fertility-friendly if you use any.
What to do now
Confirm you are ovulating. Get a semen analysis for your partner. Address modifiable factors — smoking, alcohol, weight, thyroid function, vitamin D. Start folic acid.
And do not let "it is probably just stress" or "give it more time" delay assessment past the thresholds above. Investigation takes months, so the cost of waiting compounds.
If tests come back normal
That is genuinely common. Unexplained infertility is a diagnosis, not a failure to find one — and treatment options exist regardless.
Sources
- International Evidence-based Guideline for PMOS (formerly PCOS)
Frequently Asked Questions
How long should I try before seeing a doctor?▾
Under 35: 12 months. Ages 35–39: 6 months. Age 40+: seek evaluation immediately. If you have irregular periods, PCOS, endometriosis, previous STIs, two or more miscarriages, or a partner with known issues, see a specialist earlier regardless of age.
Can I be infertile if I have regular periods?▾
Yes. Regular periods confirm ovulation is probably occurring, but not that tubes are open, the uterine cavity is normal, eggs are chromosomally competent, or the male partner has normal sperm. Many women with significant fertility issues have completely regular cycles. A complete fertility workup goes far beyond checking period regularity.
Is male infertility as common as female infertility?▾
Male factor contributes to 40–50% of all infertility cases. In approximately 30% of infertile couples, the problem is solely male. A semen analysis is one of the simplest, cheapest fertility tests and should always be part of an initial workup — regardless of whether the man has any symptoms.