Recognizing infertility symptoms, understanding why pregnancy may not be happening, and exploring paths to diagnosis and care
What This Infertility?
If you’re experiencing difficulty getting pregnant, long menstrual cycles, painful periods, or wondering “why am I not getting pregnant?”, you’re not alone. Many individuals face fertility challenges at some point, often without clear or immediate answers.
Infertility is typically defined as the inability to conceive after 12 months of regular, unprotected intercourse (or after 6 months for those over age 35). It can affect people with ovaries, uteruses, testes, or sperm, and may involve one or multiple underlying causes.
Infertility is frequently misunderstood or misdiagnosed, especially when symptoms overlap with other gynecologic or hormonal conditions. This page explains the signs of infertility, why it happens, how doctors diagnose it, and what patients should know about treatment and fertility planning.
Key Symptoms of Infertility
Common Symptoms
- Difficulty getting pregnant: Repeated unsuccessful attempts to conceive may be the first and sometimes only noticeable sign of infertility.
- Irregular or long menstrual cycles: Cycles longer than 35 days may indicate ovulation problems that affect fertility.
Less Commonly Known Symptoms
- Pain during sex infertility concerns: Deep pain during intercourse can signal conditions like endometriosis or pelvic inflammation that interfere with conception.
- Heavy periods and infertility: Excessively heavy or prolonged bleeding may reflect hormonal imbalances, fibroids, or uterine conditions.
Symptoms That Mimic Other Conditions
- Painful periods: Severe cramps can be mistaken for “normal” menstruation but may reflect underlying inflammation and infertility-related conditions.
- Pelvic pain or bloating: These symptoms can overlap with gastrointestinal or urinary disorders, delaying fertility evaluation.
When Symptoms Tend to Worsen
- During periods: Pain, heavy bleeding, and fatigue may intensify with menstruation.
- Around ovulation: Some individuals experience mid-cycle pain or discomfort related to ovulatory dysfunction.
- During intercourse: Pain during or after sex may worsen when pelvic inflammation or adhesions are present.
Causes & Risk Factors
If you’re experiencing difficulty getting pregnant, long or irregular menstrual cycles, or recurrent miscarriages, you’re not alone—these symptoms affect many people and can be confusing and stressful. Understanding what may be behind these fertility challenges is the first step toward finding effective solutions. Below, we outline the possible causes and risk factors that may contribute to infertility.
What Causes Infertility
Infertility can result from the following
- Ovulation disorders: this happen when the ovaries do not release eggs regularly, preventing fertilization. They can be caused by hormonal imbalances (like PCOS, thyroid issues, or high prolactin), early ovarian failure, or lifestyle and stress factors.
- Sperm abnormalities:This can cause male infertility by affecting sperm count, movement, or shape, reducing the chances of fertilization. They can result from genetic or hormonal issues, as well as lifestyle and environmental factors like smoking, alcohol, toxins, or heat exposure.
- Tubal blockage:This prevents eggs and sperm from meeting, causing infertility. It can be caused by infections (like PID), endometriosis, scar tissue from surgery or infections, or birth defects in the tubes.
- Uterine conditions: This can prevent an embryo from implanting or a pregnancy from continuing. Causes include fibroids, polyps, abnormal uterine shape, or a thin/damaged uterine lining.
- Unexplained factors affecting fertilization or implantation: Sometimes infertility has no clear cause, even when tests are normal. It may result from hidden egg or sperm problems, immune or molecular issues, or age-related decline in egg quality.
Hormonal, Inflammatory, Anatomical, or Reproductive Contributors
Hormonal imbalances (such as PCOS), chronic inflammation, endometriosis, fibroids, scar tissue, or tubal damage can all interfere with reproductive function.
Risk Factors
Age, genetic predisposition, long or irregular cycles, recurrent miscarriages, prior pelvic surgeries, infections, or inflammatory conditions increase infertility risk.
How This Condition Affects the Body
- Chronic inflammation: Ongoing inflammation can disrupt ovulation, implantation, and sperm function.
