Getting pregnant: 10 factors that contribute to your chances

A common question: why am I not pregnant? 

As physicians at MFC, we get asked this question all the time! And, to be honest, it’s not easily answered. The answer truly varies for every person or couple we see. But, it’s still important to talk about it. More importantly, we want to review how we tackle this question daily at Markham Fertility Centre.

Is getting pregnant, getting more difficult?

First of all, are infertility rates rising worldwide? The answer is maybe – many variables may be affecting the answer. In general, people are older when they start trying to conceive. People are also having fertility treatments at much higher numbers than ever before. There were about 42,000 IVF cycles in Canada in 2022 (CARTR data). This is twice as many cycles as there were 10 years ago! (CARTR data). 

Let’s go back to the most commonly asked question: Why am I not pregnant? 

This is a BIG question and is not easily answered. Let’s review 10 factors that contribute to infertility: 

  1. Age
  2. Hormonal imbalances
  3. Reproductive system issues
  4. Nutrition and weight
  5. Smoking and substance use
  6. Stress and mental health
  7. Exposure to toxins
  8. Chronic illness
  9. Previous medical treatments
  10. Inherited conditions
sperm fertilizing an egg for conception mean getting pregnant

1. Age

Age is the most important predictor of spontaneous conception in heterosexual relationships.

When a woman is around age 25, the chance of conceiving each month is about 25%. It is normal for a pregnancy to take a few months, even at a young reproductive age. Once a woman gets into her early 30s, the chance of pregnancy each month drops a little bit to about 20%; and by the time a woman hits 40, that chance of pregnancy each month drops to about 5% (Reproductivefacts.org).

So when is it time to see a fertility specialist? In women under 35 years of age, we normally say that after one year of unprotected intercourse is a good time to get checked out. Pregnancy will occur in about 85% of couples after a year of unprotected intercourse. So if it hasn’t happened for you, then it’s time to see a fertility specialist. In women who are 35 and over, it’s better to get checked out sooner because, unfortunately, the clock is ticking. And so after about six months of trying, it is a great time to seek out fertility help.

Infertility is estimated to affect 15% of couples or 1 in 6

Female fertility declines with age, and this happens in two ways: decline in egg quality and decline in egg quantity. Unfortunately, there is not a lot that science can do to turn back the clock. Certainly, in vitro fertilization (IVF) can help, but even in IVF, we’re still working with the eggs that are whatever age they are. So that’s why even in IVF, the pregnancy rates are much lower in older reproductive age compared to younger reproductive age.

Male fertility also decreases with age. There is a common misconception that it doesn’t matter for men how old they are. It does matter. There is an increased risk of certain congenital diseases and mental disorders in children born to older men (National Library of Medicine). There is also a decline in sperm performance with age. The big difference is that it happens much later than it does for women. So for women, the end of the fertile window is around 40 to 43 years of age, and for men, we start seeing a decline in sperm parameters after 50 years of age.

2. Hormonal imbalances 

Generally speaking, another reason why couples might be having difficulties conceiving is that there can be hormonal imbalances. Hormonal imbalances is a very broad term and it can mean many, many different things.  Probably most common is PCOS or polycystic ovarian syndrome, where we see that women will have irregular menstrual cycles and they may not be ovulating once a month.

Other hormonal issues that affect fertility include thyroid disturbances, either an overactive or an under-active thyroid. There can also be an issue with the hormones that are coming from the brain that “speak” to the ovaries as well. Many of these things can be discovered through blood tests.

3. Reproductive system issues

Another issue that could be preventing you from getting pregnant is abnormalities in the reproductive system. This can include things like blocked fallopian tubes, abnormalities in the shape of the uterus, or endometriosis that can cause inflammation in the pelvic area.  Fibroids or polyps, especially fibroids that are located inside the cavity of the uterus, can also cause issues.

For men, structural issues of the reproductive system can include varicoceles. Varicoceles are swollen veins in the scrotum that allow for increased temperature in the scrotum and therefore decreased motility and increased abnormal morphology in the sperm.

4. Nutrition and Weight

Poor nutrition and extreme fluctuations in body weight can disrupt hormonal balance and interfere with reproductive functions. Obesity, as well as being underweight, can contribute to fertility issues. 

Extreme fluctuations in weight here can cause fertility issues. For instance, somebody who has undergone bariatric surgery may lose a large amount of weight rapidly within the first year after surgery. This weight loss can be associated with hormonal imbalances that can affect ovulation and cycle regularity. In fact, many physicians recommend avoiding pregnancy for the first year after bariatric surgery. 

On the other end of the spectrum, women who have very low BMIs can also have fertility issues. Women who have very low body fat percentages, such as competitive long-distance runners gymnasts, or ballet dancers may experience irregular cycles or even have long absences of their period. 

5. Smoking and substance abuse

The harmful effects of smoking and substance abuse are well-documented, and they extend to fertility. These behaviours can compromise sperm quality in men and affect egg quality in women.

People with ovaries who smoke have lower egg reserves and, on average, go through menopause earlier than non-smokers. You may think that IVF can overcome these issues but studies show that smokers have a lower number of embryos and lower pregnancy rates in IVF cycles. This holds for whether the smoker is contributing eggs or sperm in the cycle. 

