Unable to Get Pregnant After 2 Years of Trying: Possible Causes and What to Do

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Trying to get pregnant but haven’t been successful after 2 years of actively trying? You’re not alone. Approximately 10-15% of couples struggle with infertility issues and experience difficulty conceiving after 1 year of unprotected sex (or 6 months if the woman is over 35).

While 2 years of fruitless attempts to get pregnant can feel discouraging, there are many possible explanations and effective treatments available. Understanding the common causes of infertility and working with a fertility specialist gives couples the best chance at finally getting the baby they’ve been longing for.

Key Takeaways: Why You May Be Unable to Get Pregnant After 2 Years

  • Age-related fertility decline in women after 35 can make it harder to conceive naturally.
  • Male factor infertility due to low sperm count or quality affects 50% of couples struggling with infertility.
  • Polycystic ovary syndrome (PCOS) and lack of ovulation are a common culprit.
  • Structural problems or damage in the womb, ovaries, or fallopian tubes prevent pregnancy.
  • Endometriosis can impair fertility through inflammation and scarring.
  • Being overweight or underweight, chronic stress, thyroid issues, and other health conditions also influence fertility.
  • Unexplained infertility with no identifiable cause occurs 10-30% of the time.
  • After trying for 2 years without success, it’s essential to see a reproductive endocrinologist for a full fertility workup.
  • Powerful assisted reproductive technologies like IVF and medicated cycles can help overcome infertility issues.

Fertility Gradually Declines as Women Age

One of the most common reasons couples struggle to conceive after 2 years is age-related fertility decline in women. A woman’s reproductive potential slowly decreases beginning as early as 25-35 years old as her egg count and quality diminishes.

By 35, chances of getting pregnant each cycle drop to around 20%. After 40, the odds of conceiving naturally are less than 5% per cycle. With women today having children later in life, age has become a major underlying cause of infertility for many couples.

Some key facts on how age affects female fertility:

  • Peak fertility is in the mid-20s. By 35, fertility starts declining more rapidly.
  • Women are born with all the eggs they’ll ever have – about 1-2 million. By puberty, only 300,000 remain. With each cycle, eggs are lost and egg quality goes down, accelerating after 35.
  • Older eggs have a higher chance of chromosomal abnormalities, increasing the risk of miscarriage and birth defects.
  • Menopause typically occurs around age 50-51, marking the end of a woman’s reproductive years. However, hormone levels start dropping up to 10 years before.
  • Regular periods don’t necessarily mean high fertility – egg quality cannot be measured by menstrual cycles alone.
  • Lifestyle factors like smoking, alcohol use, and being under- or overweight also speed up the natural age-related fertility decline.

If you haven’t gotten pregnant after trying for 2 years and are 35 or older, age could be the reason why. Seeking treatment sooner rather than later is recommended, as fertility continues to wane as women get closer to 40.

Male Factor Infertility Behind 50% of Cases

Roughly 50% of infertility cases are due to “male factor” issues that affect sperm count, shape, and mobility. Common reasons for male infertility include:

  • Low sperm count (oligospermia): Producing less than 15 million sperm per milliliter semen. Can be caused by varicoceles, undescended testicles, infections, tumors, malnutrition, heavy alcohol/drug use, radiation, medicines, autoimmune disorders and other health problems.
  • Abnormal sperm shape and size (teratozoospermia): High percentage of oddly shaped or small sperm. Often indicates immature sperm unable to fertilize eggs.
  • Poor sperm motility (asthenozoospermia): Sperm don’t swim properly or move ineffectively. Makes it difficult for sperm to reach and penetrate the egg.
  • Blockages: Obstructions in the reproductive tract from infections, prior surgeries, or absence of the vas deferens can prevent sperm delivery.
  • Antisperm antibodies: When the body mistakenly produces antibodies that attack and damage sperm cells. Reduces count and function.
  • Sexual problems: Erectile dysfunction, premature ejaculation, painful intercourse, and infrequent sex can make conception difficult.
  • Unhealthy lifestyle habits: Overheating testicles, heavy drinking, smoking, obesity, stress, and some medications.
  • Unknown reasons (idiopathic): No specific cause identified despite complete evaluation.

