As a fertility naturopath, one of the most common questions I hear is:

“Why am I not getting pregnant?”

Trying to conceive can be exciting at first. But when month after month passes without a positive pregnancy test, it’s natural to start asking questions.

You may be wondering whether you’re doing something wrong, whether your age is working against you, or whether there is an underlying fertility issue that hasn’t yet been identified.

The reality is that fertility is rarely as simple as fertile versus infertile. Many people fall somewhere in between. Some conceive within a few months, while others take longer than expected despite having regular cycles, no obvious health concerns and normal test results.

In practice, I rarely uncover a single explanation for delayed conception. More commonly, I see several factors influencing fertility at the same time – from ovulation and hormone balance to sperm health, nutrient status and the foundations of preconception care.

The good news is that delayed conception does not automatically mean infertility. In many cases, there are opportunities to better understand what may be influencing fertility and to optimise the conditions needed for conception, implantation and a healthy pregnancy.

While this article focuses primarily on factors which affect egg, sperm and reproductive health, many of the principles discussed may also be relevant for individuals and couples pursuing conception through donor sperm, donor eggs or assisted reproductive technologies.

Why Am I Not Getting Pregnant?

Conception may take longer than expected due to factors such as:

• Irregular or absent ovulation
• Poor timing of intercourse or insemination
• PCOS
• Thyroid dysfunction
• Endometriosis
• Sperm health issues
• Nutrient deficiencies
• Age-related fertility changes
• Recurrent miscarriage
• Underlying health factors that have not yet been investigated

Many people experience more than one contributing factor.

Fertility isn’t just about getting pregnant. It’s about creating the healthiest possible conditions for conception, implantation and pregnancy—for both partners.

Before We Talk About Infertility, Let’s Talk About Fertility

One of the biggest misconceptions I encounter is the idea that people are either fertile or infertile.

In reality, fertility exists on a spectrum. Some people conceive quickly, some take longer than expected, and others require additional support to achieve or maintain a pregnancy. This reduced ability to conceive or stay pregnant compared with what would normally be expected is sometimes referred to as subfertility.

This distinction matters because many people who come to see me are not technically infertile. They may have been trying for six months, twelve months or longer, or they may have experienced one or more miscarriages. Their concern is not necessarily whether conception is possible, but whether there are factors that reduce their chances of success.

Mistake #1: Assuming Fertility Is Simply “Normal” or “Infertile”

Many people are surprised to learn that fertility is not an all-or-nothing situation.

A person can be ovulating, have regular cycles and still experience delays in conception. Likewise, someone may be able to become pregnant but experience difficulty maintaining a pregnancy.

Viewing fertility as a spectrum allows us to move beyond the question of “Am I infertile?” and start asking a more useful question:

What factors might be influencing my fertility right now?

Mistake #2: Stopping Contraception and Assuming That’s All There Is to Fertility

For many people, the fertility journey begins by stopping contraception and immediately starting to try for a baby.

Often the only additions are ovulation predictor kits and a pregnancy multivitamin or folic acid.

While these can be valuable tools, very few people are taught about preconception health or the many factors that influence fertility before conception occurs.

Ovulation quality, sperm health, nutrient status, thyroid function, blood sugar regulation, sleep, stress and overall health can all play a role.

What I Often See in Practice

“One of the most common fertility misconceptions I encounter is the belief that fertility begins when contraception ends. In reality, many of the factors that influence conception and pregnancy outcomes—such as ovulation quality, sperm health, nutrient status and metabolic health—often deserve attention before a couple starts trying for a baby.”

Are You Actually Ovulating?

Many people assume that if they are having regular periods, they must be ovulating.

Unfortunately, it isn’t always that simple.

Ovulation may be delayed, inconsistent or occasionally absent, even in people who experience seemingly regular cycles. Conditions such as PCOS, stress, post-pill hormonal adjustment and other hormonal imbalances can all influence ovulation.

