7 reasons for not getting pregnant when all tests are normal and what to do about it.

Posted by Dr. Yahya MS on January 1, 2020

Imagine how stressful it can be after going through bunch of tests with all the advancement in technology, only to be told that the exact cause for your inability to conceive is not known. It is a common thing and about 3 in 10 women that unable to get pregnant the cause cannot be identified.

The condition is referred to as unexplained infertility, which is defined as the lack of an obvious cause for a couple that are not on any family planning to achieve pregnancy after 12months of regular unprotected intercourse. The fact that no cause can be identified does not mean no cause is there.

In unexplained infertility, the male sperm parameters are normal, the female is releasing egg every month, her womb is normal and her tubes are patent.

It has a significant emotional, social, financial and psychological effect on the couple, and their family. For couples that spend financial and physical energy into carrying out tests and no cause can be identified may have a feeling of anxiety, depression, isolation, and helplessness.
Here are 7 possible reasons why you haven’t conceived despite normal test results.

1.  Increasing age of the female partner

Women greater than 35 years of age are more likely to have unexplained infertility than younger women. Female are born with their entire lifetime supply of egg (About 1-2 million at birth), and are not capable of forming new ones.
By the time the female attend puberty the number dropped to about 300,000. Every month the egg number and quality reduce. With increasing female age the number of low-quality eggs increases, leading to inability to implant and subsequent inability to conceive.

2.  Cigarette smoking

Men that smoke cigarette (active smokers) and those staying close to cigarette smokers (passive smokers), their sperms may have decrease ability to fertilize woman’s egg. Cigarette smoking also causes damage to the genetic material of male sperm and decrease the man’s interest in woman and also decrease erection.
For women that is both active and passive smokers, their eggs die faster, their tubes have decrease ability to transport egg, and their womb may be hostile to the developing baby.

3.  Alcohol consumption

For women trying to get pregnant, the safest approach is not to drink alcohol at all. Alcohol interferes with the ability of the developing baby to implant in the womb, it decreases the level of hormone that maintain pregnancy, and causes abnormal development of the baby.
For men with infertility, excessive alcohol consumption has an adverse effect on the quality and quantity of the sperm. There is no agreed safe limit of alcohol consumption for couples trying to conceive.

4.  Obesity

A high body mass index (weight in kg divided by Height in metre2) can alter the development of eggs, and decrease the quality of the formed baby. Obese men can have inability to sustain erection, genetic damage to their sperm and decrease desire to have intercourse.

5.  Underweight

A body mass index of <18.5kg/m2 find it difficult to conceive by causing
hormone imbalances that affect release of eggs. Compared to women in a healthy weight range. Underweight women are more likely to spend years trying to succeed without success.

6.  Physical stress

Such as the type seen in competitive athletes result in a condition called female athlete triad (consisting of menstrual abnormalities, eating disorder and decrease bone density). Those women have decrease ability to get pregnant as most of their cycle no egg is released.

7.  Psychological stress

Chronic excessive stress interferes with the normal hormonal release from the brain, that influence the ovaries to release an egg. This may result in in ability to conceive.
Others include Illicit drug use and excessive caffeine intake

3 approaches to consider when the cause of the infertility cannot be found

1.  Wait and watch
2.  Injecting sperms into the woman’s womb (intra uterine insemination)
3.  Using invitro fertilization

Factors to consider when choosing right treatment include the duration the couple have been trying achieve pregnancy, the age of the female partner, and whether they previously have a baby.

Wait and watch

The anxious wait for the nature to take its course, is commonly the first line option for couples that are young and no cause can be found for their infertility. About 3 in 4 of those patients waiting may eventually conceive spontaneously. During this waiting period its prudent to change life style that can affect chance of getting pregnant. This include cessation of smoking, and alcohol, weight loss or gain depending on patient’s situation, decrease caffeine intake (two cups of coffee daily).

The couples should be aware that the chance of conception is 20% per month even for normal couples. for women with unexplained infertility this rate is significantly reduced to 1- 3 percent per month.
This option is more suitable for patient that the female partner is less than 35 years of age, and less than 2 years trying to conceive.

Direct injection of sperms into woman’s womb

This involves placement of washed sperms into the woman’s womb at the time of ovulation. The aim of this procedure is to put a high concentration of sperms close to where they can fertilize the egg. It can be done either with or without the use of medications that increases the chance of releasing eggs.
This method is widely used before resorting to more invasive invitro fertilization.

Invitro fertilization

Involves fertilizing the egg with a sperm in laboratory and subsequently transfer to the woman’s womb. This intervention results in the highest per cycle pregnancy rate in the shortest time interval. However, it is expensive and have a higher rate of multiple pregnancy.

Couples that are unable to conceive should be offered counselling services, because fertility issues them-selves, and their investigation and treatment can cause significant emotional stress. Counselling should be offered before, during and after investigation and treatment.

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