Since it only takes one healthy sperm to fertilize an egg, even couples with severe male factor infertility can achieve pregnancy through procedures like intrauterine insemination (IUI) and in vitro fertilization (IVF) using a partner’s sperm. However, sperm from a donor may be recommended in cases of extremely poor quality or azoospermia (zero sperm count).

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a very common hormonal disorder affecting 5-20% of women of reproductive age. It is the most prevalent cause of infertility due to lack of ovulation (anovulation).

With PCOS, the ovaries develop many small cysts and egg maturation and release through ovulation becomes irregular or stops completely. Without ovulation, couples cannot conceive since there is no egg for the sperm to fertilize.

PCOS is related to insulin resistance and elevated testosterone levels. Symptoms include irregular periods, excess hair growth, acne, weight gain, scalp hair loss, and dark patches of skin.

PCOS can make getting pregnant naturally very difficult, but medication and assisted reproductive procedures that trigger ovulation can significantly improve fertility. Losing excess weight through diet and exercise also helps reduce PCOS symptoms and increase ovulation.

Structural Problems in the Reproductive System

In some infertility cases, structural issues in the reproductive tract prevent sperm from meeting and fertilizing the egg. These abnormalities of the uterus, ovaries or fallopian tubes include:

  • Blocked/damaged fallopian tubes: Scar tissue or adhesions from pelvic inflammatory disease, prior infections/STIs, endometriosis, or past surgeries can obstruct the tubes that carry eggs from the ovaries to the uterus. Partially blocked tubes reduce fertility while fully blocked tubes make natural conception impossible unless repaired through surgery.
  • Uterine abnormalities: Fibroids, polyps and structural anomalies like an abnormally shaped uterine cavity or septum running down the middle can impair implantation and embryo development. Removal of fibroids/polyps and corrective surgery fixes many types of uterine problems.
  • Endometriosis: When uterine tissue grows outside the uterus, it can develop into lesions and scar tissue that block fallopian tubes. It also increases inflammation and creates a toxic environment for sperm and egg. Laparoscopic surgery helps improve fertility in mild-moderate endometriosis. Severe endometriosis requires IVF treatment.
  • Cervical factors: Scarring or abnormal mucus production caused by prior procedures, infections, DES exposure, or unknown reasons. Makes it harder for sperm to enter uterus and can require intrauterine insemination.
  • Ovarian failure/dysfunction: Ovaries don’t produce good quality eggs due to advanced age, premature ovarian failure, cancer treatment/radiation, or unknown causes. Donor eggs may be needed.

Surgeries like tubal reversal, myomectomy for fibroids, and endometriosis removal help repair structural infertility causes in some cases. IVF with ICSI is an effective treatment when surgery cannot correct the anatomical problems.

Chronic Illnesses, Infections, and Other Factors

Several other medical conditions and health issues can negatively impact fertility in both men and women:

  • Chronic infections: Sexually transmitted infections like chlamydia and gonorrhea can damage reproductive organs if left untreated. Pelvic infections cause scarring, blockages and adhesions in the uterus, tubes, ovaries. Evaluation and proper antibiotic treatment is key.
  • Hypothyroidism: Low levels of thyroid hormone cause irregular ovulation. Getting thyroid levels normalized with medication helps restore ovulation and fertility.
  • Diabetes: Poorly controlled blood sugar damages sperm and causes menstrual cycle and ovulation abnormalities in women. Managing glucose levels is vital.
  • Autoimmune disorders: Problems like lupus and multiple sclerosis can affect sexual function and cause hormonal imbalances reducing fertility. Treatment and immune-modulating drugs improve outcomes.
  • Cancer diagnoses and treatment: Chemotherapy and radiation therapy damage sperm quality and egg production. Options like egg/embryo freezing before cancer treatment help preserve fertility.
  • Medications: Certain prescription drugs like antidepressants, blood pressure meds, NSAIDs, antibiotics and more negatively impact fertility and should be reviewed.
  • Obesity/Eating disorders: Being significantly over- or underweight disrupts hormone levels causing irregular ovulation and low sperm counts. Reaching a healthy BMI boosts conception chances.
  • Substance use: Heavy smoking, alcohol abuse and illicit drug use inhibit fertility through their toxic effects on eggs and sperm and need to be addressed.
  • Environmental toxins: Overexposure to pesticides, industrial chemicals, heavy metals, and other pollutants may contribute to infertility by disrupting the endocrine system and reproductive development.

