Signs you can't get pregnant: 8 Infertility symptoms

What is infertility?

Infertility can be an emotive topic, but in healthcare terms, infertility is when a couple cannot get pregnant, despite having regular, unprotected sex for over a year [1]. It is estimated that around 1 in 7 couples experience difficulties getting pregnant [2]. Though most terminology refers to couples, infertility can also refer to the experience of an individual, including those on a solo fertility journey.  

There are two types of infertility that an individual or couple might experience. Primary infertility refers to those who have never conceived in the past, and secondary infertility is when someone has had one or more previous pregnancies and is now having difficulty conceiving [2].

What are some infertility symptoms?

The main symptom of infertility is not getting pregnant after one year of regular unprotected sex [2]. However, there are a few other symptoms that may indicate infertility, especially in those who have not yet started trying to conceive.

Female infertility symptoms

In females, irregular periods can be a sign of ovulation problems, a common cause of infertility. In females, a common symptom of infertility is irregular periods, as this can indicate a problem with ovulation, which affects fertility [3]. Periods or cycles are unique to the individual, but yours may be classed as irregular if [4]:  

• Your menstrual cycles are shorter than 21 days or longer than 35 days

• Your cycle length varies by more than 7-9 days 

• You experience three months without a period

• Your periods last longer than seven days

• You bleed much more or less than usual during your period

• You have unexplained bleeding or spotting that happens outside of your period

• You experience severe period pain

An occasional irregularity is usually nothing to worry about, and something most people who have periods will experience at some point. But if you notice a sudden change in your cycle, speak to your doctor. Irregular periods do not always indicate a fertility issue, but are always worth getting checked out. 

Other symptoms of infertility in females might include pelvic pain or pain during sex, especially if the infertility is caused by endometriosis (more on that later) [5]. 

Male infertility symptoms

The most common infertility symptoms in males are those that affect the testicles or sperm. If you or your partner has large veins on their testicles, this may indicate a condition called varicocele, which can affect sperm shape and motility [6]. 

Other potential symptoms of male infertility include erectile dysfunction, reduced libido,  reduced semen volume, or cloudy urine after ejaculating [7, 8]. These symptoms may indicate problems with sperm or hormones.  

Remember that having these symptoms does not necessarily mean you have fertility struggles, but it’s best to speak to your healthcare provider for advice.

Causes of female infertility

A common cause of infertility in females are ovulation disorders [9]. Ovulation is the release of a mature egg cell and is critical for conception. Without ovulation, there is no egg for a sperm cell to fertilize. 

Polycystic ovary syndrome (PCOS) is present in around 70% of women with anovulatory cycles (when there is no ovulation) [3]. PCOS is a reproductive condition that affects how the ovaries function, often resulting in irregular or absent periods. Our ovaries have sacs called follicles where eggs mature and are gradually released. For those living with PCOS, these follicles often fail to release an egg, and ovulation does not occur. Though the cause of PCOS is still not fully understood, it is related to hormone imbalances in the body, specifically insulin. Individuals with PCOS produce high levels of insulin, which in turn contributes to higher levels of other hormones, such as testosterone [3, 10]. 

Problems with your thyroid can also impact ovulation. Hypothyroidism, or an underactive thyroid, is when your thyroid gland does not produce enough thyroid hormones [11]. Hypothyroidism can impact ovarian function, is associated with irregular periods and higher miscarriage rates [12].

Female infertility is not always related to ovulation. Other conditions can lead to infertility, such as:

• Scar tissue: Blockages or scar tissue can affect several areas of the female reproductive system. Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside of the womb, causing inflammation and scar tissue that can affect the ovaries or fallopian tubes [13]. Pelvic or cervical surgery may also leave scar tissue, as can past sexually transmitted infections (STIs) [2, 9].

• Fibroids: These are non-cancerous growths found in or outside of the womb. Depending on their location, fibroids can sometimes prevent a fertilized egg from implanting in the womb [14].    

• Pelvic inflammatory disease (PID): PID is an infection of the reproductive system, usually caused by bacteria entering through the vagina. It can cause an abscess and damage to the fallopian tubes, preventing an egg from traveling down into the uterus for implantation [2].

• Sterilization: Also referred to as tubal ligation, this procedure is considered a permanent contraceptive method involving blocking the fallopian tubes. It is rarely reversible, and if reversed, can leave scar tissue and increase your risk of an ectopic pregnancy [15].  

Fertility is a complicated and nuanced topic — getting pregnant is not an exact science, and there is an element of chance involved. While there are many potential causes behind infertility, it is important to speak to your doctor in the first instance. For some people, there will be an underlying cause; for others, it may just take a little longer than usual to get pregnant. 

