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Why you may be having trouble getting pregnant

Why you may be having trouble getting pregnant

PCOS, an unhealthy lifestyle, smoking and stress can all affect conception. Counselling before pregnancy can help identify and treat the underlying issues

How pre-pregnancy counselling can increase my chances of pregnancy

For those planning to conceive and unable to, doctors advise that prenatal counselling, which prepares a couple emotionally and physically for pregnancy, may be helpful.

If a couple is unable to conceive for a year despite having unprotected sex, then they must consult a doctor to rule out infertility issues, says Dr Smrithi D Nayak, obstetrician at Aster RV Hospital, Bengaluru. The session also clears doubts about conception among couples, she adds.

“Any conception is determined equally by the participating man and woman. However, 20 per cent is determined by unknown factors despite testing,” says Dr Supriya Rai, Mangaluru-based obstetrician.


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For Chaitra M, a 34-year-old engineer living in California, pre-pregnancy counselling was helpful when she was planning for pregnancy when she was 30 years old. Speaking to Happiest Health, she said she was advised on multivitamins, healthy foods, regular exercises and meditation. “I conceived in less than 6 months,” says Chaitra who is now a mother of two.

However, for Sarah (name changed), 37, a working professional from Massachusetts, it was a struggle to conceive. “I had an irregular menstrual cycle since my teenage years. I could not conceive easily and suffered miscarriages too. The tests I underwent showed low ovarian reserve and endometriosis,” she recalls. “I was 30 when I tried to conceive. It took almost 5 years. Prenatal counselling, physical activeness and healthier food choices helped me birth my daughter two years ago.”

What factors delay pregnancy?

Only when a woman comes to us can we figure out what the stumbling blocks are, says Dr Rai. Some common issues are:

Menstrual cycle and ovulation

Experts recommend intercourse during women’s fertile period (in the 28- or 30-day menstrual cycle, women are most fertile between the 10th and 20th day of the cycle) to increase the chances of becoming pregnant.

Decreasing ovarian reserve 

Eggs (oocytes) are most fertile when a woman is between 20 to 30 years of age. A 2022 study suggests that the ovarian reserve “begins to diminish in the early 30s and declines dramatically after the age of 35,” thereby delaying conception. As age increases, fertility levels decrease.

Use of lubes

Lubricants, commonly known as lubes, can kill sperms if they are made of glycerine, silicone or petroleum, says Dr Mannan Gupta, gynecologist at Elantis healthcare, New Delhi. If using lubes is essential, Dr Gupta suggests using water-based or good quality fertility-friendly lubes.

Depleting eggs

Depleting eggs (when the ovarian reserve is less than 0.7 ng/ml – nanograms per millilitre) also affects fertility, says Dr Nayak. Depleting eggs can indicate if a woman has a history of infection (such as tuberculosis or mumps), has a septate uterus (wherein the tissues around the uterus are infected), or has other such conditions which are delaying pregnancy. Environmental causes such as exposure to pesticides and toxins along with treatments like chemotherapy can also deplete the eggs.

Depleting eggs can lead to early menopause (premature ovarian failure or POF) and affect conception if left untreated.  For women with early menopause (women under 45 years of age with depleting eggs), hormonal supplements or hormone replacement therapy (HRT) can help if treated early, says Dr Gupta.

Dr Kavita Pujar, obstetrician and gynaecologist at Kinder Women’s Hospital and Fertility Centre, Bengaluru, recommends preserving or freezing eggs to use them later for conception.

In Sarah’s case, tests revealed that she had a low ovarian reserve (0.53 ng/mL). She firmly believes that the changes she made to her lifestyle helped her immensely.

PCOS affects pregnancy

According to the US Department of Health and Human Services, Polycystic Ovarian Syndrome (PCOS) affects 1 in 10 women of childbearing age in the US. “Polycystic ovaries (multiple small cysts in or on the ovaries), is a reproductive disease and a metabolic disorder that affects pregnancy through an imbalance in the ovulation cycle and low-quality eggs,” says Dr Nayak.

Uterine issues

The uterus is the home for conception. Any structural changes can impact fertility. “Blocked fallopian tube, fibroids and endometriosis are some of the common pathological conditions affecting the uterine structure. Treating the symptoms through holistic measures can help manage the condition,” says Dr Nayak.

Environmental factors

External factors such as alcohol consumption, smoking and unhealthy food habits can delay conception. Sarah says, “I changed my food choices and aimed to detox and cleanse. The plant-based diet limited my intake of high-fat meats. I also practised yoga thrice a week. In five years, I conceived my daughter,” she said.

Male infertility

Pregnancy is a joint effort. Dr Nayak points out, “Some men suffer from low sperm count largely due to sedentary lifestyle, high stress levels, smoking.”

A semen analysis report (a non-invasive procedure that indicates the sperm count), as well as a scrotal ultrasound (an imaging test to analyse the scrotum health, especially the varicocele or dilated veins around the testicles or scrotum), can help assess male fertility.

Accordingly, Dr Gupta recommends, “the normal range of semen is 50-80 million sperm per millilitre (ml). Anything less than this can be corrected through medications and lifestyle modifications.”


  1. Conception can be delayed due to environmental or pathological or metabolic factors.
  2. Treatment is possible in most cases.
  3. Man’s and woman’s fertility plays a major role.
  4. Pre-pregnancy counselling helps to diagnose the underlying cause.
  5. Lifestyle modifications, healthy food habits, and meditation are recommended.

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