- Adhesions or scar tissue: Scar tissue may distort pelvic anatomy, blocking fallopian tubes or affecting the uterus and ovaries.
- Organ involvement: The ovaries, uterus, fallopian tubes, bowel, or bladder may be affected depending on the underlying cause.
- Impact on fertility: These changes can reduce the chances of natural conception or increase miscarriage risk.
- Impact on quality of life: Pain, uncertainty, and repeated pregnancy loss can significantly affect physical and emotional well-being.
Diagnosis: How Doctors Evaluate This Condition
Doctors begin with a detailed patient history, including menstrual patterns, pregnancy attempts, miscarriages, and pain symptoms. A physical exam may identify pelvic tenderness, masses, or anatomical concerns.
Imaging options such as transvaginal ultrasound, pelvic ultrasound, or MRI can evaluate ovaries, uterus, and surrounding structures. Blood tests may assess hormones and ovarian reserve.
Some causes of infertility, particularly endometriosis or adhesions, may only be confirmed through surgical visualization, such as laparoscopy. Infertility is often misdiagnosed because symptoms overlap with other conditions, and patients can expect a step-by-step evaluation rather than a single test.
Treatment Options
A. Non-Surgical Care
- Pain management: Medications may help control pelvic pain while further evaluation is underway.
- Hormonal treatments: Birth control, ovulation induction, or hormone-regulating therapies may address cycle irregularities.
- Physical therapy: Specialized therapy can improve pelvic alignment, mobility, and circulation.
- Pelvic floor therapy: Helps relieve pain during sex and supports overall pelvic function.
- Anti-inflammatory strategies: Diet, lifestyle changes, and medications may reduce inflammation and support fertility.
B. Surgical Treatments
- Laparoscopy: Minimally invasive surgery used to diagnose and treat conditions like endometriosis or adhesions.
- Robotic surgery: Provides enhanced precision for complex pelvic procedures.
- Excision vs. ablation: Excision removes diseased tissue fully, while ablation destroys surface lesions.
- Removal of lesions, cysts, fibroids, or affected tissue: Can restore anatomy and improve fertility outcomes.
- Multi-disciplinary approaches: Collaboration with colorectal or urology specialists when other organs are involved.
C. Fertility Considerations
Surgery may improve fertility by restoring normal anatomy or reducing inflammation. In some cases, IVF may be recommended, especially when ovarian reserve, tubes, or the uterus are significantly affected.
D. When Surgery Is Typically Recommended
Surgery is considered when symptoms are severe, imaging suggests structural disease, infertility persists despite treatment, or diagnosis remains unclear.
Living With This Condition
Managing infertility often involves symptom tracking, pain journals, and period tracking to identify patterns. Lifestyle support, including nutrition, stress management, and physical activity, can play a supportive role.
Seeking help early is important, especially with worsening pain, recurrent miscarriages, or prolonged difficulty getting pregnant. Emotional and mental health support is essential, as infertility can affect relationships, self-image, and long-term well-being.
Frequently Asked Questions (FAQs)
1.Is this condition the same as endometriosis?
No. Endometriosis is one possible cause of infertility, but many other conditions can also affect fertility.
2. Why does this cause pain during my period?
Pain often results from inflammation, hormonal imbalances, or abnormal tissue affecting pelvic organs.
3. Can this condition affect fertility?
Yes. Infertility directly impacts the ability to conceive and may also increase miscarriage risk.
4. How long does it usually take to get diagnosed?
Diagnosis can take months or years, especially when symptoms are subtle or overlap with other conditions.
5. What exams should I ask my doctor about?
You may ask about hormone testing, pelvic imaging, ovulation evaluation, tubal assessment, and referral to a fertility or pelvic health specialist.
6. Can painful periods affect fertility?
Yes, painful periods can sometimes affect fertility, especially if they are caused by conditions like endometriosis or pelvic inflammatory disease, which can damage reproductive organs. While mild menstrual pain alone usually does not impact fertility, underlying causes of severe pain may interfere with ovulation, egg quality, or the implantation process. Treating the underlying condition can improve fertility chances.