Causes of male infertility 

The most common cause of male infertility is problems with sperm cells and their function [9]. Low sperm count is when you do not produce enough sperm in your semen. You can also have sperm that do not move properly or are abnormal in shape, both of which make it harder for them to swim to the egg [2]. Other causes of infertility in males include: 

• Testicular problems: The testicles are egg-shaped male reproductive organs that produce sperm and male hormones [16]. Any issues affecting the testicles can impact fertility, including varicocele, injury, cancer, surgery, congenital disorders, or an undescended testicle [2].

• Ejaculation disorders: Retrograde ejaculation is when semen travels backward into the bladder, instead of out through the urethra. It is not a health concern, but it can impact fertility, and symptoms include cloudy urine and a low amount of ejaculate [7].

• Hormone imbalances: Hypogonadism is a condition in which the body does not produce enough testosterone, a prominent male hormone produced in the testicles. Low testosterone can cause erectile dysfunction, low libido, and reduced semen, directly impacting the ability to conceive [2].

• Sterilization: Male sterilization, also known as a vasectomy, is a permanent contraception method. It can be reversed, but not often successfully, especially if it happened a long time ago [2].

Having one of these conditions does not guarantee you are infertile, and many individuals will still go on to successfully conceive. But it is important to speak to your doctor if you do have a condition that impacts fertility and you are trying to get pregnant, so that they can provide you with personalized support and advice.  

Infertility risk factors

Unfortunately, in around a quarter of infertility cases, the cause of infertility is unknown, referred to as unexplained infertility [2]. Whether you know the reason behind your infertility or not, here are several lifestyle and age-related factors that we know can affect fertility.  

• Age: Females are at their most fertile in their 20s, after which natural fertility begins to decline, especially after the age of 37 [9]. One study of 2,962 North American couples found that the average time to conceive increased with age. 79% of women aged 25 to 27 became pregnant within one year, compared to 56% of women aged 40 to 45 [17]. Once we reach our 40s, we are more likely to start noticing signs of perimenopause (the years prior to menopause or the end of our periods).  Though perimenopause usually starts between ages 45 and 55, some individuals might experience perimenopause from their 30s, and in rarer cases, experience early menopause [18]. 

• Alcohol: Heavy drinking can affect fertility in both males and females. A study on 1,221 men found lower sperm quality in those who consumed more than 5 units of alcohol per week, and effects were more noticeable for heavier drinkers who drank over 25 units per week [19]. In females, several studies found that any alcohol intake negatively affects the chances of conception, but the amount you drink correlates with its impact. In other words, a small amount of drinking only has a small effect, but heavy drinking has a more significant impact [20]. 

• Smoking: Smoking tobacco has a direct effect on infertility for females, increasing the overall likelihood of both primary and secondary infertility [21]. In males, smoking affects sperm production, motility, shape, and ability to fertilize an egg [22]. 

• Very high or low BMI: Weight can be a sensitive topic to discuss, but understanding how it might affect fertility can be helpful. In some cases, being very overweight or underweight is linked with hormone changes that can disrupt ovulation [23].

• Medicines and drugs: Some medications or treatments can affect fertility outcomes. The long-term use of anti-inflammatory medicines like ibuprofen can make conception more difficult for females. In males, sulfasalazine, used to treat Crohn’s disease and rheumatoid arthritis, can decrease sperm count. Chemotherapy can sometimes cause ovarian failure or severely reduce sperm production, and illegal drugs, such as marijuana, cocaine, and anabolic steroids, can negatively affect semen quality and ovarian function [2]. 

• Stress: While stress in small doses is healthy, too much stress can disrupt our brain–ovary signaling that regulates reproductive hormones, affecting estrogen, progesterone, and androgen levels and contributing to ovulation problems and cycle irregularities [24]. 

• Scrotal temperature: Abnormal sperm quality has been associated with increased temperature of the testicles. This could be due to a sedentary work position, hot environment, or restrictive clothing [25].

Getting pregnant with irregular cycles

Many of the above factors can cause irregular cycles, making it harder to predict when you are fertile. Natural Cycles has developed a unique algorithm that combines biomarker measurements and cycle tracking to predict ovulation and your fertile window (the days when sex can lead to pregnancy), even if your cycle is irregular. The NC° app makes it easy for you to input data and check when your fertile days are, helping you plan pregnancy from the palm of your hand. 

Tips to reduce the risks of infertility

Though infertility is often caused by factors out of our control, the good news is that there are small changes you can make to help reduce infertility, and many of them you can start right away. 

