Why am I not getting pregnant?

Updated: May 13

If you are reading this it’s highly likely that you have been trying to get pregnant and are disappointed that it hasn’t happened yet.

You want a baby so much so when you see the single line on the pregnancy test and your period starts, your heart sinks. You just want to become pregnant and have a healthy baby. You want to return to having sex for pleasure and fun again rather than for functional purposes.

You’ve been following the advice you’ve read online so why aren’t you pregnant yet? This article will help you evaluate your situation so you know when to see a healthcare professional.

Time for a review

Just to be on the safe side, it’s worth checking what you have been doing so far to get pregnant and whether you should do anything different.

So many readers and clients tell me their friend told them to download an ovulation and menstrual cycle tracker app, buy some ovulation sticks or an ovulation monitor, follow the instructions and have sex when the app or monitor advises them to.

Yet doing this can be risky if it isn’t done properly and if it isn’t done properly it could delay your chances of becoming pregnant.

If you have regular sex rather than timing sex to when you suspect you ovulate you do not need to do any of this. I’ll explain why this is in the next few sections of this blog.

Fertility Awareness and estimating the day you ovulate

As mentioned in the previous section using certain apps or ovulation predictor kits to guestimate when you ovulate can be risky and may prolong your attempts to conceive if you aren’t doing it correctly. This is why the national institute for clinical excellence (NICE) guidelines for fertility problems doesn’t recommend timing sex to ovulation or the ‘fertile window’.

Many apps apply a standard textbook menstrual cycle to their algorithm to estimate your day of ovulation. The typical menstrual cycle, as written in the textbooks is classically 28 days length, with day 1 being the first day of the period, and the day of ovulation being day 14 of the cycle.

Many apps use this textbook standard and then adjust your estimated day of ovulation proportionally to the length of your cycle so if you inform them your cycle is shorter e.g. 24 days, your estimated day of ovulation will be day 10. However, this is an estimation and this estimated day of ovulation may not be accurate for your particular cycle as your body may not fit this textbook cycle.

In 2019, a study of 600,000 menstrual cycles showed that the average menstrual cycle was 29 days and the average day of ovulation was day 17; not day 14. Evidence also shows the menstrual cycle can shorten with increasing age. Therefore the typical textbook cycle does not reflect the most recent modern day findings.

Furthermore, at-home ovulation tests most commonly measure and compare the changes of the amount of a hormone in your blood called Luteinising hormone (LH). If you don’t start using the sticks early enough or for long enough you could miss the day of ovulation.

Period tracker apps and ovulation predictor kits are easy to use but aren’t reliable if you have irregular periods or have polycystic ovarian syndrome (PCOS) so if this is you, do not use these methods.

The most reliable ways to estimate when you ovulate is by doing fertility awareness properly. Fertility awareness involves using a calendar to mark the days of your cycle whilst checking and understanding how your own natural body indicators of ovulation change during your cycle.

This information can be used to help you avoid pregnancy i.e. as a natural family planning method or to help you become pregnant by estimating when you ovulate. Natural indicators of ovulation include measurement of basal body temperature (BBT), checking the consistency of your cervical mucus or measuring LH levels (which can be done using at home ovulation predictor kits)

Learning fertility awareness can be done:

  1. Manually: You can use books or these fertility guides or learn from a fertility awareness practitioner. They will practically and physically show you how to view these. You can also work with a fertility nurse or a fertility coach that specialises in fertility awareness.

  1. Using Tech: You can use an app that measures at least one natural marker of ovulation together with tracking your cycle on a calendar. Natural Cycles is a highly rated app and is discussed in my blog about the best period tracker app. Natural Cycles uses the calendar together with BBT. The data from users of the Natural Cycles app was used in the menstrual cycle study described earlier in this article. The users had consented to their data being used for research purposes.

It may take a few cycles to get used to doing this so it can take a number of months. Ideally, all womxn should learn fertility awareness well before they start trying to conceive so that it becomes second nature to understand your body.

If you are doing this already, that’s great!

You can find more trusted resources on how to get pregnant and a video about the process of conception on Your Trusted Squad’s blog. Information for readers with PCOS will be available on this blog soon.

Estimating your ‘fertile window’

Knowing your estimated day of ovulation isn’t quite enough. The next thing to check is that you calculate your ‘fertile window’. The ‘fertile window’ is the time during your menstrual cycle where the sperm can fertilise your ovulated egg.

After you have sex, sperm can live in your womb and fallopian tubes for up to 5 days. Some sperm live longer than others and some sperm do not travel make it all the way to the fallopian tube which is where it needs to meet the egg.