By diagnosing and properly managing any existing health conditions through diet, lifestyle changes, supplements, or medication, couples can overcome barriers to pregnancy and improve outcomes.

Unexplained Infertility

For roughly 10-30% of couples, extensive fertility testing reveals no specific identifiable cause for not being able to conceive after multiple years of actively trying. This is termed “unexplained infertility”.

Doctors theorize more subtle or transient issues could be at play: poor egg or sperm quality, minimal endometriosis that went undetected, subclinical thyroid issues, problems with implantation, or other unknown factors that standard tests didn’t catch.

The great news is advanced fertility treatments like IVF, IUI and fertility drugs work very well for unexplained infertility, with success rates identical to couples with an identified diagnosis. It provides hope when standard efforts fail and answers remain elusive.

Seeing a Reproductive Endocrinologist Is Key

When unable to become pregnant naturally after diligently trying for 2 years (or 1 year over age 35), it’s important for couples to promptly seek medical advice and evaluation from a reproductive endocrinologist – a physician specializing in fertility issues.

A reproductive endocrinologist (RE) will carry out a complete fertility workup, checking for any underlying conditions impacting your chances of conception through a variety of tests:

  • Medical history review – prior pregnancies/losses, health conditions, surgeries, infections, medication use.
  • Physical exam to check for structural abnormalities or issues.
  • Hormone testing – FSH, LH, AMH, estrogen, testosterone and more. Check for ovulation, reserve and other abnormalities.
  • Ovarian reserve testing to assess egg supply through AMH levels, antral follicle count and potentially clomiphene citrate challenge testing.
  • Imaging tests – transvaginal ultrasound, hysterosalpingogram, hysteroscopy, laparoscopy. Check uterus, endometrium, tubes and ovaries.
  • Hysterosalpingogram (HSG) using dye to check fallopian tubes for openness and blockages.
  • Semen analysis to evaluate sperm count, shape, mobility and concentration.
  • Bloodwork to check for infections, genetic issues, hormone disorders and immunological problems.
  • Post coital testing around ovulation to check if sperm can survive in cervical mucus.
  • Endometrial biopsy to assess uterine lining quality if recurrent implantation failure.
  • Laparoscopy for a visual exam of reproductive organs to check for scarring or endometriosis.
  • Diagnostic testing procedures like hysteroscopy or laparoscopy if needed for direct visualization.

After completing the full gamut of tests and determining the specifics of your infertility diagnosis, the RE will work with you to outline a customized treatment plan matched to your particular reproductive needs and profile.

Powerful Fertility Treatments Can Help Overcome Infertility

Thanks to the many assisted reproductive technologies (ART) available today, there are now more pathways to parenthood than ever for couples struggling with infertility issues.

Your reproductive endocrinologist will help you decide if therapies like ovulation induction medications, artificial insemination, or advanced in vitro fertilization are best to address your particular fertility problems.

Ovulation induction medication: Oral drugs like clomiphene citrate and injectable gonadotropins (Follistim, Gonal-F) stimulate ovulation for timed intercourse or IUI in women with irregular cycles, PCOS or unexplained infertility. Mild male factor can often be overcome as well.

Intrauterine insemination (IUI): Sperm is washed and prepared, then inserted directly into the uterus during ovulation using a thin catheter, increasing pregnancy chances. Used alone or with medication.