Eat a healthy, balanced diet

A nutritious, healthy diet impacts every aspect of our lives, including fertility. Research has shown that trans fats, refined carbohydrates, and foods with added sugars may be detrimental to fertility [26]. These are common in foods such as margarines, white breads and cereals, biscuits, deep-fried foods, and candy. 

On the other hand, the Mediterranean diet, rich in dietary fiber, omega-3 fatty acids, and plant-based protein, can help support both male and female fertility [26]. The Mediterranean diet emphasizes whole foods such as fresh fruit and vegetables, legumes and beans, fish and seafood, extra virgin olive oil, and wholegrain breads and cereals, and limits red meat and processed foods [27]. 

Diet can be a sensitive topic, and some people may find it easier than others to make changes. Speak to your doctor before implementing changes or if you are struggling to maintain a healthy diet. 

Consider supplementation

Sometimes, we might not be getting everything we need from diet alone, and that’s when supplements can come in handy. For those trying to get pregnant, folic acid is recommended before conception and during early pregnancy to help reduce the risk of neural tube defects [28]. In males, zinc plays an important role in normal sperm function, including sperm production and motility, but the benefits of supplementation for fertility remain unclear. [29]. 

Speak to your doctor or pharmacist before starting any new supplements, because some can interact with medicines, and taking too much of certain supplements, including zinc, can cause harm. Excess zinc may also have adverse effects on male reproductive health, although evidence on human fertility outcomes is mixed [29].

Get plenty of sleep 

Getting a good night’s sleep is restorative for many aspects of our health and wellbeing. In one study of 106 women with regular menstrual cycles, women who slept longer tended to have higher levels of FSH, a hormone involved in the menstrual cycle and ovulation. More research is needed regarding its affect on fertility, but  In terms of fertility, a study of 100 women found that longer sleep duration was associated with higher follicle-stimulating hormone (FSH) levels, which play a crucial role in ovulation. Though this study only showed a link, not proof that sleeping longer improves fertility, it is worth noting its potential impact [30]. 

Prioritizing sleep is sometimes easier said than done, but small changes to your sleep habits can go a long way. Try to avoid screens, such as phones or laptops, for at least two hours before bed, as the blue light they emit can interfere with sleep. You can also try sticking to the same sleep and wake times (even at weekends), keeping your bedroom at a cool, comfortable temperature, and using blackout blinds or an eye mask to block any light that might disrupt your sleep [31]. 

Keep active

Exercise can be good for fertility because it helps reduce your risk of some conditions, such as cardiovascular disease, and supports normal hormone function. In women with PCOS, regular vigorous exercise or strength training may improve ovulation and increase the chances of getting pregnant, even when weight does not change much. Exercise can also improve mental health by reducing stress, anxiety, and low mood, which is especially important for people dealing with infertility. However, very intense exercise combined with not eating enough calories may sometimes disrupt the menstrual cycle, so the best approach is regular, balanced exercise with enough food to support the body’s energy needs [32].

Quit smoking

Healthcare boards worldwide recommend that you quit smoking during pregnancy, so why not try to break the habit early on and potentially increase your chances of conceiving, too? It can be tough to stop a smoking habit; your family, friends, and healthcare providers can offer support. Pharmacies often have free information to get you started, and other resources are available, such as this 'how to quit smoking guide from the CDC. 

Practice mindfulness

Although the science of reducing stress and fertility is limited, we know that stress affects hormones and, in turn, hormones can affect fertility [9, 24]. Reducing stress can be another thing that’s easier said than done, but small, daily practices can make a huge difference. Mindfulness exercises such as yoga, breathwork, or meditation are linked to better well-being and energy, as well as reduced stress, anxiety, and depression [33]. It can also help to spend time with friends or family, whether you’d like to lean on them for support or as a welcome distraction from anything stressful in your life. Other mindful activities to help reduce stress include journaling, mindful coloring books, or scheduling some “me time” with a favorite book or movie [34]. 

Avoid environmental toxins and excessive heat

Exposure to some environmental toxins, including pesticides, heavy metals, radiation, and certain household items, is known to impact hormonal balance, sperm or egg quality, and overall fertility. The effects of these toxins tend to be subtle and accumulate over time [35]. Similarly, for male fertility in particular, try to avoid excessive heat around the testicles by reducing environmental heat exposure and wearing loose-fitting clothing. 

For most people, exposure to toxins and excessive heat will be limited. But any reduction can help reduce the risks of infertility linked to hormonal disruption or abnormal sperm quality. If you are regularly handling toxins or are spending long amounts of time in hot environments, for example, through your job, speak to your doctor about your plans to conceive and how you might be able to reduce your risk. 

