You’re doing everything you can to get pregnant, but it isn’t happening: what that really means

When it comes to fertility, observation always comes before action. If pregnancy is taking longer than expected despite all the effort you’ve already put in, the answer is not always to do something more. Often, it’s to understand what is genuinely worth exploring.

It’s what I see in consultations every week. The women I meet are not doing too little. They’re doing an enormous amount, often too much, and focusing on the wrong things. They’ve read, tried things, changed their diet, added several supplements and calculated every fertile window. They arrive exhausted from becoming experts in their own case, without anything changing.

So the question isn’t just ‘what more could I do?’ but ‘where should I look, and in what order?’

When I first started practising, I focused mainly on what to add: a supplement, a herb, one more change. Today, I start by understanding what is happening, and I often take things away before adding anything.

A fertility assessment answers some questions. It doesn’t answer them all. It checks ovulation, whether the fallopian tubes are open, ovarian reserve and the semen analysis. When the results are normal, that is genuinely good news: it rules out causes that require medical care.

But confusing ‘nothing abnormal was found’ with ‘everything has been understood’ is, in my view, one of the most common misunderstandings in fertility. The assessment primarily looks for certain medical causes, and that is exactly what it is for. How the cycle functions as a whole is a different question, one it is not designed to answer. These are two distinct but complementary questions, and it is often when the results are reassuring that my work begins.

Before going further, let’s recap what this assessment actually covers.

What a standard fertility assessment covers 

A fertility assessment involves a few well-established tests: for the woman, hormone blood tests at different points in the cycle, a pelvic ultrasound and sometimes a check of the fallopian tubes; for the man, a semen analysis, depending on what your doctor considers appropriate. Two things, however, often fall outside this framework. Each concerns one partner, and that is rarely a coincidence. 

Ovulation: more than whether it happens

Let’s start there. A urine test or blood test confirms that ovulation has occurred. That’s valuable. But this confirmation gives a yes-or-no answer: it tells us nothing about the surrounding hormonal conditions or what happens afterwards, during the luteal phase. Ovulation can occur without everything around it being optimal. No simple yes-or-no test can capture that distinction, and this is precisely where the cycle itself can tell us more.

Semen analysis and what it doesn’t measure

One point on the male side is rarely discussed. A semen analysis provides a snapshot of sperm production at a given moment. Sperm are produced continuously, which explains why two results a few months apart may differ. It assesses sperm volume, concentration, motility and shape. It does not assess the integrity of sperm DNA. Yet the standard parameters of a semen analysis cannot assess the integrity of sperm DNA : a perfectly normal semen analysis can therefore coexist with high DNA fragmentation (Human Reproduction Archives, 2020, sources at the end of the article). An index below 15 % is generally considered normal, between 15 and 30 % moderate, and above 30 % high. This is not an obscure line of investigation: European urology guidelines recommend this test for couples with unexplained infertility (World Journal of Men’s Health, 2023, sources at the end of the article). Yet it is rarely offered as a first step.

This distinction is worth knowing, especially as male factors are involved in around half of cases, and 10 to 15 % of infertile men have a normal semen analysis (International Journal of Molecular Sciences, 2024, sources at the end of the article). If you’ve been trying for some time and everything appears normal for both partners, it’s something to discuss with your doctor, who knows your history.

The main mechanism behind this fragmentation is oxidative stress. It is also one of the few areas that lifestyle and targeted antioxidant supplementation may influence over a full cycle of sperm production, or around three months. Targeted is the key word: the aim is not to add more bottles, but to support a specific mechanism when the circumstances warrant it.

Our recommended product Cocooning Men, male fertility supplement An antioxidant formula designed to support sperm production, to consider taking for three months.

This is a reminder of something all too often forgotten: fertility involves two people, never the woman alone.

This is also why we talk about unexplained infertility, a situation affecting around 15 % of couples, with estimates ranging from 5 to 35 % depending on the study (World Journal of Men’s Health, 2023). The term can be frightening. In reality, it simply means that the usual tests have not found a cause. Not that there is no cause.

When pregnancy is taking longer than expected, there are two approaches: add more, or look more closely. The first can make you feel as though you’re taking immediate action. The second means understanding before making changes. Let’s look at what each involves in practice.

Why adding more doesn’t move things forward

The first instinct is very human. It points you towards the next test, the next supplement, a protocol you’ve seen somewhere, as though the answer were hiding in something you haven’t tried yet. These situations are far from exceptional. Looking back at my 50 most recent fertility consultations, 35 women were already taking at least four dietary supplements before our first consultation. For many, it was difficult to explain exactly why they had chosen each one and what they hoped it would do. And often, at the very start of the appointment, I hear: ‘I don’t understand what we’ve missed.’ They’re not asking for a miracle solution. They’re asking for things to make sense.

