From monitoring your basal body temperature to tracking your ovulation window, you’ve been doing all you can to increase your chances of getting pregnant. But it hasn’t happened yet – and it’s okay to be disappointed.

If getting pregnant is taking longer than you expected, try not to worry. While some couples get pregnant within the first few months of trying, others can take up to a year.

But you may be wondering if you’re experiencing infertility. The idea can be scary, but the good news is that there’s a lot you can do about it if you have information on your side.

Below, we explain what infertility means, some common signs and causes, and when to consider fertility testing and possible treatment.

What does infertility mean?

Infertility is defined as when you haven’t gotten pregnant after having carefully timed, unprotected sex for one year. If you’re 35 or older, infertility can be diagnosed after six months of trying.

Infertility means that it may be harder for you to conceive and that you may need some extra help to do so.

How common is infertility?

Infertility may be more common than you think. Somewhere between 10% and 15% of couples in the United States experience infertility. Research shows that one partner isn’t more likely to be infertile than the other, and sometimes the cause of fertility issues can’t be identified.

Signs of infertility in women

Not getting pregnant is often the first sign of infertility. Again, it’s perfectly normal for getting pregnant to take anywhere from six months to a year of trying. But there can be early indicators of infertility in women. If you experience any of the signs listed below, see your care provider.

Irregular menstrual cycles

Some people’s menstrual cycles move like clockwork. A normal range can be every 21 to 35 days. But if you have unpredictable or irregular cycles, it can be hard to time sex for conception. Irregular periods can be caused by disruptions in the production of hormones, which can be brought on by a variety of stressors.

Hormone fluctuations

Our bodies need a certain balance of hormones to function properly. When hormones are under- or overproduced, issues can arise that may affect fertility. Symptoms that may signal hormonal issues can include:

  • Acne
  • Thinning hair or facial hair growth
  • Weight gain
  • Reduced sex drive

Inconsistent bleeding, cramps or painful periods

Spotting between periods, heavy bleeding, extremely painful cramps or missing two or more periods can indicate a problem that should be evaluated.

Pain during sex

Conditions that cause pain during sexual intercourse may affect fertility. This is the case with endometriosis and infections in the reproductive organs. Sex can also be painful if you experience vaginal dryness, which could be a sign of low estrogen levels.

Signs of infertility in men

Male infertility can come from a range of sources, including chronic health conditions, hormonal dysfunction, genetic abnormalities, lifestyle choices or abnormal sperm function. Symptoms of male infertility can take a number of forms, including:

Changes in sexual function or desire

Male sexual function is controlled largely by the hormone testosterone. Low testosterone can cause a low sex drive, trouble getting or maintaining an erection, or trouble ejaculating.

Testicular abnormalities

The testicles play an important role in male fertility. They make and store sperm, and they’re also involved in producing testosterone. Testicle-related signs of infertility can include:

  • Pain or swelling in the scrotum
  • Decreased testicle size
  • A history of undescended testicles
  • Testicle surgery in childhood

Sperm quality

Sperm health is another important factor for male fertility, and there are a few factors that contribute:

  • Sperm quantity (or sperm count) – A reduced sperm count can cause infertility. Sperm quantity is the number of sperm per milliliter of semen from one ejaculation. There’s a wide range for “normal” sperm quantity – but it starts at 15 million sperm per milliliter of semen.
  • Sperm mobility (or motility) – Sperm must be able to move to reach and fertilize an egg. Generally, sperm are considered healthy if at least 32% move well.
  • Sperm structure (morphology) – Healthy sperm have oval-shaped heads and long tails. Abnormally shaped sperm can be a sign of poor sperm health or sperm damage.

Chromosomal or hormonal abnormalities

Genetic abnormalities or hormonal imbalances can lead to having no sperm production or poor sperm production. Sometimes these abnormalities don’t have any physical symptoms, but possible symptoms include:

  • Breast growth
  • Decreased facial or body hair
  • Small testicles
  • Sexual dysfunction
  • Poor or absent sense of smell

Causes and risk factors of infertility

You and your partner may not notice any symptoms besides not getting pregnant. But there are other factors that may be impacting your chance of conception.

Age

Both male and female fertility decreases with age. However, the rate of the decrease tends to be greater in women. Women are about two times more fertile in their 20s than they are in their 30s. Female fertility generally sees bigger decreases the closer women get to menopause. Egg quality and quantity usually become too low for a successful pregnancy by the mid-40s. Men, meanwhile, tend to see a continual decrease in sperm quality as they continue to age.