Mistake #3: Assuming a Period Automatically Means Ovulation

A monthly bleed does not necessarily confirm healthy ovulation.

Ovulation is also about more than the release of an egg. After ovulation, the ovaries produce progesterone, a hormone that helps prepare and maintain the uterine lining for implantation. In some cases, ovulation may occur, but progesterone levels may not rise sufficiently or remain elevated for long enough to optimally support early pregnancy. This is one reason why confirming ovulation can involve looking beyond cycle length alone.

While ovulation is usually occurring in regularly cycling women, the only way to know with greater confidence is to assess ovulation directly through methods such as cycle charting, progesterone testing or other appropriate investigations.

What I Often See in Practice

“Many women assume that a regular monthly period automatically confirms healthy ovulation. More often, I find the important question isn’t whether bleeding is occurring, but whether ovulation and progesterone production are providing the conditions needed to support conception and implantation.”

Regular periods can provide useful clues about cycle health, but they don’t always tell the whole story.

Even when ovulation is occurring, timing still matters. Understanding your fertile window, recognising cervical mucus changes and knowing when ovulation is likely to occur can make a meaningful difference to your chances of conception.

Research has consistently shown that conception is most likely when intercourse occurs during the fertile window.

Fertility Is About More Than Egg Count

One of the most common concerns I hear is:

“Am I too old?”

Age does matter. Ovarian reserve matters. Tests such as AMH can provide useful information about egg quantity.

However, fertility is about far more than egg numbers alone.

Mistake #4: Focusing Only on Age and AMH

Many people become understandably fixated on ovarian reserve results, particularly if they have been told their AMH is lower than expected.

While these results can provide valuable information, they do not tell the whole story.

Fertility is also influenced by:

• Egg quality
• Ovulation quality
• Hormonal balance
• Endometrial receptivity
• Nutritional status
• Sperm quality
• Overall health

What I Often See in Practice

While age and ovarian reserve are important considerations, fertility depends on far more than egg numbers alone.

A low AMH result does not automatically explain every fertility challenge, just as a normal AMH result does not guarantee conception.

One of the Most Common Fertility Oversights I See: Sperm Health

Fertility is often framed as a women’s health issue.

In reality, fertility is rarely solely a women’s health issue or solely a men’s health issue. More often, fertility reflects the health of both partners.

Where sperm is involved, sperm health deserves the same attention as egg health.

Male factors contribute significantly to fertility challenges, yet many couples do not investigate sperm health until much later in their fertility journey.

International fertility guidelines recognise male factor infertility as a significant contributor to delayed conception and recommend appropriate assessment of sperm health.

Mistake #5: Assuming a Normal Semen Analysis Means Everything Is Fine

A semen analysis can provide valuable information about sperm count, motility and morphology.

However, semen analysis results are typically reported against established reference ranges. While these results provide useful information, they do not always tell the whole story about sperm health or reproductive potential.

What I Often See in Practice

“One of the most common fertility oversights I see is extensive investigation of the female partner while sperm health remains largely unexplored. Their partner has either never had a semen analysis, or has been told a “normal” result means sperm can no longer be part of the conversation”.

While general guidelines can be helpful, many people choose to seek fertility support long before they reach those thresholds

This doesn’t mean every man requires extensive testing. Rather, it highlights the importance of viewing fertility as a shared journey that deserves assessment from both sides.

If You Are Conceiving but Experiencing Miscarriage

Sometimes the challenge isn’t becoming pregnant—it’s staying pregnant.

Experiencing a miscarriage can be heartbreaking. Experiencing recurrent miscarriages can be particularly distressing and often raises questions about whether something deeper is contributing.

Mistake #6: Assuming Conception and Pregnancy Are the Same Challenge

The factors involved in becoming pregnant are not always the same as those involved in maintaining a healthy pregnancy.

Recurrent miscarriage deserves investigation and support.

