Here’s 4 scientific possibilities.

If you've been trying for a baby and you're not getting pregnant, it's hard not to spiral. Month after month of timed sex, analyzing cervical mucus, using OPKs, reading fertility forums — TTC is like a monthly roller coaster of hope and disappointment. It's hard to know whether to relax and keep trying, or panic because you're missing something. Each passing month you think, "Why am I not getting pregnant?"

I really wish I had a magical way to know and be able to tell you for sure. But through my experience providing infertility care and fertility-focused work since 2006, I can say the inability to get pregnant is usually for one of these 4 reasons.

Realistic odds of getting pregnant.

As hard as it is to be patient, getting pregnant is an odds and chances game. If you're convinced something is wrong but a) you've only been trying to get pregnant for 3, 6, even 9 months, b) you're less than 36 years old, and c) have body and menstrual cycle that seem pretty healthy, you just might have to keep trying for a while. Eight out of 10 couples get pregnant in their first year of trying to conceive, and 9 out of 10 within 18 months. And that's with having sex 2 - 3 times per week when they're most fertile.

So my advice on this one is to keep trying! Our expectations of how quickly a pregnancy should happen is often not realistic. And in the meantime, think about ways to keep yourself from going down the rabbit hole of fertility freak-outs and research.

If you feel like you're still in the window where it makes sense to keep trying, but it's driving you absolutely batty, redirect your energy to a healthier place. Check out my Banish Fertility Burnout mini-course. It's 1 week to recharge, refresh, and renew your pregnancy hopes by helping you shift your focus and start feeling better while in the thick of things. It absolutely will help your fertility while protecting your mental health, relationships, and quality of life. That's a TTC win-win-win scenario.

Treatable medical or biological issues that cause infertility.

There's a chance you may have a root medical or biological issue that you haven't yet discovered or treated. There could be an anatomical issue like a fibroid in your uterus or a hormonal imbalance like low progesterone or high prolactin. In other words, there may be something medication, surgery, or treatment can fix. Hurrah for issues we can find and treatments that can actually work.

If you've been trying to grow your family for 6 - 12 months and haven't started to investigate and rule out some root issues, it might be time for a basic fertility work up for both partners.

For people with ovaries, testing AMH or doing a follicle study to assess ovarian reserve and HSG, or a saline infusion sonohysterogram (SIS) to make sure there's no anatomical issues like blocked tubes, uterine fibroids, or scar tissue are my top two fertility specific tests I suggest sooner rather than later. Don't forget about less obvious — but easy to check out — issues with thyroid levels too.

For people with sperm, a semen analysis PLUS a sperm fragmentation test should be done at the same time. Testing both partners at once (if applicable) is super smart. Sadly, I often see male partners putting off their tests while their counterparts get poked and prodded for months. This has got to change! Male factor infertility is just as common as female factors. Knowing about them can save a lot of time and suffering.

Some bodies are more sensitive to stress.

You may have a stress-sensitive body. Even if you have unexplained infertility and everything checks out fine, or you're using all the right treatments for a known fertility issue and they're not working, some bodies are just more sensitive to stress and need to feel in a safer place and more balanced before committing to getting pregnant. We know this from many many animal studies. You can stress out some members of a species and they'll keep having babies. And others? Not so much.

And yes, there will always be the types of bodies and people who are able to just "go on vacation and get pregnant." So stress affecting your pregnancy is not the answer for everyone. But for some — it's a big deal.

While it's frustrating to fall into this camp, and impossible to force or fake relaxation, the good news is you don't have to be perfect and you can get where you need to be. Maybe you're at a stress level of 7 and your body simply wants you to get to a level of 6. You can work on lowering your stress level and help yourself feel better right here and now. It's totally doable!

Some of my favorite options for decreasing stress include acupuncture + education about healthy emotional expression, offsetting stress (you don't have to get rid of it), and getting more holistic by seeing yourself as a whole person instead of just reproductive bits and pieces. If you need some concrete lessons and guidance my Banish Fertility Burnout mini-course is a 1-week springboard into all these ideas in super friendly bite-sized pieces.

(Not yet) Treatable medical or biological issues affecting pregnancy.

Maybe there's a root medical or biological issue that's preventing you from getting pregnant, but we simply don't have a way to find it or treat it yet. This is undoubtedly the hardest group to fall into. But the reality is we are limited by time and space, and we need to be honest and talk about the possibility that something biological may not be able to be 'fixed' with current medical know-how.

Several years ago I met a man who was adopted in the 60's. He shared that his mom had this "impossible to treat" fertility issue called endometriosis. Back then there was nothing that could be done for her. Now, we have options. And although it's fabulous we've made so much progress, I guarantee we'll know even more in 50 years. There's some things we just can't understand or treat right now that will be much different in the future.

But we're here and now, and we need to talk about this openly and not treat it like a personal failure — because it's not.

For every one reproductive and biological thing we know and can treat, there's 5 things we don't yet know or can't treat. Even our best treatments today aren't anywhere near 100% effective. IVF live birth rates, even at the best clinics in the world with the 'easiest' to treat cases, only achieve about a 50% live birth rate per cycle.

It is critical for every person going through fertility challenges to have realistic expectations. As an industry we need to talk more about the ethics of infertility care and how it is marketed. And this should 1000% include being more honest about realistic odds and protecting the women, people, and couples who are going through infertility.

If you fall into this fourth group, it's all the more important you're supported, protected, and have evidence-based guidance. When we treat people like they're only 'worth working on' if there's a chance we can 'fix a problem' — it's awful. I care deeply about every person who is TTC or grow their family. My goal is to help each of you have the family you want with less trauma along the way. Sometimes that will involve letting go of biology. That's not a failure. That's a triumph of the human spirit and a testimony to resiliency and love. We should never lose sight of this.

I love truly holistic evidence-based fertility education because I know my practice, program, mini-courses, and educational resources are literally the only thing in this vast world of infertility that'll help and serve each and every person - no matter where your fertility story takes you. My education will help you have your best chance of decreasing stress, finding the root cause, and getting the best treatments — which works for many people.

But even if you're in this not-yet-treatable group and you have to move into harder choices like using 3rd party treatments, being childless, or having fewer children not by choice, I know being more supported and feeling more whole and less burned out is going to help you come out of this hard process so much better off.

So whichever of these four reasons has led to you not getting pregnant yet, you're in the right place. I want to be on your team. And there are many many ways I would love to serve you and your goals. I hope you'll keep exploring all the options I've put my heart and energy into creating and see for yourself.

XO,

Nicole

Nicole Lange

LICENSED ACUPUNCTURIST
HOLISTIC FERTILITY EDUCATOR