1. Regular periods but not getting pregnant — what could be happening?

One of the most common things we hear in fertility clinics is:   “…but my periods are regular, so surely everything should be fine?”

Regular periods are reassuring. They usually suggest that your brain, ovaries and uterus are communicating properly and that you are probably ovulating. However, regular periods do not automatically mean that pregnancy will happen.

Fertility depends on several things working together at the same time. Ovulation is only one part of the four essential ingredients

To conceive naturally:

  • The ovaries need to release a healthy egg
  • The sperm needs to be good and to reach the egg
  • The tube should be “open” and healthy to let fertilisation and the early growth of the embryo happen
  • Finally, the embryo needs to implant in the uterus – so the endometrial lining should be good! 

You can ovulate regularly and still have difficulties with one or more of these steps.

Common reasons may happen

Fallopian tube problems

The tubes may not be blocked completely, but they may not function normally. Previous infections, endometriosis or pelvic inflammation can affect how the tube moves the egg and embryo.

Egg quality

Egg quantity and egg quality are different things. Some women have regular cycles but reduced egg quality, especially with increasing age.

Sperm problems

A semen analysis may look “normal”, but it still has to swim to the Fallopian tubes, bind to the egg and fertilise.

Unexplained infertility

Sometimes all standard tests look normal, yet pregnancy still does not happen easily.

When should you seek advice?

As a general rule:

  • Under 35 years: seek advice after 12 months of trying
  • Over 35 years: seek advice after 6 months
  • Earlier if you have irregular periods, endometriosis, previous pelvic surgery or known sperm issues

A quick check of the sperm and the ovarian reserve (AMH) is perhaps simple tests you can do, much earlier in your journey – soon as you think you are ready to start trying. At our clinic we offer just these 2 tests (together) for £200/ –

What happens next?

Usually the first steps include:

  • Semen analysis (the easiest, simplest test)
  • Blood test for AMH in the woman
  • Pelvic ultrasound scan
  • Tubal assessment when appropriate

At Acorn Fertility, we prefer sensible, targeted testing rather than ordering large numbers of unnecessary blood tests.

A good fertility assessment is not about doing every test available. It is about doing the right tests for the right reason.

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