It is also important to mention vaping. We find that a lot fewer people are smoking yet they don’t often mention vaping because vaping has a reputation of being “safer” or “okay”.  Although there is less evidence available about the effects of vaping, we know that vaping involves many of the same chemicals so it can also negatively affect egg quality, egg reserve, and the quality of the sperm. 

Marijuana is now legal in Canada and so we have increasing numbers of patients asking about the impact of marijuana on sperm, eggs, and pregnancy rates. Although the amount of studies right now is limited, there is increasing evidence that there is an impact on sperm and egg quality. It’s also worth noting that marijuana has been shown to harm the developing fetus in pregnancy as well. 

So does this mean you have cut out everything immediately and go “cold turkey”?  While eliminating smoking, marijuana and vaping may improve your outcomes this may not be a realistic goal for everyone. We encourage you to think about how you can cut down your usage as this has been shown to improve outcomes (in getting pregnant) too!

6. Stress and mental health: everyone trying to conceive is under stress

Probably one of the biggest things that we get asked about is stress and the role of stress on fertility. This is a tricky one! We all know that infertility in and of itself can lead to significant amounts of stress so is it the stress that causes infertility or the infertility that causes stress?  

The main takeaway point, however, is not about trying to reduce stress. Stress is unavoidable! We always tell people to think about how they’re processing stress. Think about how you’re dealing with stress and how you’re coping with stress. Stress is a constant – if you’re not stressed about one thing, you’re going to be stressed about fertility, or your work, or family, or whatever.

The journey to getting pregnant can be stressful. Learning to cope with stress and build resilience can be done through things like therapy. Other ways to manage stress include exercise, practicing a hobby, or socializing with good friends. You can also try to make your life, for lack of a better word, less stressful. And that might mean looking at your job and your relationships and evaluating their impact on you. We’re not saying stress is the cause of your infertility, but please protect your mental health!

7. Exposure to toxins: environmental toxins can also have an impact on fertility rate 

Prolonged exposure to certain environmental toxins, such as pesticides, heavy metals, and certain chemicals, can have adverse effects on reproductive health and interfere with the production and function of sperm and eggs. The data and research in the field is growing and more and more insights will likely come out in the next few years. 

Environmental toxins include some pesticides, heavy metals, and BPA in plastic. It’s worth looking into your daily products, such as your cleaning products, your preferred nail polish, your shampoo and conditioner, and the cosmetics that you’re using.  Also, consider switching from plastic food containers to glass.  

8. Chronic illnesses

Certain chronic conditions, such as diabetes, thyroid disorders, and autoimmune diseases, can impact fertility by affecting hormonal regulation.

Not only that, but some medical conditions also affect the health of the baby and the pregnant individual. So if you’re trying to get pregnant and you have chronic medical issues, it’s a great idea to talk to your family doctor or your fertility doctor.  Questions you may want to ask include: when I get pregnant, how are we going to manage my medical condition? What’s the plan? How is my medical condition going to impact the pregnant and my baby?

9. Previous medical treatments

Some medical treatments, like chemotherapy or radiation for cancer, can have detrimental effects on fertility. Additionally, previous surgeries in the pelvic region may result in scarring that affects reproductive organs. 

Medical treatments like chemotherapy or radiation for cancer can significantly affect your future fertility. If you have had these treatments before it’s important to let your fertility doctor know.  If you have a new diagnosis of cancer and you’re worried about the impact on your future fertility you can talk to a fertility specialist about freezing your eggs. In Ontario, egg freezing prior to some medical treatments may be covered by the Ontario funded program. If you’re having surgery in the pelvis and especially surgery on the ovaries, we know there may be an impact on ovarian reserve. Anytime anybody has surgery on any part of the body there is always a risk of scarring.  When you have scarring in the pelvis, it can affect the ability of the uterus, the ovaries, and the fallopian tubes to move freely in the way that they need to. Before surgery on the pelvic organs, it may be worthwhile to discuss your fertility with a fertility specialist. 

10. Inherited conditions: genetic factors can have an impact on fertility issues 

And last on our list, but certainly not the least, is inherited conditions. For example, there could be abnormalities of the Y chromosome in males causing low sperm count. There could be abnormalities in the X chromosome in females, like Turner syndrome or Fragile X syndrome, that can cause issues with ovarian reserve. This could be another factor as to why you’re not getting pregnant. And again, infertility specialists can help determine that. 

Getting pregnant is not always a straightforward path; we are here to support you

It’s also important to point out that any person or couple can have a combination of any of these different factors. It’s pretty rare that it’s ever just one thing. And some of these diagnoses are only revealed as you go through your journey.

Our goal is the same as yours – to help you achieve a healthy pregnancy! We want you to know that your feelings are valid, and your journey is uniquely yours. The path to parenthood is not always straightforward, and the emotional weight of infertility can be overwhelming. It’s okay to feel a mix of emotions – sadness, frustration, anger, and also glimmers of hope. 

Infertility can be an isolating experience, and we want you to know that you are not alone. We are here for you.

You are more resilient than you will ever know. 

Also, remember, it’s okay not to be okay all the time. Allow yourself the grace to feel and process each emotion as it comes, knowing that your journey is a testament to your strength. 

If you have questions about getting pregnant, to book a consultation, contact Markham Fertility today.

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