Regular Periods but Infertile?

Regular periods are one of the strongest benchmarks for determining a female’s fertility. If she experiences regular menstrual cycles, she is having regular ovulation, and her ovaries are releasing mature eggs every month. Does this mean she is fertile enough to conceive? Or can she be infertile despite having regular periods?

The Menstrual Cycle

First, let’s understand what exactly the menstrual cycle is and how it works, before we dig into the issues related to menstruation.

A woman’s menstrual cycle can be split into four phases.

Menstruation – This is the first 5 days of the cycle when she has her menstrual period. She experiences active bleeding during this period. Some women can have shorter periods, and some can have them longer than 5 days, too.
Follicular – Day 6 to day 12 is the follicular phase, when the follicles in the ovaries develop the eggs for maturation. While multiple follicles will have eggs, only one dominant follicle’s egg will be developed for maturation.

During this phase, hormones increase, triggering the uterus to develop a lining to receive a fertilised egg. The uterine lining has to be developed enough to help the egg implant or attach. Only after the egg attaches to the uterine lining successfully will it result in a pregnancy.

Ovulation – Day 13 to day 15 is the ovulation period when the dominant follicle will rupture to release the egg. If the sperm meets the egg during this time, the chance for pregnancy is at its highest.

Luteal – Day 16 to day 28, or until the period starts, is the luteal phase. After ovulation, the egg travels down the fallopian tube to reach the uterus. The sperm has to fertilise the egg before it starts descending. If the fertilisation was succesful it will result in an embryo. This embryo will attach itself to the uterine wall and start developing into a fetus.

During this luteal phase, progesterone levels increase to thicken the uterine lining. If fertilisation did not happen and no embryo is implanted in the uterus for implantation, the hormone levels will drop. This will cause the uterine lining to rupture as it is not needed anymore. The uterus will shed this lining through the menstrual period, which marks the beginning of the next cycle.

Regular Periods But Not Fertile?

A woman can menstruate regularly without any delays or issues. Menstruation indicates the proper functioning of the ovaries and hormones. It does not, however, tell us anything about the quality of the eggs or other factors necessary for a successful pregnancy.

Poor egg quality, DNA fragmentation, or issues with the uterus can interfere with a woman’s ability to conceive despite her regular periods. Since her period is regular, it is a common assumption that the woman is healthy and has nothing to worry about when it comes to pregnancy. She may discover her fertility issues only after taking a fertility test or undergoing ultrasound scans after failed attempts at pregnancy.

Reasons for Infertility Despite Regular Period

So, what could be causing infertility in a woman despite regular periods? Here are some possible causes –

Poor Egg Quality – If the egg quality is not good enough for a successful pregnnacy it may not implant or even cause early miscarriages. Sometimes the miscarriage can happen even before the woman takes a pregnancy test, and she may not know about such an issue until she takes fertility tests.
Hormonal Issue – The body requires the hormones to increase and decrease throughout the menstrual cycle for successful fertilisation and implantation. If these hormones don’t change as required, it can interfere with one or more steps involved in conception, leading to infertility.
Inadequate Lining – The uterine lining has to be thick enough by the time the embryo reaches the uterus after descending the fallopian tube. If the lining is not adequate, implantation will not happen. Hormonal imbalances can also lead to inadequate uterine lining.
Thyroid Issues –Thyroid is an important hormone that controls various other hormones, including those responsible for reproduction. Too high or too low thyroid levels may not interfere with ovulation and menstruation, but may negatively impact the egg quality, fertilisation, or implantation process.
Blocked Tubes – If there is a blockage in the fallopian tubes, it can interfere with the fertilisation process by making it difficult for the egg to descend in time or for the sperm go up to meet the egg, thus making it difficult to conceive naturally or even through IUI.
Uterine Issues – Uterine issues like fibroids, polyps, or uterine scarring due to previous surgeries can prevent the uterine lining from thickening for implantation. Congenital deformities like a septate uterus, bicornuate uterusor unicornuate uterus can make implantation and pregnancy very challenging.
Failed Implantation – Despite being fertilised, the egg may not implant properly due to various reasons, like insufficient lining, chromosomal abnormalities in the embryo, or other issues. Scar tissue in the uterus can also hinder implantation. Without implantation, pregnancy is not possible.

Endometriosis – Endometriosis is a condition where uterine lining-like tissues grow outside the uterus

Endometriosis – Endometriosis is a condition where uterine lining-like tissues grow outside the uterus, usually on the ovaries or the fallopian tubes. This can interfere with the egg’s fertilisation and implantation process. The periods can be regular but very painful.
Male Factor Infertility – Infertility in the male partner will also prevent the couple from conceiving naturally or even through assisted reproductive techniques. Until both partners undergo fertility tests, it is not possible to determine the exact reason for infertility.
UTIs – Urinary Tract Infections, when not treated in time, can cause severe damage to the reproductive organs and also hinder fertility. The infection can spread to the uterus or fallopian tubes and cause inflammation, damage, or scarring. These can block the egg’s transportation and implantation.
PID – Pelvic Inflammatory Disease is a major cause of infertility in women. When STIs or UTIs are not diagnosed and treated in time, they can lead to PID and damage reproductive organs. If the infection is in the early stages or mild, it may not impact the menstrual period. It may cause heavier bleeding or more pain, but the periods can still be regular.
Lifestyle – Excessive smoking, drinking, and other substance abuse may not impact a woman’s menstruation, but can impact her fertility. Such exposure can interfere with the hormones responsible for reproduction and reduce conception chances. They can even cause early miscarriages.

Book an online appointment with Dr. Shilpa Singhal for fertlity related issues.

Silent Infertility Symptoms to Look Out For

Most women may not know they have fertility issues until they start trying to conceive. Here are a few silent warnings one should look out for if they are unable to conceive despite regular menstruation -

Sexual intercourse is very painful.
Periods are heavier or longer than before.
Menstrual blood is not bright red; it is dark or pale.
Hormonal changes (can cause other issues).
Underlying medical conditions.
Obesity or overweight (much more than the recommended BMI).

How to Treat Infertility?

If you are menstruating regularly but are still unable to conceive despite multiple attempts, it is time to consult a fertility specialist. They will test both partners and also suggest the necessary treatments or how to plan for pregnancy. Refrain from self-diagnosis or self-medication. Be cautious about using the various home remedies and unapproved medications that promise to help you get pregnant quickly.

Conclusion

A woman’s periods are the most common yardstick for her fertility. Diagnosing infertility despite regular periods can be very challenging, but not unheard of. Seeking professional help and following the doctor’s advice is crucial for such complications.

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Frequently Asked Questions

Why am I not getting pregnant if my periods are regular

Despite regular periods, you could be facing issues with the uterus, hormonal imbalances, poor egg quality, or other medical conditions that could be hindering your pregnancy attempts. Your male partner could also be suffering from fertility issues that are preventing conception.

Does male fertility play a role if periods are regular?

Yes. Healthy sperm are a must for successfully fertilising an egg and leading to the formation of an embryo. If the sperm quantity, quality, shape, or motility is not enough, it can prevent conception or cause early miscarriages.

When should you seek fertility testing if periods are regular?

If you and your partner have been trying to conceive for a year without any success, it is recommended to consult a fertility specialist for professional testing and guidance. If you notice other signs like painful periods, very long or heavy periods, you should let your gynaecologist know

Can egg quality be poor even with regular periods?

Yes, a woman’s age and genetic factors influence the quality of her eggs. She can have regular periods every month, but the egg released during ovulation may not be mature or healthy enough for pregnancy. Hormonal imbalances can also interfere with the egg development and maturation process, thus negatively impacting its quality.