not pregnantMillions of women all over the world are struggling with infertility. If you’re one of them, you know the devastation every month when you get your period or when a missed period doesn’t result in a positive pregnancy test.

It could be that you are simply missing your window of ovulation opportunity or it could be something more serious.

Here are five common medical reasons women have trouble getting pregnant:

1. Polycystic ovarian syndrome (PCOS)
PCOS is one of the most common hormonal problems in women of reproductive age and it is the main cause of infertility because it affects ovulation. There is no real “cure” for PCOS but if you have it, there are many options for treating the symptoms. Healthy eating with regular exercise to maintain a normal weight [can] restore the imbalanced sex hormones and help optimize your body’s ability to maintain normal menstrual periods.

2. Endometriosis
Endometriosis is a disease in which uterine tissue grows outside the uterus. Painful periods and heavy bleeding are hallmarks of this common condition that prevents pregnancy. What can sufferers do? Treatments for endometriosis include medication, surgery, or a combination of the two. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to relieve the pain of endometriosis, and hormones like birth control pills, progestin and GnRH drugs (gonadotropin-releasing hormone) may stop the condition from getting worse—but they will not heal scarring that is already there. Laparoscopic surgeries, which use a thin, light-transmitting instrument (laparascope) can also be used to view the pelvic organs and remove or burn away endometriosis tissues that produce many chemicals toxic to sperm and embryos.

3. Age
Despite more women waiting until they are in their 30s or even 40s to get pregnant, women who are older can have more difficulties conceiving. Ultimately, we know that the age of the egg is the most important factor in determining success in getting pregnant. We have a number of simple tests such as the AMH and FSH blood tests and examination of the ovarian follicles by ultrasound that can give us an indication of the health of the ovaries and, subsequently, the chances of success at different ages.

4. Undiagnosed medical issue
Some women are unaware of medical conditions, such as thyroid issues or diabetes, that can lead to infertility. Talking to an infertility specialist about a blood panel that can detect potential underlying problems and prescribe a treatment plan, if necessary is highly recommended. Some of the common health issues that have big negative effect on the chances of conceiving are under-functioning thyroid (hypothyroidism), obesity, and smoking. You should see your primary care physician regularly and consult a specialist if you have any unique medical conditions which you feel may be affecting your fertility.

5. Low sperm count
You’ve been tested for various conditions and the doctor can’t find any medical reason why you aren’t getting pregnant. What gives? Perhaps it’s your husband. If your partner has low sperm count or low sperm mobility, it will lower your chances of getting pregnant. Sperm count and mobility issues are common and that there are treatments that can result in successful conception. In some cases, men may even be able to [impregnate] without medical assistance, but if conception does not occur, most mild sperm deficiencies can be treated with a simple intrauterine insemination (IUI). This is a simple and inexpensive procedure in which a concentrated sperm sample is placed high in the uterus to get the sperm closer to the egg and increase the chances of conception. More severe sperm abnormalities can be treated very successfully with advanced procedures including in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI).