Trying to get pregnant but it’s just not happening after 2 years of regular, unprotected sex? You’re not alone. About 10-15% of couples experience infertility, the inability to conceive after 1 year of trying (or 6 months if a woman is over 35).

Not getting pregnant when you want to can be frustrating and emotionally draining. But there are many possible reasons why conception isn’t occurring, and treatments available that can help.

This comprehensive guide covers all you need to know about potential causes of infertility after 2 years without conception, and provides expert-recommended tips on next steps.

Key Takeaways:

• After 2 years of unsuccessful trying, it’s time to see a fertility specialist to identify any issues. 1 in 3 cases are due to female fertility problems, 1 in 3 are male factor, and 1 in 3 are a combination or unexplained.
• For women, common causes include ovulation problems, blocked fallopian tubes, advanced maternal age, endometriosis, and uterine issues. For men, abnormal sperm is often the culprit.
• Getting tested by an REI doctor is critical, as they can run exams like semen analysis, bloodwork, HSGs, and laparoscopy to pinpoint problems.
• Depending on the diagnosis, treatment options range from oral meds to promote ovulation to IVF and surgery. Don’t delay seeking help.
• Making healthy lifestyle changes, tracking ovulation, and carefully timing intercourse can also optimize your conception chances while pursuing treatment.

Why You Might Be Struggling to Conceive After 2 Years

When you’ve been having well-timed, unprotected sex for 2 years and still don’t have a positive pregnancy test, it’s natural to feel anxious and wonder what’s preventing pregnancy.

There are many possible explanations why couples fail to conceive after 24 months of actively trying. Here are some of the most common causes of fertility problems:

Ovulation Disorders

Failing to release eggs regularly accounts for about 30% of female infertility cases. The following ovulation problems can make it difficult to get pregnant:

• Irregular Cycles: If your cycle length keeps changing, you likely aren’t ovulating consistently. This makes timing sex for conception impossible.
• PCOS: Polycystic ovarian syndrome interferes with normal ovulation due to hormone imbalances. Symptoms include irregular periods, ovarian cysts, excessive body hair, and sometimes obesity.
• POF: Premature ovarian failure causes menopause before age 40 due to low estrogen. Periods become irregular or stop.
• Thyroid issues: Both hyperthyroidism and hypothyroidism can disrupt ovulation.
• Premature menopause: 1% of women experience menopause before 40, ending the ability to conceive.

Tubal Factor Infertility

Damage or blockage of the fallopian tubes affects around 25% of infertile women. This prevents eggs from traveling into the uterus. Causes include:

• Pelvic inflammatory disease (PID): Scar tissue from past pelvic infections can block the tubes.
• Endometriosis: When uterine tissue grows outside the uterus, it can form scars blocking tubes.
• Previous surgery: Such as having tubes tied or complications from c-sections.
• Birth defects: Some women are simply born with tubes that don’t function as they should.

Advanced Maternal Age

A woman’s fertility steadily declines in her 30s and drops rapidly after 35. Each month after 35, egg quality and number diminishes, lowering chances of conception.

By 40, a women’s chance of getting pregnant in any cycle is only 5%, compared to a 20% chance per cycle in her late 20s/early 30s.

Male Factor Infertility

Problems with sperm production and function cause around 30% of infertility. Common issues include:

• Low sperm count: Producing less than 15 million sperm per mL makes conception unlikely.
• Abnormal sperm: High numbers of misshapen or slow moving sperm lessens the odds of fertilization.
• Varicocele: Varicose veins around the testes, which can overheat the scrotum and reduce sperm count/quality.
• Ejaculation issues: Problems with erection, ejaculation, or retrograde ejaculation can affect conception.
• Hormone imbalances: Low testosterone, thyroid disorders, and other hormone issues impact sperm.
• Undescended testicles: When testes fail to descend into the scrotum at birth, sperm production suffers later.
• Infections: STDs, prostatitis, mumps or other infections that can damage the reproductive system.
• Chromosomal defects: Genetic issues like Klinefelter syndrome are linked to reduced sperm production.

Endometriosis

When tissue that normally lines the uterus grows outside of it, it can cause pain, scar tissue formation, inflammation, and reduced fertility. Endometriosis causes infertility in up to 50% of women who have it.

Uterine Factor Infertility

Structural abnormalities in the uterus can hamper conception and embryo implantation. Examples include:

• Fibroids: Benign tumors that bulge into the uterine cavity.
• Polyps: Abnormal tissue growths that form on the uterus lining.
• Adenomyosis: Uterine lining cells grow into the muscular uterine wall.
• Intrauterine adhesions: Scar tissue bands form inside the uterus.
• Congenital malformations: Being born with an irregularly shaped uterus.

Unexplained Infertility

Even after undergoing testing, about 30% of cases end up “unexplained” – no obvious cause is found. This may be due to subtle egg, sperm or embryo issues that current tests can’t detect.

Combined Male-Female Factor Infertility

Sometimes a couple’s infertility arises from a combination of problems in both partners. For example, a mild sperm issue combined with subtle ovulation problems.

Diagnostic Tests to Identify the Cause of Infertility

After trying unsuccessfully on your own for 2 years to conceive, your first step should be making an appointment with a reproductive endocrinologist (REI). Also known as fertility specialists, REIs are ob-gyns subspecializing in infertility treatment.

The REI will take your full medical history, conduct a physical exam, and run tests to pinpoint any issues. Standard infertility testing includes:

For Women

• Bloodwork: Checks levels of hormones like FSH, estrogen, TSH, and AMH to assess ovarian reserve and identify ovulation disorders, PCOS, hypothyroidism and other problems.
• HSG: During this x-ray procedure, dye is injected into the uterus and fallopian tubes to check for blockages and abnormalities.
• Ultrasound: Allows the doctor to visualize the ovaries and uterus to check for cysts, fibroids, endometriosis and other structural issues.
• Laparoscopy: Minor surgery in which a tiny camera on a thin tube is inserted abdominally to inspect pelvic organs for endometriosis, adhesions, blockages
• Ovulation tests: Using OPKs to confirm ovulation at home for several months.
• Post-coital test: Checks if sperm can survive in cervical mucus by analyzing a sample 12-36 hours after intercourse.
• Hysteroscopy: Inserting a thin camera through the cervix to examine the uterine cavity for fibroids, polyps, adhesions.
• Sonohysterogram: Saline is injected into the uterus during an ultrasound to more closely inspect shape and check for polyps, fibroids, etc.

For Men

• Semen analysis: The most important test checks semen volume, sperm concentration, motility, and morphology. At least 2 samples are analyzed.
• Hormone testing: Measuring testosterone, FSH, LH and other hormones helps detect deficiencies impacting sperm production.
• Genetic testing: Checks for chromosomal disorders like Klinefelter syndrome that cause infertility.
• Testicular biopsy: Extracts testicular tissue to check sperm production levels and health; used rarely.
• Ultrasound: Helps find structural issues like blockages, varicoceles, undescended testes and other testicular abnormalities.
• Post-coital test: Analyzes if sperm is present in mucus after intercourse around ovulation.
• Vasography: Dye is injected into the vans deferens to check for blockages that prevent sperm from exiting.

Possible Fertility Treatments to Help You Conceive

Once the cause of infertility has been identified through diagnostic testing, the REI will recommend the best treatment options tailored to your particular case. Here are some common medical approaches used after 2 years of infertility:

For Ovulation Disorders

• Fertility drugs: Oral medications like Clomid, Femara and injectables like FSH and LH to stimulate ovulation.
• Intrauterine insemination (IUI): Sperm is inserted directly into the uterus around the time of ovulation. Often paired with fertility drugs.
• Assisted reproductive technology (ART): Advanced methods like IVF with your eggs or donor eggs can help achieve pregnancy when others fail.

For Tubal Factor Infertility

• Surgery: Laparoscopic procedures can remove adhesions or scar tissue blocking tubes in some cases.
• Tubal surgery: Selective tubal cannulation or tuboplasty may repair damaged tubes.
• In vitro fertilization (IVF): Eggs are extracted and fertilized/implanted outside the body, bypassing tube issues.

For Male Factor Infertility

• Fertility drugs: Dopamine agonists, anti-estrogens, gonadotropins, and other drugs can raise sperm count and quality in some men.
• Surgery: To repair varicoceles, unblock obstructions, or correct other anatomical problems impacting sperm.
• ART: IUI, IVF with ICSI (direct sperm injection into eggs), and other technologies can help achieve pregnancy with low sperm numbers/quality. Donor sperm is an option too.

For Endometriosis

• Laparoscopic surgery: Endometrial implants can be removed to reduce inflammation, pain, and harm to fertility
• Fertility drugs/IUI: Used to achieve pregnancy before endometriosis recurs and worsens.
• ART: IVF circumvents the fallopian tubes and implants embryos directly into the uterus for best results with endometriosis.

For Uterine Factor Infertility

• Surgery: Polyps and fibroids distorting the uterine cavity can be removed. Adhesions may be cut.
• Hysteroscopy: Can remove problematic tissues like fibroids inside the uterus.
• ART: All uterine factor issues are bypassed with IVF, as embryos are placed directly in the uterus. Gestational surrogacy is an option too.

The key is identifying your specific fertility problems through testing, and having your REI tailor a treatment plan to address those particular issues, giving you the best chances of conception.

