If you have been trying to get pregnant without success then you’ve come to the right place. The fertility doctors at the RMA Network have outlined how to get pregnant if you have been trying to conceive and have been unsuccessful.
Table of Contents:
- Aging and Fertility
- Identifying Medical Barriers to Getting Pregnant
- Medical Conditions That Affect Female Fertility
- Medical Conditions That Affect Male Fertility
- Getting Started: When to See A Fertility Specialist
- Getting Pregnant with IVF
- How to Improve Your Infertility
- How to Choose the Right Fertility Clinic
It can be frustrating when friends and family repeatedly ask you when you plan to start a family. It can be worse when everyone around you seems to be getting pregnant without even trying. Below the fertility doctors at RMA have outlined how to get when you’ve been trying with no success.
You’re not alone. According to Resolve, The National Infertility Association, infertility affects 1 in 8 couples in the U.S. – that’s 12.5 percent. In this story, we’ve outlined the possible barriers to getting pregnant, and solutions that can help aspiring parents achieve their dream of starting a family.
When your attempts to get pregnant are unsuccessful and you begin to feel hopeless and lost, know that there are many treatments that can help you achieve your dreams of starting a family. Ongoing advancements in assisted reproductive technologies, many of them driven by RMA, are giving fertility specialists the research, tools, and protocols they need to help aspiring parents overcome their barriers so they can move ahead with plans to start their family.
More often than not, couples who struggle to get pregnant naturally may be unaware of an underlying condition, in one or both partners, that may be hindering conception. This is why it is important for each partner to get evaluated by a reproductive specialist as early as possible.
If you are a woman aged 35 or younger and you have been having unprotected sex with your partner for over a year and not getting pregnant, it’s time for you both to see a fertility specialist. Women over 35 years old, and their partners, should see a specialist after six months of trying, or sooner since there is a greater chance of age-related fertility problems.
The primary reason women struggle to get pregnant as they get older is that the quality and quantity of a woman’s eggs, or “ovarian reserve,” decrease over time. A woman is born with all the eggs she will ever have in her lifetime, between 1 and 2 million, but by the time she reaches puberty, that number drops to about 300,000 and, of those, only about 300-400 will ovulate during her reproductive lifetime.
Age is also a factor for men since sperm counts decline over time. However, men can have issues with sperm count, shape and motility at an early age. In fact, fertility issues are related to men as often as they are to women, which is why it is important for both partners to consult with a reproductive endocrinologist if they are having trouble conceiving. Learn more about male infertility.
While some infertility cases are unexplained, most barriers to getting pregnant can be identified with some basic testing. They may sound simple, but a semen analysis for the male and a blood test and vaginal ultrasound for the woman – often the first tests to be ordered by a fertility doctor – return a huge amount of information about a patient.
Blood tests don’t only reveal a patient’s blood type, they also tell doctors about hormone levels in a woman’s body and how they relate to her fertility. The two most important hormones doctors check for are Follicle Stimulating Hormone (FSH), and Anti-Mullerian Hormone (AMH). (For further explanation, please see hormone imbalances section below.)
A semen analysis is a simple microscopic examination of a man’s semen to determine information about a man’s sperm.
Many men are embarrassed by this test, but it can be performed by collecting sperm in the office or at home if this is more comfortable. Doctors check for sperm count (how many there are), motility (how well they swim) and morphology (how many are normally shaped), along with other factors.
Low sperm count can often be traced to either low or extremely elevated testosterone levels, certain medications, a blocked duct, or medical conditions that cause sperm to back up into the bladder.
Since many conditions can be treated, males who have concerns may want to speak to one of RMA’s reproductive urologists who specialize in treating a wide range of male-specific conditions.
For a female, a physical exam usually involves a routine vaginal ultrasound which is often performed during the first visit. This allows a basic evaluation of the uterus and ovaries which can identify cysts or fibroids.
It is also important to check the fallopian tubes so a hysterosalpingogram (HSG) may be ordered to view the fallopian tubes since any blockage would explain why sperm is not able to reach the egg during natural attempts to get pregnant. An HSG is an X-Ray test where dye is flushed through the fallopian tubes. It can be performed during the first two weeks of the menstrual cycle.
In some cases, the doctor may order a saline sonogram to get a closer look at the shape of the uterus and check for fibroids, scar tissue, or other abnormalities. A physical exam for the male is similar to an annual physical, but with a more detailed discussion about medical history so the doctor can check for fertility-related anomalies.
Some conditions can be resolved with medications or minor procedures.
For patients with chronic or untreatable conditions, however, doctors usually recommend In Vitro Fertilization Treatment (IVF) since IVF can circumvent many medical issues. The close supervision and science-backed protocols offered by IVF treatment can give patients a viable, safe and successful route to achieving family-building goals when attempts prove difficult.
A variety of factors can contribute to female infertility. Fortunately, fertility treatment can address most conditions in order to increase the chances of a successful pregnancy.
Problems getting pregnant may be due to hormonal imbalances in either or both partners. Simple blood tests can be performed to identify imbalances that are usually easy to treat.
- Estradiol is a type of estrogen produced by the ovary inside of growing follicles. It is a good indicator of reproductive viability of the eggs growing inside of the follicles. Estradiol is also important for the uterine lining to grow and support a pregnancy.
- Anti-Mullerian Hormone (AMH) is a good barometer of a woman’s ovarian reserve and a possible hormonal indicator for Polycystic Ovary Syndrom (PCOS). AMH is produced inside the ovarian follicles where eggs develop. It is a marker of how many eggs are available at any given time. While a low AMH could signal a low ovarian reserve, a high AMH could be indicative of PCOS which is a condition where a woman ovulates irregularly or not at all. You can learn more AMH levels in this blog: AMH Blood Test Levels – Understanding AMH Fertility Test Results.
- Follicle Stimulating Hormone (FSH) measures how hard your brain’s pituitary gland (a gland in the neck responsible for the control of metabolism) is working to tell your ovarian follicles to grow. A high FSH can mean the patient has a low ovarian reserve, since the harder the gland is working, the smaller the reserve. If you have high FSH levels, your chances of becoming pregnant naturally are often lower, but IVF offers good success rates in many cases. For more information check out this blog: Do High FSH Levels have you Frustrated?
- Luteinizing Hormone (LH) stimulates the release of the egg from the follicle and plays a role in stimulating the ovary to produce hormones. The LH Surge refers to a spike in LH levels around the time of ovulation that can be detected with blood tests or urine test strips. Low levels of LH may indicate a deficiency that can be treated with medication.
- Progesterone prepares the uterine lining so that an egg can implant. Healthy levels of progesterone are extra important early in a pregnancy. Patients with low levels would be prescribed a progesterone medication, whether they are trying to get pregnant naturally or with IVF. Progesterone can be given to induce a period if a woman does not ovulate on her own.
- Androgens, such as testosterone and DHEA, are normally produced at low levels in women. The presence of excess androgens can be a sign of Polycystic Ovary Syndrome (PCOS) and often results in increased facial hair or acne.
- Prolactin is produced in the pituitary gland. Healthy amounts are needed after pregnancy to stimulate milk production. High prolactin levels outside of pregnancy can interfere with the normal production of other hormones, which may lead to problems with ovulation or cause irregular or missed periods. High levels of prolactin are often produced by small benign tumors of the pituitary gland called prolactinomas, which can be detected by MRI and are easily treated with medications.
- Thyroid Stimulating Hormone (TSH) reflects how the pituitary gland communicates with the thyroid gland. A high TSH indicates that the thyroid is underactive (hypothyroid) which can cause problems with ovulation and miscarriage. A low TSH may reflect an overactive thyroid (hyperthyroidism) which can cause missed periods and difficulties conceiving. Both of these conditions are easily treatable with medication so it is important to get checked and monitored.
Polycystic Ovarian Syndrome (PCOS)
PCOS is a common metabolic and hormonal imbalance that results in irregular or no menstrual cycles and this makes it hard to conceive. Women with PCOS can be treated with oral medications such as Clomid or Letrozole and many will conceive.
If oral medications are not successful, IVF offers high success rates for PCOS patients. In fact, a recent study in the New England Journal of Medicine found that Frozen Embryo Transfer (standard care at RMA) leads to higher than average success rates among PCOS patients.
Endometriosis is a condition that results in endometrial cells from the lining of the uterus implanting outside the uterus and attaching to other organs in the abdominal cavity. During a menstrual cycle, the blood from the uterus can flow backward through the fallopian tubes, which allows endometrial cells to implant on the pelvic walls, bladder or ovaries.
During subsequent menstrual cycles, hormones stimulate these implanted cells to bleed which leads to scarring and inflammation that can damage the fallopian tubes and the eggs. Many women with endometriosis develop painful periods and infertility due to blocked fallopian tubes and egg quality issues.
While surgery can help patients with endometriosis in some cases, IVF is the best treatment for fertility as it allows egg and sperm to meet in an environment free from inflammation.
Uterine Fibroids, also known as leiomyomas, are non-cancerous muscle tumors that develop in the walls of the uterus. Fibroids are a common cause of heavy periods and pelvic pain or pressure.
If a fibroid grows into the cavity of the uterus, it can interfere with implantation and make it difficult for a woman to conceive. If fibroids grow to be large, they can compress the fallopian tubes and cause pain.
In many cases, fibroids can be monitored with routine ultrasound and women can become pregnant with them in place. In some cases, the fibroids will need to be removed in a surgery called a myomectomy which can be performed through the vagina or through an abdominal incision.
If fallopian tubes are blocked or damaged, it is difficult for sperm and egg to meet and can increase a woman’s risk for a tubal (ectopic) pregnancy. These blockages are often caused by prior surgery, infections or endometriosis.
While some patients may be candidates for surgery, most will need IVF to bypass the fallopian tubes in order to conceive. For these patients, IVF offers a high success rate and a safe way to avoid a tubal pregnancy.
Diminished Ovarian Reserve
Women are born with all the eggs they will ever have. Throughout a woman’s life, she is constantly using eggs and eventually, all women run out of eggs at the time of menopause. A woman does not move from being fertile to menopausal overnight.
This is a transition that can take 10 to 12 years. As the quantity and quality of eggs decrease, causing diminished ovarian reserve, it becomes harder for a woman to conceive.
Diminished ovarian reserve can be diagnosed by looking at hormone levels (low AMH or high FSH) or by seeing fewer follicles on an ultrasound of the ovary. IVF is usually the best treatment for women with diminished ovarian reserve as it speeds up the time to pregnancy and can offer the option to bank embryos for future use.
Embryo banking allows women to complete their family even after their ovarian reserve has decreased significantly.
Primary Ovarian Insufficiency (POI) / Premature Ovarian Failure (POF)
Primary ovarian insufficiency (POI) is the medical term for early menopause. While menopause usually occurs between ages 42 and 56, women with POI reach menopause before age 40.
In a few situations, there are genetic causes for POI, although most cases are unexplained. For women with POI, IVF treatment using a donor egg offers high success rates.
Recurrent miscarriage is defined as three or more consecutive pregnancy losses. This condition can be emotionally devastating as well as physically challenging.
Most cases of recurrent pregnancy loss are unexplained, although it may reflect a genetic condition, anatomic disturbances, hormonal imbalances or poor egg quality. It is important to have a thorough evaluation after two or three miscarriages without a successful live birth in order to find potential causes that might be treatable.
During cancer treatment, chemotherapy and radiation can damage a woman’s ovaries, and affect the quality and quantity of her eggs.
Fortunately, RMA has been leading the way with its fertility preservation program. RMA doctors work with cancer patients to help them quickly preserve their fertility (through egg freezing), after a cancer diagnosis but before treatment, so they may attempt to conceive with IVF when they are in remission.
RMA has also gone one step further by rallying for legislation that mandates insurance coverage for cancer patients who want to preserve their fertility.
Elective Fertility Preservation
IVF technology has also empowered women to take control of their fertility. If a woman is looking to delay conception or has not found the right partner, egg freezing has evolved as a powerful tool.
Bloodwork and a vaginal ultrasound can give physicians enough information to help women decide the right time to freeze eggs. While many women wait until their late thirties or early forties to consider egg freezing, it is actually most successful in women in their early thirties.
About one-third of infertility cases point to male issues.
These may include hormonal imbalances, low sperm count, sperm abnormalities, problems with reproductive anatomy, and lifestyle factors like weight, alcohol use, smoking, and stress.
In difficult or untreatable cases, the male can still start a family using a sperm donor. Outlined below are conditions that affect male fertility, and related treatments that make parenthood possible.
Men with no sperm in their semen suffer from a condition called Azoospermia. Diagnoses and treatments vary, however, a procedure called microsurgical testicular sperm extraction (microTESE) identifies sperm in many cases. These sperm can be used to fertilize eggs in the embryology lab to create embryos during an IVF cycle.
A varicocele is a condition where the veins in the testicles are dilated slowing the return of blood. This slow blood flow increases the temperature of the testicle and in some cases can impair sperm production. While many varicoceles are not significant enough to require surgery, men with large varicoceles and low sperm counts may benefit from surgical correction.
The immune system has antibodies that fight off foreign substances such as infections. Sometimes these antibodies find their way into the reproductive system and cause problems with fertility.
In males, this can be due to an infection in the prostate, or the result of blood coming in contact with sperm during an injury to the testicles or after a vasectomy. A test can be done on sperm during a semen analysis to look for antibodies.
There are several modalities for treatment, with IVF combined with Intracytoplasmic Sperm Injection (ICSI) offering the best chances for getting pregnant.
Hormonal Imbalances in Males
Hormonal imbalances affect fertility in men, just as they do in women. In men, the pituitary gland stimulates the testicles to produce sperm and testosterone.
Some men with low sperm counts will also have low testosterone levels. It is often possible to increase sperm counts by jump-starting the hormones (FSH and LH) that stimulate testosterone and sperm production.
Men who take testosterone supplementation are at risk to have low sperm counts. It is possible to reverse this imbalance, but it may take several months to restore sperm counts in former testosterone users.
The first step in your fertility journey should be to have a full evaluation by a competent specialist. A reproductive endocrinologist is a specially trained gynecologist who has spent additional time learning how to evaluate and treat infertile couples.
The initial evaluation usually consists of blood work and a vaginal ultrasound for female partners. Sometimes an x-ray test called a Hysterosalpingogram (HSG) will be performed to check the fallopian tubes.
Male partners usually have blood work in addition to a semen analysis. Once you have had a thorough evaluation, your specialist can help you determine the correct path for treatment.
In many cases it is possible to initially start with medications to enhance ovulation. Often medications are combined with Intrauterine insemination (IUI) which involves injecting sperm into the uterus around the time of ovulation. Some patients may benefit from a surgery to restore surgical anatomy.
For some patients with more serious conditions, In Vitro Fertilization (IVF) may be necessary to bypass blocked tubes or make the most of low sperm or egg counts. While IVF is a more involved process, it is also highly successful.
While it is clear that IVF is the best option for aspiring parents struggling to get pregnant, it is also important to note that not all IVF treatments are alike. After 20 years of honing the science, RMA founders and researchers have established a standard of care that has increasingly led to higher IVF success rates, while safeguarding the health of mothers and babies.
Years ago, IVF treatment often resulted in twins or triplets because doctors would transfer more than one embryo, hoping for successful implantation. However, multiple pregnancies put the health of mothers and babies at risk. This is why RMA’s standard of care is Single Embryo Transfer (SET) and Frozen Embryo Transfer (FET), combined with genetic screening.
Pre-implantation genetic testing allows doctors to test an embryo for chromosomal abnormalities (too many or too few chromosomes) before deciding whether to transfer that embryo. Since embryos with chromosomal abnormalities are the most common cause of miscarriage, and can also result in an affected baby after birth, pre-implantation genetic testing is a reliable and vital tool that allows doctors to choose the best embryo for transfer and dramatically increases chances of pregnancy, ongoing pregnancy and the birth of one healthy baby for patients.
An RMA study which looked into the cost-benefit of pre-implantation genetic testing also found it cost-effective, since it reduces the risk of failed transfers or miscarriages and the resulting cost of multiple cycles.
In addition to medical issues, factors like lifestyle, diet and the environment affect fertility in both women and men. If you are looking to increase your chances of getting pregnant, here are some lifestyle choices you’ll want to evaluate.
- Smoking not only harms ovarian function during IVF, but threatens the health of a mother, the fetus, and the people around them breathing in second-hand smoke. Smoking also affects sperm health. Anything both partners can do to stop or decrease smoking will help with fertility.
- Alcohol consumption and drug use should be eliminated altogether when trying to get pregnant since they negatively affect reproductive and sexual function and can cause health problems in a newborn should a pregnancy go to term.
- Being overweight increases BMI which can contribute to infertility. Changes to your diet can go a long way toward preparing your body for a healthy pregnancy. Exercise plays a vital role as well.
- Environmental toxins, also known as endocrine disruptors, have been contributing to worldwide decreases in fertility. They are hidden in our food, water, and the products we use on our bodies, in our homes and on our properties every day, as well as in the indoor and outdoor air we breathe. It is important to pay attention to labels, eat organic food whenever possible, and to use green products to the extent possible.
- Sexually Transmitted Infections (STI) can negatively affect fertility so always use condoms during sex until you are in a committed relationship and you have both been tested.
- Some prescription medications can decrease fertility or inhibit conception so check with your doctor about weaning off such medications or finding safer alternatives, if possible.
More and more fertility clinics are opening their doors to meet the needs of aspiring parents looking to start and build families. It is not always clear which clinics are practicing cutting edge medicine and your closest clinic might not be your best choice.
Online reviews provide limited information and every clinic will claim to be the best. Since this is one of the biggest decisions you’ll make in your life, you’ll want to be informed. Here are some thoughts to consider when weighing your options.
- Choosing a clinic where the doctors are also researchers will increase your chances for success since their knowledge of emerging technologies and protocols will be current. As a research and training institute, as well as a clinic with high success rates, RMA has been at the forefront of advancements in reproductive medicine. In fact, at this year’s annual American Society for Reproductive Medicine (ASRM) global conference, 68 of RMA’s scientific abstracts were accepted for presentation and several were recognized with awards, including the event’s top honor for research into extended embryo culture and the origins of aneuploidy.
- Schedule an initial appointment with the clinic, feel it out and trust your gut. Does the administrative staff seem accommodating and efficient? Do they treat you with patience and respect? Do the doctor and care team seem supportive and compassionate? Are the labs advanced? Are monitoring hours flexible? Are the doctors readily available? For 20 years, RMA patients have assured us that we check those boxes.
- Look closely at doctor profiles to be sure they are highly trained and licensed. RMA physicians have exceptional credentials, and many are internationally recognized research leaders, clinicians, and educators.
- Ask about the clinic’s protocols and how they relate to your chances of conceiving. For example, RMA adheres to a strict standard of care -- Single Embryo Transfer and Frozen Embryo Transfer -- because it has consistently resulted in higher success rates while mitigating risks to mothers and babies.
- Be sure the clinic shares patient testimonials and has plenty of them. RMA’s blog offers many. More can be found on our #MyRMAStory page.
- Since the topic of infertility is less taboo than it used to be, people are more willing to share their success stories. If you know someone who has had a child with fertility treatment, be sure to get a referral. Since RMA now has 19 locations in the U.S., you are bound to hear a happy parent mention our name.
At RMA, it is our mission to help hopeful parents build families each day. We wish you well on your journey toward parenthood. Know that we are always here to help.