Struggling to conceive


Dr Tharni Vasavan BSc (hons) MSc, PhD

Published: May 16th, 2022 | Last medically reviewed: January 10th, 2024

10 minute read

If you’ve been struggling to conceive for a while, you may be asking yourself ‘‘Why am I not getting pregnant?’’. The thing is, getting pregnant can sometimes take a while and it might not always be as easy as it’s made out to be.

There are many possible reasons why you are struggling to conceive, including hormone imbalances, problems with ovulation, low sperm count, underlying medical problems or it could simply be down to not trying at the right time. The lifestyle choices of you and your partner can also impact your ability to get pregnant.

Your TTC journey may be proving to be more difficult than you expected, so it is important to understand fertility during this time. We will talk you through how your menstrual cycle and hormones play a part, why trying to conceive at the right time is crucial, some warning signs of infertility and more.

Understanding Fertility

Understanding fertility 

Before taking the vital steps to understand your fertility, first, you need to understand what fertility is and how it works. Put simply, fertility is defined as your ability to conceive a child. But despite the messaging we’ve all grown up with, it’s anything but simple. If you’re biologically female, also known as assigned female at birth (AFAB), your fertility will depend on different aspects of the reproductive system.

A hormone test is a great starting point for you to understand your fertility. However, a fertility test for women will only investigate half of the equation. It’s important to know it takes two to tango and we also know that one-third of infertility cases in heterosexual couples are related to male causes such as low sperm count or poor quality sperm. So the other half of the fertility equation is having enough quality sperm in the right place at the right time.

Menstrual cycle hormones and fertility

Menstrual cycle hormones and fertility

We know periods can be a bloody pain but they are key to successful conception. So, let’s get you up to speed. We’re all born with all the eggs we will ever have, and after puberty, most of us will start having menstrual cycles which lead to eggs being released in a process called ovulation.

The menstrual cycle is composed of two different parts that work together:

  • The ovarian cycle, during which the egg matures and is released from the ovary.

  • The uterine cycle, during which the uterus is prepared for pregnancy.

These intricate processes are carefully curated by your hormones, including follicle-stimulating hormone (FSH), estradiol (E2) and luteinising hormone (LH). We call these your menstrual cycle hormones. If any of these hormones are out of whack , then your menstrual cycle and therefore your fertility will be compromised.

How our online health assessment can help you:

Our online health assessment will take into account all the information about your menstrual cycle health to see exactly what’s going on (or potentially going wrong). We’ll then check in on your menstrual cycle hormones, your thyroid hormones and your ovarian reserve (an indication of how many eggs you have left).

We will send you an at-home sample collection kit that you’ll post to our lab to get analysed. This ultimately means that one of our private gynaecologists who reviews your results will have a 360-degree view of your health and fertility and can start giving you clarity into what’s going on and what you might need to take action on if you’re trying to conceive.

Ovulation and pregnancy success

Without ovulation (i.e.: the release of an egg), there will be no successful pregnancy. But how do you know if and when ovulation occurs? For most people that have regular periods, ovulation occurs around the middle of the cycle, around two weeks before the start of your next period. Determining your exact ovulation day is tricky, however, there are signs you can watch out for to hint that ovulation is near or has just happened.

Ways to confirm you are about to ovulate or have ovulated include:

  • Testing the levels of LH and/or progesterone in your blood or urine.

  • Tracking basal body temperature (which increases after ovulation).

  • Tracking the cervical mucus (which has an egg white-like consistency before ovulation occurs).

  • A sharp pain in the lower abdomen (also known as mittelschmerz )can be a signal to some women of ovulation.

  • Using an ovulation tracker - There are many free mobile apps that you can use to help track your menstrual cycle and ovulation.

To have the most accurate depiction of when you are ovulating, you can combine a couple or more of the above methods.

Whilst ovulation pain and pregnancy success do not always have to go hand in hand, a sharp pain in the lower abdomen (also known as mittelschmerz) can be a signal to some women of ovulation. Other ways to confirm you are about to ovulate or have ovulated include testing the levels of LH and/or progesterone in your blood or urine, tracking basal body temperature (which increases after ovulation) and tracking the cervical mucus (which has an egg white-like consistency before ovulation occurs).

Right timing is important for fertility

Why is the right timing so important?

Knowing when you have ovulated can be a useful way of predicting when you’ll be the most fertile. In fact, there are only about 6 days during your menstrual cycle when you have the highest chance of conceiving, which is often called the “fertile window”. It includes the 5 days leading up to ovulation and the day after it. Having sex and trying for a baby during this window will give you and your partner the best chance of conceiving a baby.