Polycystic ovary syndrome (PCOS) and other conditions

PCOS is the most common cause of female infertility. PCOS is a hormone disorder that can affect ovulation. People who have PCOS may have irregular or prolonged periods, too much androgen hormones, or polycystic ovaries. In the case of polycystic ovaries, follicles may grow in the ovaries that block eggs and negatively affect ovary function.

Endometriosis is another condition that can affect fertility. It involves uterine tissue growing outside of the uterus. This can lead to scarring that may block the fallopian tubes and prevent eggs from reaching a position where they can be fertilized.

Along with PCOS and endometriosis, any condition that affects ovulation can be a risk factor for infertility.

Smoking and alcohol use

Drinking alcohol and smoking tobacco negatively affect multiple aspects of both male and female fertility. For example, alcohol can lower men’s testosterone levels and affect sperm production, and smoking can damage women’s cervixes and fallopian tubes. These are only a few of the reasons why it’s best to quit drinking and smoking before trying to get pregnant.

Weight

Being outside of a normal body mass index (BMI) of 19 to 24 has been linked to fertility issues for both men and women. Women who are under or overweight often experience irregular menstrual cycles and ovulation. Men who are under or overweight often have lower sperm quality. They’re also more likely to experience erectile dysfunction.

Environmental exposure

Overexposure to health hazards like chemicals, heavy metals and radiation can lead to infertility. In men, for example, it can affect both sperm production and sperm functionality.

History of sexually transmitted infections (STIs)

STIs like chlamydia and gonorrhea can lead to fallopian tube damage and can cause infertility if they aren’t treated. Because many infected women do not have symptoms, it’s important to get screened for STIs if you have a history of multiple sex partners or a partner who has had an STI.

Around 10 to 15 percent of women with untreated chlamydia also develop pelvic inflammatory disease (PID). PID can lead to fallopian tube blockage as a result of scarring, as well as infertility.

Chronic illnesses or cancer

Chronic illnesses can cause the body to focus its energy away from the reproductive organs. A chronic illness may affect ovulation in women and sperm production in men. In the case of cancer, chemotherapy and radiation treatments can both negatively impact fertility.

When to consider fertility testing

Fertility testing may be a good next step if you and your partner are in your 20s or early 30s and have been trying to get pregnant for a year. Testing may be considered sooner if you’re in your mid-30s or older and have been trying for six months.

You might also benefit from fertility testing sooner if you or your partner have a physical issue such as erectile dysfunction, inability to ejaculate, irregular periods or no ovulation.

Tests to check for infertility

Whether you’ve been trying for the full year or you haven’t started yet, fertility tests can help determine what factors might impact your chances of conception.

Keep in mind that these tests can’t completely predict whether you’ll have trouble getting pregnant. But they can give you more information to help care for your health and fertility. Different kinds of fertility tests include:

  • Physical exam for men and women: Assesses your overall health. Involves a Pap test and pelvic exam for women and usually a testicular exam for men.
  • Blood or urine tests for men and women: Checks the levels of hormones that can help identify fertility issues and also tests for STIs.
  • Semen analysis for men: Checks sperm count, shape and movement. Also checks overall semen volume and how many white blood cells are in it.
  • At-home ovulation predictor kit for women: Identifies ovulation by checking luteinizing hormone (LH) levels in urine. LH helps trigger the release of an egg from the ovary. Testing LH levels can help you time sex when you’re most fertile.

There are several other tests that check for infertility in women. Some of these tests use imaging, such as ultrasounds, hysterosalpingography (HSG) or laparoscopy, a surgical procedure that looks at a women’s pelvic organs. Your care provider will discuss the right test or tests for you.

How early can you get fertility testing?

You don’t have to have an infertility diagnosis to get fertility testing. But if you’re considering getting fertility tests done early, there are a few things to consider:

  • Fertility tests can help you plan for when you’re ready to get pregnant.
  • You may learn about certain health conditions or factors from your genetic and medical histories ahead of time. This may give you an idea of whether or not you’ll need infertility treatment.
  • If done too soon, you may have to repeat testing.

Take your next step towards conception

A large number of factors can contribute to infertility, and not all of them have obvious symptoms. That’s why it’s best to talk to your primary care doctor, OB-GYN or midwife if you haven’t gotten pregnant after six to 12 months of trying, depending on your age. They can get you in for fertility testing, then help you get medications or refer you to a specialist if necessary.

And in the meantime, if you don’t have any serious health conditions that may affect your fertility, there are a lot of ways to naturally increase your chances of getting pregnant.