Optimizing Your Conception Odds While Pursuing Treatment

In addition to medical interventions, there are various lifestyle habits and conception tips you can adopt to try to maximize your chances of getting pregnant while under a doctor’s care for infertility at the 2 year mark.

Have Regular Intercourse 1-2 Days Before Ovulation

Once you know when you typically ovulate (from ovulation test strips and fertility charting), aim to have sex at least every other day starting 1-2 days before your ovulation date, as well as on ovulation day for the highest chance of conception each cycle.

Chart Your Cycle to Pinpoint Ovulation

Pay close attention to cervical mucus changes, basal body temperature spikes, ovulation test results, period start dates, and PMS symptoms to identify when you ovulate each month. Free apps like Flo can help.

Maintain a Healthy BMI

Carrying too much body fat produces excess estrogen, throws hormones off balance, and makes ovulation irregular. Reach a BMI in the healthy zone of 18-25 to improve fertility.

Take a Prenatal Vitamin

Folic acid, iron, vitamin D, and other vitamins & minerals in prenatals create a nurturing environment for conception and early embryo development.

Limit Caffeine & Alcohol

Consuming more than 1-2 caffeinated beverages and 1-2 alcoholic drinks daily is associated with decreased fertility. Stick to moderation.

Quit Unhealthy Habits

Smoking, using illicit drugs, and abusing prescription meds are confirmed to reduce the chances of conception and healthy pregnancy. If relevant, seek help kicking these habits before trying to conceive.

Manage Stress

High stress levels disrupt hormones needed to support ovulation, fertilization and implantation. Practices like meditation, yoga, journaling, and talking to supportive friends can help tame stress.

Get Plenty of Sleep

Insufficient sleep leads to hormonal issues that interfere with ovulation and fertility. Get 7-9 hours a night minimum for ideal fertility levels.

Exercise Regularly

Moderate exercise for about 3-5 hours per week can keep hormones, weight, and energy levels optimal for conception. But excessive exercise can disrupt ovulation.

Making these healthy lifestyle adjustments gives you the power to control some factors affecting your fertility potential while you undergo medical treatments to address diagnosed issues preventing pregnancy after 2 years of disappointment.

Frequently Asked Questions

Q: What are the chances of getting pregnant after trying for 2 years?

A: After trying unsuccessfully to conceive for 2 years, your odds of achieving pregnancy in the next year without medical intervention are only around 5%. This is why it’s critical to see a fertility specialist after 2 years to identify and treat any issues. With proper treatment matching your diagnosis, chances of conception can significantly improve.

Q: When should I worry about fertility if I’m not getting pregnant after 2 years?

A: The medical definition of infertility is lack of conception after 1 year of well-timed, unprotected sex (or 6 months if a woman is over 35). Therefore, you should make an appointment with a fertility specialist for an infertility evaluation after attempting pregnancy without success for 1 year – you don’t have to wait 2 full years. The sooner you can identify and treat underlying issues, the better.

Q: Can you get pregnant after trying for 5 years?

A: Getting pregnant after trying for 5 years or longer without success is unlikely without medical intervention. However, with proper fertility testing and personalized treatments matching your diagnosis, many couples are still able to conceive successfully even after 5 years of infertility or more. Advancements in fertility treatments make achieving pregnancy possible even after long periods of inability to conceive. Don’t lose all hope.

Q: What tests should be done after trying to conceive for 2 years?

A: After failing to get pregnant naturally after 2 years of trying, a full infertility workup is warranted. Some common tests the fertility specialist will perform include: bloodwork, semen analysis, HSG test, SHG, laparoscopy, hysteroscopy, pelvic ultrasound, ovulation testing, hormonal labs, and specialized sperm function tests. These exams help pinpoint the underlying cause(s) of infertility so proper treatment can be provided.

Q: When is IVF recommended after trying for 2 years?

A: Many doctors recommend moving on to in vitro fertilization after unsuccessful treatment with 2-3 cycles of ovulation induction with oral meds plus timed intercourse or intrauterine insemination. If you’ve already tried less invasive approaches for several months without pregnancy, IVF may be the next step after the 2 year mark. Or if testing reveals blocked tubes, severe male factor infertility, or other issues unsuitable for treatments like fertility drugs, proceeding straight to IVF could be warranted.

The Bottom Line

If you’ve been unsuccessfully trying to have a baby for 2 whole years or more, don’t give up hope. Seeking medical testing and help for infertility at this stage can still make your dream of parenthood come true. Identifying and addressing any issues standing in the way is key.

Patience, perseverance and maintaining a positive mindset will help you to eventually achieve your goal of holding that long-awaited positive pregnancy test. Listen to your doctor’s guidance and don’t delay in having an infertility evaluation. There are solutions out there – your baby could still be in your future!