When Getting Pregnant Isn’t Easy

On average, a woman’s odds of getting pregnant in a given month are around 20%. It takes the typical couple (with no preexisting fertility issues) about five months to successfully conceive.

If these statistics surprise you based on what you learned back in sex ed, you’re in good company.

Brianna Steinhilber, a 31-year-old editor based in New Jersey, started trying for a baby last winter and believed it would happen right away. “I started trying the minute I was ready to be pregnant and assumed I’d be pregnant within a month or two,” she says. When that window passed without success, she took to the internet to do some digging.

“I basically was teaching myself Sex Ed 101 as a 30-year-old—learning exactly how all the female reproductive organs work, what your fertility window is, and everything that has to happen in order to actually fertilize and implant an egg,” she says.

So why do we spend so much time educating women on how not to get pregnant in adolescence, but never talk about what needs to happen to successfully conceive?

As Northwell Health’s System Chief for Reproductive Endocrinology and Infertility Dr. Nicole Noyes explains, when we first learn about pregnancy in our teens, it is easier to get pregnant than it will be for the remainder of our lives. “The odds of conceiving in a given year are about 75% at age 30—but if you’re a teenager, it’s 90%,” she says. “Women are most fertile from ages 13 to 30. That’s reproductive prime, with 18 to 25 being the peak.”

Of course, everyone understands the importance of encouraging teens to be extra cautious about preventing pregnancy—especially given the above odds. But Steinhilber points out that what you learn in health class sets up a false expectation when you’re ready to start a family. “It does mess with your mindset, because then the minute you stop using protection you think BAM! You’ll be knocked up. Which isn’t how it actually happens for most people.”

How it does actually happen for most people

A quick birds-and-the-bees recap for those of you who were too paralyzed by the fear of pregnancy to take in how it all works back in health class: The average woman releases an egg once per month. Once it drops, she has about 24 hours to get it fertilized. But even if you time it right, the fertilization process is far from over, as Noyes explains.

“The egg gets released from the ovary and goes into the fallopian tube. The sperm swims up through the uterus into the fallopian tube, they date for a couple of hours, and by the next morning you’ve got an embryo. The embryo then travels to the uterus.” From there, it plants itself in the uterine wall, and if all goes well, nine months later you have a baby.

Now, factor all that in with the common issues that can impact fertility potential. For starters, if you have an irregular period (an estimated 14% of the population, according to the U.S. Department of Health & Human Services Office on Women’s Health) you’re not ovulating every month, which means you have fewer times per year to potentially conceive. Low sperm count, which Noyes says accounts for 30% of trouble conceiving, is another common offender. Fibroid tumors (which impact around 25% of women in their reproductive years) and fallopian tube damage from conditions like endometriosis (which affects 1 in 10 women) or damage from STDs can impede the process too. Factor in age (the average age of first birth in the United States is 27, with peak fertility beginning to decline at 30) and genetics, and the miracle of birth really does start to seem pretty darn miraculous.

So, why do we think this is so easy?

Our early days of sex ed set us up with this belief, but pop culture, social media, and the linear view of stories told about conceiving (read: the successful ones) really help solidify this perception as we age. We see celebrities conceive in their 40s without hearing the backstory. “Some people are fertile in their 40s, but a lot of women who conceive in their 40s either have embryos they froze from IVF [in vitro fertilization], or the process required a couple of cycles in order to get one normal embryo,” Noyes explains. “But stars might say, ‘I just rubbed a Buddha belly at 43.’ No, you went to a fertility doctor.”

And while people are entitled to their privacy, keeping these struggles a secret is part of the larger problem, says Nicole Lippman-Barile, PhD, a clinical psychologist and certified nutritional therapist consultant with Northwell Health Physician Partners CBT Practice. “It’s very narrow to just focus on the success of women who can easily conceive when that’s not the majority of women’s experiences,” she says. “Talking about the other realities that exist is the only way we can educate people.”

Steinhilber echoes this sentiment. “Promoting family planning as something you do earlier than when you are actually ready to have kids could be helpful, so that you sit down with your doctor, get all the facts, and make a more educated decision about when to start trying, how long that process takes on average, what kind of infertility issues you possibly could run up against, and what those mean.”

After doing her own research, Steinhilber decided to focus on what she could control—tracking her ovulation and timing it right—until she conceived five months later.

If you’re part of the majority of women who aren’t getting knocked up immediately, here are a few steps to take:

Ask your doctor to perform a blood test to check your ovarian reserve, test your ovulation, and take a look at your uterus and fallopian tubes to make sure everything is up to par. (Now would also be a good time for your partner to get his sperm levels checked.)

“Sometimes the ovulation apps aren’t enough, particularly if your cycles don’t happen with regularity,” says Noyes. To be certain about ovulation, ask for a progesterone blood test, the most sure-fire way to document that you’re releasing an egg in a given month, and when. “If you have a history of an infection—e.g., chlamydia—you can have a special X-ray test to see if your fallopian tubes are still functional,” Noyes recommends. If you have a history of endometriosis or irregular periods, make sure to inform your doctor.

You’ve both been examined, you’ve been trying, tracking your ovulation closely . . . and nothing’s happening. How long should you try before you consult the doctor again? “For anyone over 32, I would say 4 to 6 months,” says Noyes. “If you’re over 38 and have tried for over 3 months, I recommend you go to the doctor. If you’re 40, don’t wait at all, but rather go straight to the doctor.”

And now, for the hard part: getting your mind right while all of this is happening.

Well-meaning folks like to advise that if you just stress about it less, you’ll instantly conceive. Easier said than done. To put the level of stress into perspective, according to Noyes, studies have shown that finding out you may not be able to have a baby garners the same stress response as being told you have cancer.

“Focus on what you have right now, versus going into the stories in your mind about potentially never being able to conceive,” says Lippman-Barile. Mindfulness works differently for everyone (and takes practice), but one easy place to start is by focusing on your breathing. Lippman-Barile also suggests alleviating stress through activities like yoga and physical movement, taking up a hobby, and spending time with those you care about.

If you’re suddenly the only person in your group of friends without a protruding belly or bouncing baby on their lap, sharing your fertility struggle can feel like you’re being a killjoy. On the flipside, Lippman-Barile says having these conversations with women who have been through it can also be eye-opening. “There’s this cycle of anxiety about talking about it—the antidote to a lot of that is communicating with each other openly, because it’s the only way we’re not going to feel alone in this, and it’s a way we can collectively problem solve,” says Lippman-Barile.

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