Raise your hand if back in high school you got the impression that making babies was as easy as 1, 2, 3, sex?  [Slowly raises hand].  

For so many women, fertility struggles become a shocking and agonizing reality after years of hoping, dreaming and planning for a family. Many prospective parents assume that pregnancy will be relatively easy to achieve and sustain, then after months of trying, they are disappointed each time their periods arrive. 

With significant shifts in societal norms, women are pushing family building back by many years compared to prior generations. “It’s the ‘Halle Berry myth,’” says Laura Erlich, a holistic fertility and obstetric specialist of Mother Nurture Wellness in Los Angeles. She explains, “People see a celebrity having a baby at 46 and assume it will work that way for themselves.” Ehrlich notes that conversations and education around women’s fertility windows are still lacking, even now. 

Knowledge is power, and without this knowledge women may be set up for failure when it comes to achieving pregnancy. Here’s what you need to know about the signs of potential fertility struggles, and how to take your next step. 

What is infertility? 

While a person may be thinking, Why can’t I get pregnant? after just a few months of trying without success, the generally accepted definition of infertility is the inability to achieve a pregnancy after one year of trying to conceive. For women over the age of 35, infertility may be diagnosed after six months of unsuccessful attempts to get pregnant.  

The experience of fertility struggles is a lonely one. Women often feel isolated as others around them achieve first, second or even third pregnancies. However, 12% to 13% of women in the U.S. and about 17% worldwide experience fertility difficulties. Thanks to social media, the ability to find support from a community with similar challenges is getting easier as people become more vocal about fertility and reproductive issues. 

What are common signs or symptoms of infertility?

“It’s all about the period,” says Erlich. And of course it is, since your menstrual cycle is the literal evidence of your body’s monthly preparation to potentially house a baby, with the period itself representing the reset button if a baby did not make a home in your uterus that month. Periods were biologically designed to be somewhat regular, predictable and moderate. If your period is not, take notice. 

Here are seven menstrual symptoms that may indicate fertility issues: 

  1. Very heavy periods: Very heavy periods to the point that they interfere with your ability to go about your normal day can suggest a diagnosis like endometriosis. 
  2. Very painful periods: Similarly, periods that are excessively painful, particularly those that are debilitating and make you stay home from work or prevent you from your normal activities are highly suggestive of an underlying diagnosis that will affect fertility. 
  3. Very long or very short periods: The generally accepted norm is to bleed anywhere between 3 and 7 days.  Bleeding for only 1 or 2 days or bleeding for well beyond 7 days should prompt a person to seek an evaluation. 
  4. Severe acne: Severe acne can be a sign of hormonal problems in women, and since hormones drive the menstrual cycle, this can indicate a fertility problem. 
  5. Chin or chest hair: Chin or chest hair in a biological female also suggests a possible hormonal problem. (Not that we don’t all get that stray chin hair or two that drive us bananas!) If you have excessive hair in these regions, your medical provider will want to investigate. 
  6. Unpredictable, irregular periods: There is a wide range of normal when it comes to the length of a menstrual cycle. Between 21 and 35 days is considered fine, but the key here is regularity. Your period should come consistently every so-many days. If that number varies so much that you are never sure when you may need a pad or a tampon, evaluation is recommended. 
  7. Absence of a period: No period at all is not a good thing unless you are pregnant.  Otherwise, going long stretches of time without a period is a red flag. For people who had been on hormonal contraception and then came off, a month or two without a period is OK, but going longer without return of your period is worth investigating. 

While problems with your period could be symptoms of things like stress, poor nutrition or too much or too little exercise, they can also be symptoms of more significant medical diagnoses.

Medical conditions that can contribute to infertility 

In addition to menstrual symptoms, Lauren Bishop, MD, an OBGYN and faculty member at Columbia University explains that two of the most common medical diagnoses that contribute to fertility challenges are uterine fibroids and endometriosis.

Fibroids

Fibroids are a common benign tumor made of muscle and other types of cells. According to Dr. Bishop, symptoms that suggest the presence of fibroids in the uterus are very heavy periods and particularly painful periods. Although they are benign, their physical presence in the uterus can make it hard to get pregnant. 

Endometriosis

Endometriosis is a condition in which the cells that make up the interior lining of the uterus grow in places where they should not. Dr. Bishop explains that symptoms of this disease include debilitating pelvic pain while on your period or severe pain during sex. Regarding endometriosis, Erlich reports that it is quite common, with 1 in 10 women having been diagnosed. However, endometriosis is still largely underdiagnosed. On average, it takes 8 years from when a woman first brings up concerns to a medical professional to when she is diagnosed.  

Hormonal disorders

Hormonal disorders, of which there are many, are often causes of infertility. Things like severe acne, chin hair, chest hair and very unpredictable periods can suggest PCOS (polycystic ovary syndrome) or other hormonal issues.  

Erlich points out that because of problems related to their menstrual cycle, many women go on the pill “to fix the problem, then stay on it until they are ready to have a baby, but they have forgotten why they were using [oral contraception] to begin with, and the problems unexpectedly come back.” 

Taking the pill itself won’t result in you having trouble becoming pregnant. But because the pill can often cover up other menstrual issues, you simply may discover after coming off the pill that you have a problem you had not been aware of previously. 