What I see most often is solutions layered on top of one another without ever being prioritised. In consultations, I actually remove supplements more often than I add them. I’m not criticising supplementation; it has its place. I’m criticising adding supplements without a strategy, which is expensive and makes it harder to see the bigger picture. Useful supplementation answers a specific question: which mechanism am I supporting, and why this one? On the female side, oxidative stress and egg quality are among these documented mechanisms, and a targeted formula makes more sense here than an ever-growing collection of bottles.

Our recommended product Ovo+, female fertility supplement A targeted formula with coenzyme Q10, zinc and N-acetylcysteine, to support egg quality and help protect cells from oxidative stress. Compatible with assisted reproduction treatment.

What changes when you look at the wider picture

The second approach is to pause and revisit what’s already there. The information is often available, scattered across several reports, several appointments and sometimes several years. It’s just that no one has yet taken the time to bring it together.

In practice, I go back over the whole history. The test results, of course. But also the cycles: their pattern, length and signs. A temperature chart, when available, can sometimes tell us more than an isolated blood test. Symptoms and how they’ve changed. Sleep, digestion, circumstances and medical history. And I always look at both partners, never just the woman.

What strikes me after seven years is that most of these women don’t come with a new symptom. They come with signs that have been there for years, which they’ve come to accept as part of how their bodies normally work. Marked premenstrual symptoms. Painful periods. Fatigue that follows their cycle. Spotting before a period. Significant changes in energy levels. Often, they don’t even mention these things at first, because they’ve lived with them for too long to consider them noteworthy. Among those same 50 most recent fertility consultations, 20 women had marked premenstrual symptoms which they had come to see as simply part of everyday life. None of them would have spontaneously linked it to their fertility, and I’m not claiming it explains their fertility either. It’s simply one piece of useful information for understanding how hormones are functioning.

You may have come to think of them as normal, too. But they are useful information to take into account.

On its own, none of these signs explains infertility, and I’m careful not to suggest otherwise. But together, they suggest something else: a way of looking at the wider picture. The question then becomes: ‘Of everything we already know, what deserves a closer look, and in what order?’ And the order matters as much as the list. I always start with what can be changed quickly and checked easily, before moving on to what takes months. Trying to investigate everything at once is the best way to miss what matters.

If you’d like to start looking at your own situation this way, I’ve created a fertility assessment tool free, which helps identify areas to explore based on your profile. It does not provide a diagnosis. It helps you see things more clearly, which is already a great deal.

An example makes this more concrete. Domitille, 35, had been trying to conceive for around eighteen months when she came to see me.

Her fertility assessment was comprehensive and reassuring. Regular cycles, ovulation confirmed, nothing unusual on the ultrasound, an AMH of around 2 ng/mL, consistent with her age. Her partner’s semen analysis was normal. And yet, nothing. During our first conversation, she said something I often hear: ‘I don’t understand why it isn’t working when all my tests are fine.’

Looking back over her history, several things caught my attention. Domitille was ovulating, yes. But her cycle told another story. Significant premenstrual symptoms. Marked fatigue at certain stages. Difficult periods. And, above all, a progesterone at the lower end of the range during the luteal phase, raising questions about the conditions after ovulation, beyond simply whether it occurred. Her TSH was around 3 mIU/L, a value that remains within the laboratory’s normal range but, in the context of trying to conceive and associated symptoms, warrants a closer look and a discussion with her doctor.

None of these findings, taken on its own, explained infertility, and I’m careful not to claim otherwise. Together, they suggested a pattern.

We didn’t add a long list of supplements. We focused on specific areas: adapting her diet to her actual needs, micronutrients involved in reproductive physiology, supporting the conditions for healthy ovulation, and rebalancing a few habits that affected her overall health. The aim wasn’t to correct a problem that wasn’t there, but to improve the conditions.

A few months later, Domitille told me she was pregnant. What I take from her journey is that there was no single hidden cause. By looking more closely at her cycle, we simply identified areas to work on that standard tests are not designed to explore.

(Details have been changed to protect confidentiality. Every situation is different, and results vary from person to person.)

If your fertility test results are normal but pregnancy is still taking longer than expected, here’s what I’d like you to remember. You haven’t reached the end of the road, and you haven’t failed to try hard enough. It’s about looking at things differently, rather than continuing to add more.

That doesn’t mean investigating on your own or going without medical care. Quite the opposite. My work never replaces a diagnosis or medical treatment. When further investigations are needed, a gynaecological condition is suspected, an abnormal blood test result appears, or a situation falls outside the scope of the support I offer, I refer you to the appropriate healthcare professional. And there are situations where I say no: when a woman is looking for an alternative to medical care, I refer her back, because I cannot offer a substitute. Looking at the wider picture and medical follow-up go hand in hand, never against each other.

So I won’t promise that every situation has an explanation. That would be dishonest, and you deserve better than a promise. What I can say, though, is that most of the women I work with leave with more than answers: they leave knowing what to prioritise. At last, they understand why they’re doing what they’re doing.

So if you take away just one thing, let it be this: the fact that no obvious cause has been identified doesn’t mean there’s nothing more to understand. In fertility, the challenge isn’t always to find more information. Often, it’s to understand what the information you already have tells you when you put it together.