Its length is determined by how long the egg and sperm can survive in the reproductive tract without being fertilised, the sperm can survive for up to 5 days and the egg usually survives about 12-24 hours post ovulation. Although it’s not impossible to conceive at other stages of your menstrual cycle, the most optimal time for you to create a baby is during this time.

Causes of infertility

While there are lots of stories of couples conceiving without any problems, it’s important to get to grips with the facts. It’s estimated that 1 in 7 couples experience infertility. One-third is due to female factors, one-third are due to male factors (e.g.: low sperm count, poor sperm quality) and the final third is either a combination of both or could have an unknown cause called unexplained infertility.

There are many different causes of female infertility, including:

Issues with ovulation

It is common that problems with ovulation can be the result of infertility. This occurs when the monthly release of the egg from the ovaries does not function properly or an underlying health condition is stopping the egg from being released at all. PCOS can cause ovulation problems, as well as having a diminished ovarian reserve.

Poor egg quality

As women get older, there is a higher risk of ovulating a chromosomally abnormal egg - which is the result of lower fertility as well as an increased risk of miscarriage. Although it is more likely that older women produce lower quality eggs, it can happen with younger women too.

A diminished ovarian reserve can also be the cause of poor egg quality, especially in women over the age of 35.

Structural problems in the uterus

Structural problems in the uterus create a blockage, where the egg can not move from the ovaries to the uterus and the sperm is not able to reach the egg to create a baby.

Hormonal imbalances

Common conditions such as PCOS and Anovulation may be caused by hormonal imbalances. These conditions can be the result of infrequent ovulation, which makes conception a lot more difficult.

Read our full blog on hormonal imbalances to gain a deeper understanding of it.

Other infertility risk factors

Genetic factors

Genetic disorders such changes in the number or structure of the chromosomes such as Turner’s syndrome, Klinefelter’s syndrome, Fragile X syndrome can cause fertility issues. Specific genetic tests may be necessary to identify the cause.

These syndromes can result in issues with the reproductive system and can make conceiving very difficult and sometimes impossible.

Age factors

The older women get, there is a higher chance of issues when trying to conceive, as well as an increased risk of pregnancy complications. This is the result of a diminishing ovarian reserve, the rate of which starts to reduce drastically in the mid 30s.

Lifestyle choices

There are many lifestyle choices that can affect you and your partner's ability to conceive a child. These can include:


Drinking alcohol

Taking recreational drugs

Poor diet and eating habits


Excessive exercise

Being overweight or underweight

Irregular sleeping patterns

High mental stress levels

Read our full blog on how you can optimise your fertility whilst trying to conceive.

Warning signs of infertility

Warning signs of infertility

As women, we’re so used to putting up with symptoms but it might be that your body is trying to tell you something. And from our experience, it often is. 64% of Hertility users haven’t had a diagnosis but suspect something is up, and go on to have at least one out-of-range hormone.

The takeaway? Listen to your body as there are many symptoms that could be a sign of a hormonal imbalance or an underlying reproductive health condition which may affect your fertility. It is also important to know that although there are some symptoms of infertility, a lot of infertile cases of both men and women are also silent.

Irregular or absent periods

If you have irregular or no periods at all, it can be a sign that you have an issue with the quality of your eggs and/or ovulation. So what should you be looking out for? Periods that last more than 7 days or cycles that are either shorter than 21 days or longer than 35 days are usually signs that something isn’t quite right.

Period pain

We are often told that period main is normal, but extremely painful periods that come in the way of our daily routine are not. It can be a sign of conditions such as endometriosis, PCOS, Pelvic Inflammatory Disease, or Fibroids, all of which can impact fertility.

Vaginal dryness

Have you ever noticed vaginal dryness or hot flashes along with irregular or absent periods? It could be a sign of menopause or premature ovarian insufficiency (POI) which is experiencing menopause before the age of 40 and this can affect 1 in 100 women. Both POI and menopause are triggered when you have a low or diminished ovarian reserve.

Fatigue & feeling cold

Now, life gets busy so most of us feel tired every now and again but fatigue, along with feeling cold often, and hair thinning or loss, can be a sign of thyroid dysfunction or hypothalamic amenorrhea, both of which also affect ovulation. So, before reaching for that cup of coffee, check-in - are you just a bit tired or is something going on?

Deep pain during intercourse

Finally, feeling deep pain during intercourse is definitely not something you should ignore. It can be a sign of scarring or structural abnormalities in the fallopian tubes or uterus, which can be caused by conditions such as pelvic inflammatory disease, endometriosis or fibroids all of which can impact fertility.

