Trouble Getting Pregnant: Signs of Infertility and When to Get Help

How long it normally takes to get pregnant

Even for healthy couples, the chance of conceiving in any one cycle is only about 20% to 25%. Rough cumulative chances with regular unprotected sex:

Female fertility falls gradually from the early 30s and more steeply after 35 to 37, mainly because egg numbers and quality decline. Male fertility also declines more gradually with age.

Signs that may point to a fertility problem

In women

• Irregular, infrequent or absent periods: suggest you may not be ovulating regularly. Polycystic ovary syndrome is the most common cause, often with acne, excess hair growth and weight gain.
• Very heavy or painful periods, pain during sex, or chronic pelvic pain: possible endometriosis or fibroids.
• Past pelvic infection, chlamydia or gonorrhea: can block or damage the fallopian tubes.
• Hot flashes and missed periods under 40: possible premature ovarian insufficiency.
• Milky nipple discharge: high prolactin.
• Being very underweight or overweight, or exercising very heavily: can stop ovulation.

In men

Male infertility often causes no symptoms. Possible signs include:

• erection or ejaculation problems, or very low semen volume
• small or firm testes, or a lump or swelling in the scrotum (a varicocele feels like a "bag of worms")
• reduced facial or body hair, or breast development, suggesting low testosterone
• past undescended testes, mumps affecting the testes, testicular injury, cancer treatment, or anabolic steroid or testosterone use

See male factor infertility.

Things that lower fertility

• age, particularly female age over 35
• smoking (both partners) and heavy alcohol use
• obesity or being underweight
• anabolic steroids and testosterone supplements, which can switch off sperm production
• some medicines, chemotherapy and radiotherapy
• sexually transmitted infections
• untreated thyroid disease or diabetes
• infrequent sex, or sex timed outside the fertile window

Improving your chances while you try

• Have sex every 2 to 3 days through the cycle, or daily in the fertile window (the 5 days before ovulation and the day of ovulation). Ovulation kits can help pinpoint it if cycles are regular.
• Take folic acid (at least 400 micrograms daily) from before conception to prevent neural tube defects.
• Stop smoking, limit alcohol, and aim for a healthy weight.
• Avoid lubricants that may harm sperm unless labeled fertility-friendly.
• Men: avoid testosterone and anabolic steroids, and avoid overheating the testes for long periods.
• Get any long-term conditions such as thyroid disease or diabetes well controlled.

When to see a doctor

• After 12 months of trying if the woman is under 35.
• After 6 months if she is 35 to 39.
• Right away if she is 40 or older, or if either partner has a known risk factor or symptom listed above.

Go together. Initial tests are straightforward: blood tests to confirm ovulation and check hormones, a pelvic ultrasound, a test of the fallopian tubes, and a semen analysis. The infertility condition page explains causes, tests and treatments such as ovulation induction, IUI and IVF in detail.

Emotional impact

Trying for a baby without success is stressful and can strain relationships. Many people feel grief, anxiety or isolation each month. Talking with your partner, joining a support group, or seeing a counselor experienced in fertility issues can help. Stress does not usually cause infertility, so it is not your fault.

Frequently asked questions

How long should it take to get pregnant?

About half of couples conceive within 3 to 6 months and about 85% within a year of regular unprotected sex. If you have been trying for 12 months (or 6 months if the woman is 35 or older), see a doctor.

What are the early signs of infertility in women?

The commonest warning signs are irregular, infrequent or absent periods, very painful or heavy periods, pain during sex, and a history of pelvic infection. Many women with fertility problems have no symptoms, so not conceiving within the expected time is often the only sign.

What are the signs of infertility in men?

Most men with low sperm counts have no symptoms. Possible signs include problems with erection or ejaculation, low semen volume, small testes, a swelling in the scrotum, and reduced body hair. A semen analysis is the key test and should be done early.

When should I see a doctor about not getting pregnant?

See a doctor after 12 months of trying if the woman is under 35, after 6 months if she is 35 to 39, and straight away at 40 or over. Go sooner if you have irregular periods, endometriosis, past pelvic infection, or a known male fertility problem.

Can you be infertile and still have periods?

Yes. Regular periods usually mean ovulation is happening, but infertility can still result from blocked fallopian tubes, endometriosis, uterine problems, egg quality decline with age, or male factors. Regular cycles are reassuring but do not rule out a fertility problem.