If you’ve been trying for a baby for a while with no success, you’ve probably asked yourself why can’t I get pregnant? For some people it all happens so easily, while others face month after month of continued disappointment. It’s important to know that you are not alone in your struggles. In fact, it’s estimated that sub-fertility affects a whopping 1 in 7 couples in the UK, with global fertility rates dropping by over a half in the last 50 years.
Infertility is considered when a couple has failed to conceive after 1 year of having regular unprotected sex. Unfortunately, causes aren’t always clear cut, it’s often multifactorial and can affect both partners. These factors can range from simple, fixable things such as missed ovulation windows or poor lifestyle choices, to more complicated issues such as structural damage or unexplained infertility.
Let’s take a look at the top 10 factors that could be causing problems:
1. Ovulatory disorders
Ovulation is a crucial step in the process of conception. We need an egg to be released by the ovaries in order to get pregnant, therefore if there’s a problem within this process we will most definitely run into difficulties. Ovulatory dysfunction counts for approximately 25% of all cases of infertility. It can be affected by a whole host of
things, including:
Extended time on birth control
Being under or overweight
An imbalance of hormones which can have a direct impact on your cycles
Conditions such as PCOS, hypothyroidism & hyperprolactinemia
Premature ovarian failure
Deterioration of egg quality and quantity – most commonly associated with age
Any of the above can result in sporadic ovulation or an absence of ovulation all together (anovulation). This manifests as irregular periods, no period at all or abnormal bleeding. With all this going on it can be extremely difficult to know when it’s the best time to have intercourse when trying for a baby. The key here is to address the underlying cause of your ovulatory disorder, which can range from anything from poor diet and lifestyle, genetic links and the environment you surround yourself in. This is where working with a nutritional therapist can become really
beneficial, as we work to uncover the root cause of your issues.
2. Tubal damage
Tubal damage counts for 20% of all cases of infertility. Pelvic inflammatory disease (PID), commonly contracted via sexually transmitted microorganisms such as chlamydia, is a leading cause of tubal infertility.
Endometriosis can be another factor. This is where tissue similar to the lining of the womb grows in other places such as fallopian tubes or the ovaries. Endometriosis affects more than 10%-15% of women who are of childbearing age. It causes pelvic adhesions, distorted anatomy and ovarian or tubal damage. This can also have a knock-on effect in the ovulatory process.
3. Factors in the male causing infertility
Male infertility is on the rise, with approximately 30% of all infertility cases being due to male factors. 21st century living and Western diets have seen a dramatic impact on sperm parameters, with increasingly lower sperm counts, poorer motility (movement) or abnormal shapes and sizes (morphology).
Structural issues such as testicular damage, undescended testicles or blockages due to varicoceles can fundamentally inhibit or reduce sperm production. A urologist or testicular scan can investigate these issues further and suggest a treatment plan, which may include surgery.
As with women, infections can also be a common problem for men. A semen culture is worth having when struggling to conceive to rule this out, as it can be a simple fix by treatment with antibiotics.
Hormonal imbalance can also wreak havoc on male fertility. Low testosterone levels can reduce sperm production and lower libido. While testosterone supplementation, which many men take to build muscle, can actually further damage the quality of sperm.
An increase in temperature can also have a significant impact of semen production. Any activity that increases the temperature of the scrotal area should be avoided when trying to conceive. This includes sauna’s, cycling, sitting for long periods of time, working with a laptop over the groin area and wearing tight clothing. An elevated temperature can result in DNA damage and increase in free radicals, which leads to reduced functional competence and structure of sperm
4. Too much exercise
While exercise can definitely have positive outcomes on fertility, over exercise or intensive forms of exercise can be detrimental to both men and women. Maintaining a BMI of 18-25 is the ideal for successful pregnancy, anything below 18 can inhibit conception. In women, over exercise can cause hypothalamic suppression, disrupting hormones and causing problems with ovulation. In men, moderate exercise can increase sperm production however excessive exercise can have the opposite effect.
In both sexes intense exercise can increase cortisol levels, up-regulate our sympathetic nervous system and generate harmful free radicals. Strength training, yoga, gentle jogging and swimming are all great options for gradual weight loss or maintaining a healthy weight.