A history of STIs or pelvic infections

A history of sexually transmitted infections can lead to pelvic inflammatory disease, or PID. PID is an infection and inflammation of the organs in the pelvis, which can lead to scarring. Scarring in the uterus might make it difficult for a baby to implant there, and scarring in the fallopian tubes may make it impossible for an egg to travel to the uterus from the ovaries, for example. PID can even result in life-threatening situations. Chronic pelvic pain and severe pain during sex in combination with a history of STIs may suggest PID. 

Male factor infertility

Of course, infertility is not exclusively a female problem. Dr. Bishop reports that “about one-third of infertility is male-related, one-third is female-related, and the remaining third is a combination of those factors or is not able to be explained.” 

In males, unless there is a known injury, history of sexually transmitted infection (STI) or a history of chemotherapy, for example, there are rarely symptoms to suggest fertility issues before they start trying to conceive. 

When should I seek help for infertility?

If you’re younger than 35 and have been trying to get pregnant unsuccessfully for at least 12 months, your OBGYN should refer you to a fertility specialist. If you’re 35 or older, you should be referred after six months of unsuccessful trying.  

You can also seek help from a holistic fertility specialist before you reach the six month or 12 month benchmarks. Early consultation with a specialist can be particularly helpful for women who already know they have a hormone disorder like PCOS. Erlich will support women in lifestyle changes, herbal supplements, acupuncture and dietary measures for three to four months. In that time frame, she often sees women’s periods becoming more regular, which increases their chances of successfully becoming pregnant.  

If you have any symptoms like the ones described, consider checking in with your primary care or regular women’s health provider regardless of whether you’re trying to conceive or not. Women with two or more back-to-back pregnancy losses should seek consultation with a specialist, even young, otherwise healthy women. 

According to Dr. Bishop and Erlich, consecutive miscarriages can suggest either a physical uterine problem or a blood disorder that is interfering with maintaining a pregnancy. 

Though incredibly heartbreaking for anyone who experiences it, a single miscarriage is typically not a reason to seek fertility treatments quite yet. “One-third of pregnancies end in miscarriage,” says Dr. Bishop, most of which are due to major genetic problems with the embryo. 

How is infertility treated?

If you seek care through a fertility specialist, there is a relatively standard process that most fertility offices follow, like the one below described by Dr. Bishop:

  1. A thorough medical history will be taken, including as much information as possible about family members. This will assist the specialist in determining whether there is something specific to investigate beyond the standard evaluation. 
  2. A blood sample will be tested to evaluate hormones that give an idea of your egg supply. 
  3. You will have an ultrasound of their ovaries and uterus to see if they look normal. 
  4. You will also have a special X-ray of the fallopian tubes to make sure they appear normal.  These tubes transport the egg into the uterus each month. 
  5. The male partner will provide a sample of semen for analysis to see if his sperm appear normal. 

Depending on the results of the initial evaluation, treatment for infertility will vary. About 85% to 90% of couples who seek infertility care only need medications or surgery to correct something anatomical.  

Fertility drugs

Drugs like Clomid help to stimulate ovulation–they encourage a woman’s body to release a mature egg during her cycle. Sometimes men receive similar medications to help increase sperm production. 

Intrauterine insemination (IUI)

IUI is often the next step in fertility treatment. Sperm that is provided by a male partner or donor is specially prepared and then placed directly into the woman’s uterus when she is likely to be ovulating with or without the help of fertility drugs

In vitro fertilization (IVF)

IVF is probably the most well-known assisted reproductive technology.  During this process, women take fertility drugs to stimulate the production of many eggs in each ovary in one cycle, instead of the 1 or 2 that would normally be matured.  A procedure called egg retrieval occurs when they are mature, during which a fertility specialist uses special medical equipment to retrieve the eggs from the ovaries. The eggs are then exposed to the sperm in a specialist laboratory environment and allowed to fertilize, after which the resulting embryos are allowed to grow for several days before either being frozen for future use or placed back into the woman’s uterus with another minor procedure

The above treatments are the most basic, but there are many others that can include use of donor eggs, donor sperm, or even adoption of an already existing embryo that has been frozen previously through a different person’s IVF process.  

Through a holistic specialist like Erlich, fertility assistance will more heavily involve lifestyle changes and herbal supplements as well as the use of acupuncture to assist in eliciting a healing response, balancing the nervous system, and energizing the body.  Acupuncture may even be used in combination with treatments like IVF to encourage embryo implantation before and after the embryo is placed back into the uterus. 

A note from Motherly

If you are here already, in the throes of fertility struggles, know you’re not alone. These issues are all too common—making a baby is not always as easy as 1, 2, 3, sex! Let’s talk about it, and give more women the knowledge they need to take each step in their fertility journey with purpose and understanding.  

Featured experts

Lauren Bishop, MD, Assistant Professor of Obstetrics and Gynecology at Columbia University Irving Medical Center, board-certified Fellow of the American College of Obstetricians and Gynecologists, member of the American Society for Reproductive Medicine and Society for Reproductive Medicine, Director of Fertility Preservation Program

Laura Erlich, LAc, FABORM, Holistic Fertility & Obstetric Specialist, board-certified Fellow of the American Board of Oriental Reproductive Medicine (ABORM) with a BA from Emory University, a degree in Swedish, Shiatsu and Medical Deep Tissue massage from the Swedish Institute in NYC, and a master's degree in Traditional Oriental Medicine from Emperor’s College.