Clinical guidelines recommend considering a range of potential contributing factors, including genetic, anatomical, hormonal and lifestyle influences.

Potential contributing factors may include:

• Hormonal factors
• Thyroid dysfunction
• Nutritional deficiencies
• Uterine factors
• Genetic factors
• Sperm factors

While recurrent miscarriage is complex and can have many contributing factors, both egg and sperm health may warrant consideration as part of a comprehensive assessment.

What I Often See in Practice

Many people assume that once pregnancy occurs, the fertility journey is over. In reality, conception and maintaining a healthy pregnancy can involve different factors and may require different lines of investigation.

When Continuing to “Just Keep Trying” May Not Be the Best Strategy

Many people are advised to simply keep trying.

Sometimes this is appropriate.

Sometimes it delays important conversations.

If you have been trying for many months without success, consider whether additional investigations or more targeted support could help identify your next steps.

Particularly if you have:

• Irregular cycles
• Significant period symptoms
• Known PCOS
• Endometriosis or adenomyosis
• Recurrent miscarriage
• No confirmed ovulation
• No semen analysis
• Previous fertility concerns

What I Often See in Practice

“Many people focus on how long they’ve been trying to conceive. I often find the more useful starting point is: ‘What have we learned about your fertility during that time?’ Understanding ovulation, sperm health, cycle patterns and other influencing factors can be just as important as the amount of time that’s passed.”

In practice, many people feel caught between being told to “just keep trying” and moving towards fertility treatments such as ovulation induction medications or IVF. While these approaches can be incredibly valuable and appropriate in some situations, I often find there are opportunities to better understand ovulation, sperm health, nutrient status and other factors that may be influencing fertility before deciding on the next step.

Further testing may include thyroid assessment, iron studies, vitamin D, ovulation assessment, progesterone testing, ovarian reserve markers and semen analysis, depending on your circumstances.

The goal isn’t to find something wrong. The goal is to better understand what may be influencing fertility and identify opportunities for support.

When Should You Seek Fertility Support?

While general guidelines can be helpful, many people choose to seek fertility support long before they reach those thresholds However, seeking support is not only for people who have been trying unsuccessfully for a specific period of time.

Many people choose to learn more about their fertility before trying to conceive, while others seek support after a few months of trying, following a miscarriage, or when they have concerns about ovulation, cycle and hormone health or sperm quality.

You do not need to wait until fertility challenges arise before taking a proactive approach to your reproductive health.

Whether you are preparing for pregnancy, have recently started trying, or have been trying for some time, understanding the factors that influence fertility can help you make informed decisions about your next steps.

My Perspective as a Fertility Naturopath

After more than a decade of supporting women and couples through their fertility journeys, I’ve found that delayed conception is rarely caused by a single factor.

More often, I see a combination of issues that have simply never been investigated together. For some people, ovulation is the missing piece. For others, sperm health, thyroid function, nutrient status or a history of miscarriage may be contributing. Often, several factors overlap.

Understanding the whole picture often provides the clearest path forward.

Rather than viewing fertility as fertile versus infertile, I prefer to think about creating the healthiest possible conditions for conception, implantation and pregnancy.

Because fertility isn’t just about getting pregnant. It’s about supporting the health of both partners and building the strongest foundation possible for the journey ahead.

If you’re wondering why you’re not getting pregnant, or would like support understanding your cycle, fertility testing or preconception health, learn more about working with Anna Naturally or book a fertility consultation.

Kia ora, I’m Anna Jolly

I’m a degree-qualified naturopath and medical herbalist based in Aotearoa / New Zealand with a focus on women’s hormones, fertility and menstrual health.

Through Anna Naturally, I combine evidence-informed practice with traditional herbal medicine and a root-cause approach to help women better understand their bodies and create sustainable changes that fit real life.

Meet Anna and learn more about my approach.
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Questions I’m Often Asked About Fertility and Delayed Conception