5. Lack of crucial vitamins and minerals
Micronutrient status affects the capacity to conceive and support a pregnancy through to birth. In particular, your body needs sufficient levels of vitamins B, C, D and E, as well as minerals including iron, zinc, selenium, choline, iodine, COQ10 and magnesium. These nutrients are crucial for supporting menstruation and ovulation, thyroid function, energy production, immune function and egg and sperm quality and maturation.
A highly processed diet will also have detrimental effects on fertility, by promoting inflammatory pathways and increasing oxidative stress throughout the body.
6. Being overweight
There are strong links between obesity and infertility across both sexes. In women excess adipose tissue can wreak havoc on hormone health, which then disrupts ovulation and can cause irregular menstruation. Obesity in men can cause erectile dysfunction, lower sperm counts, reduce semen quality and create hormonal issues.
The closer a person is to being a healthy weight, the better their chances are for conception. Anyone with a BMI >30, which is considered overweight, should try to lower this with regular moderate exercise and a healthy diet.
7. Smoking and toxic load
Studies have shown that 40% of infertile men are smokers. The number, quality and motility of sperm all decrease in smokers, meaning they are less likely to fertilise an egg. Toxic chemicals such as nicotine, cyanide and carbon monoxide in cigarettes cause a rapid destruction of eggs in females, causing female smokers to experience menopause up to 1-4 years sooner than a non-smoker. Female smokers also have a 30% lower change of successful pregnancy via IVF. Infertility rates almost double in smokers when compared to non-smokers.
8. Not having enough sex
In many cases the problem could be as simple as not having sex within your fertile window. When trying to conceive it’s important to track your cycle and know the day you ovulate. Your peak fertility will be approximately 5 days before ovulation and the day you ovulate, so 6 days in total. This is because in the right environment sperm can live for up to 5 days in the female reproductive system waiting for an egg. Once released from the ovary an egg can survive for 48hrs. The two combined is your fertile window, so knowing when this occurs and having unprotected sex every other day in this timeframe will increase your chances of pregnancy.
9. Unexplained infertility
Unfortunately, in many cases fertility issues just can’t be explained. This is perhaps the most frustrating of causes, where semen analysis is normal and female infertility factors have been ruled out. Unexplained infertility is thought to account for up to 25% cases in the UK.
It’s important to take into account and support even subtle factors that could be causing infertility. These could be problems with fertilisation, implantation, the uterine environment, change in egg or sperm health due to ageing and lifestyle/life load.
10. Reproductive age
Although semen quality does indeed decline with age it’s nowhere near as dramatic as women, where infertility rates accelerate after 35 years. In this day and age women are far more career driven and holding off thinking about having children until later in life. Unfortunately, both the quality and number of eggs decline with age, unlike a man who continues to produce sperm throughout his life. There is a 71% chance of pregnancy in women below 30, however this decreases to 41% when over 36. As a woman gets older the risks also become higher, with increased rates of miscarriage and chromosomal abnormalities.
What can we do to improve our outcome?
Given the vast range of causes of infertility, it’s crucial to investigate appropriately and work on personal requirements with your GP, fertility specialist or nutritional therapist.
Couples with 4 or more negative lifestyle variables, including things like smoking, high alcohol consumption, poor diet, stress, obesity, toxic exposure etc, can take up to 7 times longer to get pregnant. The good news is, we have control over all these factors. Pre-conception is the most impactful time – in an ideal world a couple would start making changes to their diet and lifestyle at least 3 months prior to conception.
The process of making new sperm takes 86 days, with eggs taking a similar length of
time to mature. If you give yourself at least 3 months of making healthy changes, both
egg and sperm will be in the best possible condition and stand a higher chance of
fertilisation. It’s also important to stress diet and lifestyle changes need to come from
both parties, not just women.
Do you want support in your fertility and pregnancy journey? Book a free consultation with Gail to find out more.
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Gail Madalena
Registered Nutritional Therapist
Gail Madalena is a registered nutritional therapist specialising in fertility, pregnancy and women’s health. Her expertise lies in hormonal imbalances, such as irregular cycles, debilitating PMS, PCOS, endometriosis, thyroid issues and sub-optimal fertility. Her goal is to reduce hormonal side effects and symptoms by addressing the root cause of the issue. Gail helps couples optimise your nutrition and lifestyle choices, supporting you on your journey to achieving a healthy pregnancy.