I Cannot Get Pregnant. What Can I Do?

When pregnancy is not happening as you hoped, it is very easy to start wondering what you are doing wrong.

Often, the more you search online, the longer the list becomes: supplements, diets, fertility teas, acupuncture, hormone tests, egg-quality protocols, sperm tests and increasingly complicated fertility treatments.

A more helpful place to start is to understand

What needs to happen for pregnancy to occur?

An egg needs to mature and be released from the ovary. Sperm need to be present at the right time and be capable of reaching and fertilising the egg. The fallopian tube needs to allow the egg and sperm to meet and the resulting embryo to travel towards the uterus.

The embryo then needs to implant into a receptive uterine lining, called the endometrium, where it can continue developing until the placenta gradually takes over.

1. Are you ovulating?

The first question is whether an egg is actually being released. Regular menstrual cycles of around 21–35 days usually suggest that ovulation is occurring, although there are exceptions. Irregular or absent periods can sometimes point towards an ovulation problem related to conditions such as PCOS, thyroid problems, significant weight changes or other hormonal factors. If your cycles are very irregular, very short, absent, or have changed significantly, this is worth discussing with a doctor rather than simply trying harder to identify your fertile window.

2. Are you having sex at the right time?

The highest chance of conception generally occurring in the couple of days immediately before ovulation. Having sex every one to two days during this period is usually sufficient.

You do not necessarily need to become obsessed with tracking. Cervical mucus, ovulation predictor kits and knowing your usual cycle pattern can help if timing is unclear.

3. Do not forget the sperm

Male factors contribute to a substantial proportion of fertility problems, which is why professional fertility assessment normally includes semen analysis early in the investigation rather than waiting until every possible female test has been completed.

A semen analysis looks at factors including sperm number, movement and morphology. If the result is abnormal, further assessment may be recommended. Lifestyle also matters for sperm health. Smoking and recreational drugs should be avoided, and a generally healthy diet and lifestyle are encouraged for both partners.

4. What about egg quality?

When people talk about “improving egg quality,” it can sound as though there is one diet, supplement or routine that will fix everything. In reality, egg health is affected by age, genetics and many other factors that are not fully within our control.

What we can do is support the body as well as possible: eat well, avoid smoking, move regularly, sleep enough, take folic acid and review any health issues that may affect fertility.

These steps may support general reproductive health, but they should not be sold as a promise that conception will happen.

5. Are the fallopian tubes open?

Even if you ovulate regularly and sperm parameters are good, the egg and sperm still need to be able to meet. Blocked or damaged fallopian tubes can prevent this.

Depending on your history, your fertility team may recommend a test such as an HSG or HyCoSy to assess whether the tubes appear open. Previous pelvic infection, endometriosis, ectopic pregnancy or pelvic surgery can sometimes increase the likelihood of tubal problems.

6. What about the uterus and endometrium?

The uterus needs to provide an appropriate environment for implantation. Conditions such as fibroids, polyps, adhesions or some abnormalities of the uterine cavity can occasionally interfere with fertility and may require investigation depending on symptoms and medical history.

However, this is also an area where fertility patients can easily become overwhelmed by expensive tests. Testing is guided by symptoms, previous history and clinical findings.

7. Hormones matter, but more testing is not always better

Hormones control ovulation and the menstrual cycle, but that does not mean everyone needs a huge hormone panel. Depending on your symptoms and cycle history, doctors may assess ovarian reserve, thyroid function or other hormones. Some tests are only useful in particular circumstances.

8. What about stress and the nervous system?

Fertility treatment and prolonged trying to conceive can affect sleep, mood, concentration and overall wellbeing. Supporting the nervous system through rest, movement, oga or counselling may help reduce the emotional burden of the process.

However, stress should not be presented as the cause of infertility or as something you must eliminate in order to conceive. These practices are valuable because they can support resilience, emotional regulation and quality of life while you navigate fertility difficulties.

9. When should I ask for fertility investigations?

Current guidance recommends fertility assessment after:

• 12 months of regular unprotected intercourse if the woman is under 35

• 6 months if she is 35 or older

• more promptly after age 40, or when there is already a known reason to suspect a fertility problem.

You should not necessarily wait for these time limits if you have irregular or absent periods, known endometriosis, previous pelvic disease or surgery, recurrent miscarriage, suspected male-factor infertility or another condition that may affect fertility.

So, what can you actually do?

If pregnancy is taking longer than expected, I would start by asking:

Am I ovulating?Are we having sex during the fertile window?Has the sperm been assessed?Are my fallopian tubes likely to be open?Is there anything in my history suggesting a uterine or endometrial problem?Are there medical conditions or medications that need reviewing?Are there realistic lifestyle changes that could support our overall reproductive health?

Then look at the whole picture rather than chasing one supplement, one hormone or one fertility “hack.”

Sometimes the answer is relatively straightforward. Sometimes several small factors are involved. And sometimes all the initial tests are normal — what is often called unexplained infertility. That does not mean nothing is happening. It means our current tests have not yet identified an explanation.

You do not need to work through all of this alone

If you are trying to make sense of fertility tests, treatment options or what questions to ask next, having someone help you organise the information can make the process feel much less overwhelming.

My role as a fertility doula is not to diagnose infertility or prescribe treatment. I can help you understand the information you have been given, prepare for appointments, explore questions and options, look at relevant lifestyle factors and provide emotional support while you decide what feels right for you.

If you would like to talk through where you are in your fertility journey, you are welcome to book a discovery call.