Skin and hair concerns

Excessive facial and body hair growth, hair thinning or hair loss, and acne can all be due to high testosterone levels, commonly seen in PCOS.

Not just a womans issue

Infertility is not just a women’s issue

Although men can produce sperm throughout their lives, studies have shown that the male's age also affects the chance of pregnancy and outcomes. Age can also affect sexual health which can cause issues with libido and maintaining erections, which can make trying to conceive tough. Here are some things that may be able to optimise your partner's fertility.

Avoid wearing tight underwear

Wearing tight underwear can increase testicle temperature. Although there is no concrete research to show that tight underwear does affect sperm quality and production, opting for loose-fitting underwear, such as boxer shorts may be recommended.

Give up smoking and alcohol

Smoking is known to negatively affect fertility. It can affect sperm quality, quantity and motility, making it harder to conceive.

Drinking alcohol excessively can affect the quality of sperm and make maintaining an erection difficult. It is best to drink in moderation or avoid alcohol altogether for optimal reproductive health.

Eat a healthy diet

Eating a healthy, balanced diet and maintaining a healthy weight is essential. It will provide essential nutrients that support proper sperm production and function.

Cut down on stress

Stress can not only negatively impact sperm production and libido, but it can also have a negative effect on your relationship - which may result in less time trying to conceive.

Read our Ultimate Guide on Trying to Conceive to get more tips on how you and your partner can optimise your fertility.

Not just a womans issue

What are the options for fertility treatment?

Although you are currently struggling to conceive, it does not mean you are infertile but it is good to know what fertility treatment options are available. The most well-known options for fertility treatment are either medication, assisted reproductive technology or surgical procedures.

Fertility Medications

Let’s start by taking a look at fertility medications. Medications, such as Clomid, Metformin and Gonadotropins encourage ovulation and so are often used for people who do not ovulate regularly and are having trouble conceiving.

Assisted Reproductive Therapy

There are several options when it comes to assisted reproductive technology. A commonly used treatment is Intrauterine Insemination (IUI), which is a procedure where the best quality sperm is directly inserted into the uterus. It is often recommended when donor sperm is required or there is a problem with having sexual intercourse.

There is also In Vitro Fertilisation (IVF) or Intracytoplasmic Sperm Injection (ICSI) which are other common procedures. They are often recommended for those who have a problem with their eggs and/or sperm. These procedures involve harvesting both the eggs and sperm (either from yourself or a donor), fertilising the egg with the sperm in a laboratory, and then transferring a resulting embryo back into the body.

Surgical Procedures

Finally, surgical procedures may be recommended for those who have a structural issue which is preventing them from getting pregnant. In these cases, surgery may be used to repair fallopian tubes or remove fibroids, polyps, cysts and endometrial lesions.

When to get help with fertility

Whichever stage you are at, along your conception journey, try not to worry too much about it if it does not happen straight away. Every woman is unique and it may just be taking a little longer than average. However, it is advisable to speak with your doctor if:

  • You have been consistently trying to get pregnant for 12 months or more and you are under the age of 35.

  • You have been consistently trying for a baby for 6 months or more and are over the age of 35.

  • You have irregular, very painful periods or no periods at all.

Reproductive health

Get the answers you need with our at-home fertility test

If you’ve been trying to conceive for a while the last thing you want to hear when struggling to conceive is ‘just relax’ or ‘keep trying and wait and see.’ Traditional healthcare makes women waste a full year proving they can’t get pregnant before taking action. But we say, enough with the waiting and answered questions. That’s where we come in.

At Hertility we can help you understand your fertility. With our convenient at home fertility tests , you can take your test in the comfort of your own home. With a fraction of the cost of going to a fertility clinic, you can get clarity on what is going on inside your body, assess your ovarian reserve, and warning signs of infertility and get screened for up to 18 different health conditions.

Wherever you are on your journey, we are here to support you through it.

Written by

Dr Tharni Vasavan, BSc (hons) MSc, PhD

Contributed to by

Medically reviewed by

Dr Benjamin Jones, MBChB BSc (Hons) MRCOG PhD

Published May 16th, 2022

Last medically reviewed January 10th, 2024


Here's what we'll cover


Understanding fertility 

Menstrual cycle hormones and fertility

Ovulation and pregnancy success

Why is the right timing so important?

Causes of infertility

Other infertility risk factors

Warning signs of infertility

Infertility is not just a women’s issue

What are the options for fertility treatment?

Get the answers you need with our at-home fertility test