Track your cycle

When you know your own body and cycle, it is easier to spot potential fertility issues early on. Natural Cycles can help you take control of your fertility, providing you with a cycle report to highlight any irregularities, so you can keep an eye on what your body is doing from one cycle to the next. You can also easily record any symptoms you experience, such as spotting or pain, and download the report to bring to your doctor when discussing your fertility. 

How is infertility diagnosed?

The first step for diagnosing infertility is to speak to your doctor or a fertility specialist. They will ask you and your partner questions about general health and lifestyle, including any medication you take, health conditions, past STIs and surgeries, any previous pregnancies, and your use of tobacco, alcohol, and drugs. They will also ask about your fertility journey so far, including birth control use, how long you have been trying to conceive, frequency of sex, use of lubricants, and previous sexual relationships [9]. Finally, they may also give you both a physical examination [2]. 

It might feel intimidating to answer lots of questions about your health, fertility, and sexual activity, but your doctor is there to help, and this first appointment is an important step in supporting your fertility journey. 

Testing for infertility

Following your initial appointment, your doctor might organize infertility testing for you and your partner. This often includes a test for chlamydia, via a vaginal swab or urine test. Chlamydia is a common sexually transmitted infection that, if left untreated, causes infertility, though it is usually treatable with antibiotics [2]. 

For males, your doctor might order a semen analysis that checks your sperm count, sperm motility, sperm cell shape, the pH level of your semen, and your white blood cell count in semen [36]. 

For females, your doctor may order a blood test to check progesterone levels, which can indicate whether you are ovulating. If you have irregular cycles, your doctor might test for hormones that stimulate the ovaries, called gonadotrophins [2]. If there is a suspected thyroid condition, you may have your thyroid hormones tested, too. Your doctor might also suggest an ultrasound or X-ray to check the health of your ovaries, uterus, and fallopian tubes [2]. 

Infertility treatment options

Infertility can be a difficult diagnosis, but there are treatment options available. 

 In many cases, your doctor will suggest lifestyle changes, such as improving your diet, quitting smoking, or managing your weight. Your doctor may prescribe you medication to treat an underlying condition, especially hormonal imbalances such as thyroid conditions. Ovulation stimulation may be used to help people with irregular or absent ovulation, but the underlying cause should be assessed first, as some gynecological or hormonal conditions may require specific treatment [1]. 

Your doctor might recommend surgery if there is a physical condition affecting your fertility. This could be repairing a damaged fallopian tube, removing fibroids, or treating endometriosis. In males, surgery can treat enlarged veins on the testicles [1].

If you are struggling with long-term infertility, you might consider using in vitro fertilization (IVF). IVF is a form of assisted reproductive technology (ART), offered amongst other treatments in situations of unexplained infertility, a need for genetic embryo testing, or when other options (such as medication or surgery) are unsuccessful. In IVF, the sperm and egg cells are combined in a laboratory setting, and the embryo is transferred to the uterus. It is a multi-step process that often involves suppressing natural ovulation, artificially inducing maturation of multiple eggs, removing the eggs, collecting sperm, fertilizing the eggs, and transferring the embryos into the womb [1]. 

Your choice of treatment will depend on the cause of infertility, if known, and your personal circumstances. Cost and availability will depend on where you live and vary greatly. Check with your doctor for more information. 

When to see a doctor

It is always best to speak to your doctor if you have any concerns about conceiving or fertility, especially if: 

• You are aged 36 or over

• You have an irregular menstrual cycle

• You have been trying to get pregnant for more than 12 months

• You have any medical conditions that can impact fertility, such as PCOS

• You have had treatment for cancer

• You have a condition that could be passed on to your baby

• You take regular medication that could impact fertility or pregnancy

• You think you have, or may have previously had, a sexually transmitted infection (STI) 

[2, 37]

Healthcare professionals, doctors, and family planning clinics are there to help you at whatever stage you are in your fertility journey. Speaking about these topics can be difficult, but the sooner you raise any concerns or ask questions, the sooner you can address any barriers you might be facing. 

Understand your fertility journey with Natural Cycles

Natural Cycles is more than a cycle tracker. In addition to cycle reports and symptom tracking, our FDA-cleared app is built to predict your ovulation day and fertile window, clearly showing which days you are most likely to be fertile. The NC° app is your modern fertility companion; a study of NC° Plan Pregnancy users found the average time to conceive was four cycles, reducing to two cycles for those under 35 with no known fertility issues [38]. And using NC° Partner View, you can invite your partner to learn about your cycle and fertile days, too. Support your fertility journey with Natural Cycles!