IVF (in vitro fertilization): Eggs are retrieved and fertilized by sperm in the lab to create embryos, then transferred into the uterus. Highest success rates for most causes of infertility.

ICSI: Used alongside IVF, the embryologist directly injects a single sperm cell into each mature egg to achieve fertilization. Very helpful for moderate to severe male factor.

Donor eggs, sperm or embryos: For couples with limited/no viable eggs or sperm, donor gametes offer another path to pregnancy and parenthood via IVF or embryo adoption.

Surgery: To repair damaged or blocked fallopian tubes and correct issues like fibroids, endometriosis, polyps, scar tissue that are impacting fertility. Done prior to IVF.

Gestational carrier: When a woman can’t carry a pregnancy herself, another woman (gestational carrier) can undergo IVF and embryo transfer to carry the couple’s baby through surrogacy.

Fertility preservation: Freezing eggs or embryos through IVF provides fertility options in the future for those facing procedures or treatments that may damage reproductive function, like cancer patients.

Thanks to ever-improving assisted reproductive technology success rates, almost any fertility problem can be addressed through evidence-based treatment protocols customized for each couple by a skilled reproductive endocrinologist.

FAQs – Fertility Challenges After 2 Years Trying

What percentage of couples struggle with infertility?

Approximately 10-15% of couples have difficulty achieving pregnancy after one year of frequent unprotected intercourse. After 2 years of diligently trying, 45% are estimated to experience infertility.

What are signs of potential fertility problems?

Irregular menstrual cycles, painful periods, PCOS symptoms, recurrent miscarriages, prior pelvic infections, endometriosis, abdominal surgery, charts showing lack of ovulation, azoospermia, very low sperm count/motility, etc.

At what point should you see a fertility specialist?

Experts recommend consulting a reproductive endocrinologist if you’re under 35 with no pregnancy after a year of trying, and if you’re over 35 and have not conceived after 6 months of frequent timed intercourse.

Do fertility drugs or IVF increase your chances of having twins or multiples?

Yes, fertility medications and IVF do increase the odds of a multiple pregnancy since they stimulate the ovaries to produce more mature eggs per cycle. However, a reputable clinic will work to minimize your risk through careful monitoring and single embryo transfer.

What lifestyle habits improve fertility when trying to conceive?

Eating a balanced diet, exercising moderately, achieving a healthy weight, limiting alcohol/caffeine, quitting smoking, reducing stress, avoiding toxins, taking prenatal vitamins, and having frequent sex during the fertile window.

How successful is IVF? What are average success rates?

Success rates vary based on the clinic, your age and fertility diagnosis. In general, among women under 35 using their own eggs, there is approximately a 45% chance of pregnancy per IVF cycle using fresh embryos. Success rates decline as maternal age increases.

The Takeaway – Be Proactive Seeking Answers and Treatment

Not being able to get pregnant after 2 years of consistently trying every month can feel very discouraging as you watch the months go by with disappointing results. Gripped by feelings of frustration, grief and self-blame are common.

Yet it’s important for couples to avoid viewing infertility as an unsolvable dead end, and instead stay hopeful in the proven fertility treatments available today. Patience, understanding and leaning on your partner will help you get through this challenging chapter in your journey to have a baby.

Be proactive in promptly seeking specialized medical testing and advice rather than delaying. Then, you and your doctor can develop a tailored treatment plan designed to successfully overcome whatever issues are preventing pregnancy based on your particular fertility profile and needs.

With an individualized protocol of ovulation medications, surgery if needed, IUI, IVF or donor alternatives, the vast majority of couples facing infertility challenges can eventually welcome their long hoped-for child.

So don’t lose heart after 2 years of fruitless trying on your own – instead, reach out for the expert reproductive help now available. The family you’ve been dreaming of is still very possible with the right assistance. Modern fertility medicine offers more innovative options than ever before so you can finally experience the joy of holding your baby in your arms.