About Fertility

Signs of a Fertility Problem

It’s common for a couple to only discover they have a fertility issue after they have tried to get pregnant unsuccessfully for a year. Many causes of infertility are “silent” and don’t have obvious symptoms. However, the following signs might indicate a fertility problem and may signal a call to your doctor:

• You are age 35 or older, and you’ve been trying get pregnant for six months.
• You’re younger than 35 and have had unprotected sexual intercourse for one year without getting pregnant.
• You have had two or more successive pregnancy losses.
• You have any risk factors for infertility.

The most common symptoms of a fertility problem are:

• Irregular menstrual cycles
• Unusually light or heavy bleeding and bad menstrual cramps
• Unusually heavy periods or abnormal menstrual bleeding
• Pelvic pain or pain during sexual intercourse
• Sexual dysfunction (including erectile dysfunction or low libido)

Causes of Infertility

Some factors that may reduce your fertility are things that you can control. For example, smoking reduces fertility in men and women, so quitting is advised (for this and, of course, many other reasons).

Other causes for reduced fertility are not within your control—for example, age-related fertility decline. Here is a closer look at some causes of reduced fertility or infertility:

Age

Female fertility peaks in a woman’s early to mid-20s, and after age 35, it starts to rapidly decline. Male fertility also goes down with age, though not as dramatically. While some men are still fertile after age 50, women after menopause are completely infertile.

Chronic Diseases

Even if a disease is not directly related to the reproductive system, it can still impact fertility. Several chronic diseases, along with their treatments, can lead to fertility problems in women and men, including:

• Diabetes
• Hypothyroidism
• Periodontal disease
• Untreated celiac disease

Hormonal Imbalances or Diseases of the Reproductive System

Hormonal imbalances in both men and women can reduce fertility or even cause infertility. For example, endometriosis, polycystic ovary syndrome, and premature ovarian failure (also known as primary ovarian insufficiency) can lead to female infertility. Low testosterone can lead to male infertility.

Infection of the Reproductive Tract

Both men and women can become infertile after a reproductive tract infection. The most common cause of these infections is sexually transmitted diseases (STDs). In women, this can cause pelvic inflammatory disease (PID). Men can also become infertile after contracting an STD. However, not all reproductive tract infections are caused by STDs. For example, some medical procedures can cause an infection.

Medication Side Effects

Some medications may reduce fertility in men and women, including:

• Allergy medications, which may dry up cervical mucus
• Antidepressants, which may cause fertility problems for men
• Certain types of cancer treatment (radiation therapy near reproductive organs)

Obesity

Obesity is one of the leading causes of preventable infertility. Even being slightly overweight can reduce female fertility.4 Obesity can cause ovulation problems in women and may reduce sperm health in men.

Reproductive Tract Blockages or Abnormalities

Problems with the ovaries, fallopian tubes, or uterus can cause fertility problems for women. Issues with the testes, vas deferens, prostate gland, or seminal vesicles can cause problems for male fertility. Blockages or abnormalities may be present from birth (congenital abnormalities), the result of an injury or medical procedures, or occur after a disease or infection. Most commonly, blockages are caused by adhesions (scar tissue).

Many people are unaware that they have these conditions. They may cause no symptoms and go undetected during routine medical visits. But specialized fertility testing can uncover them.

Unhealthy Lifestyle Habits

Smoking, excessive drinking, and recreational drugs can reduce fertility. This is true for men and women. Less dramatically, more common unhealthy lifestyle habits like not getting enough sleep, too much stress, and eating an unhealthy diet may slightly reduce your fertility.

Unexplained Infertility

About one in four couples never find out why they can’t conceive. This is known as unexplained infertility.

What Does It Take to Get Pregnant?

Here’s a very brief overview of what needs to happen for a couple to conceive naturally.

Egg and Sperm Production

A woman’s reproductive system must produce the cascade of hormones that will result in ovulation, which is when an egg is released from one of the ovaries. This occurs once per month during a woman’s childbearing years.

A man’s reproductive system must be producing sperm cells in the testes. After puberty, new sperm cells are generated daily.

Sexual Intercourse

A couple must have sexual intercourse (or at the very least, semen must come in contact with the vaginal area) during the five to six days prior to ovulation.

During ejaculation, sperm in the vas deferens gets mixed together with semen created in the prostate and seminal vesicles. (The male testes create sperm cells, and then those sperm cells are stored in the vas deferens.) This mixture of sperm and fluid is forced out from the penis by a series of muscular contractions.

Fertilization

After sexual intercourse, semen collects in the cervical area. Next, sperm cells must swim out from the semen and into the woman’s cervical mucus. The sperm then must swim up through the cervical opening into the uterus. From the uterus, the sperm now swim to the fallopian tubes.

The strongest and healthiest sperm (a very small percentage of the total) will linger in the fallopian tubes until an egg comes along. After an egg is released from one of the ovaries, it is gently guided into the fallopian tubes.

In the fallopian tubes, one of the waiting sperm cells eventually burrows itself into the egg. This is the moment of fertilization.

Implantation and Pregnancy

After ovulation, the woman’s reproductive system releases a new cocktail of hormones that builds up the endometrium, or uterine lining.

The fertilized egg (or embryo) goes through a series of cell divisions. As this is happening, the embryo continues to travel down the fallopian tube into the uterus.

Once the embryo reaches the uterus, it eventually implants itself into the uterine lining, or endometrium. This occurs about four to 10 days after fertilization.

After implantation, the embryo creates both fetal cells and placental cells. The hormone human chorionic gonadotropin (hCG), or the “pregnancy hormone,” will begin to be produced. About one week later, or approximately 14 days after ovulation, there is enough circulating hCG for a pregnancy test to give a positive result.

If your cycles are usually 30 days long, you will want to take a pregnancy test on day 31 or later. If you take the test too early before your period is due, you’re unlikely to get a positive result even if you are pregnant.

Tips for Trying to Conceive

Some things you can do to boost your odds of getting pregnant include:

• Avoid douching: Vaginal douching can wash away the valuable cervical mucus you need to get pregnant. Douching can also wash away good bacteria, leading to an increased risk of vaginal infection.
• Choose lubricants wisely: Personal lubricants, like Astroglide and KY Jelly, are harmful to sperm. However, if your own cervical fluid isn’t enough, there are sperm-friendly options, including mineral oil, canola oil, or hydroxyethylcellulose-based lubricants such as Pre-Seed and ConceivEase.
• Have sex more often: If you have sex every other day or every two days, you’re likely to have sex at least once or twice during your most fertile time. Many people think having sex daily is helpful, but sperm takes one or two days to fully mature and regenerate. So if you have sex every day, sperm may be immature.
• Optimize the time you have sex: You want to have sexual intercourse during your fertile window, which lasts between five and eight days, and occurs just before ovulation. However, keep in mind that the day of ovulation varies from woman to woman; it could be as early as day 10 or as late as day 22. Your odds of conceiving the day before ovulation are between 21% and 34%, and between 8% and 17% four days before ovulation.

Assuming you and your partner are fertile, there are many methods for detecting ovulation so you can determine your fertile window, including:

• Charting your body basal temperature
• Checking for cervical position changes
• Checking your cervical mucus
• Tuning into your body’s sexual desire (Your libido is higher when you’re in fertile mode.)
• Using an ovulation chart, calendar, or calculator

Fertility Testing

If you’re a woman and are concerned that you might have a fertility problem, the first person you should speak to is your gynecologist. Men should see a urologist.

Male infertility, either alone or together with female infertility, is the cause for why a couple can’t get pregnant at least 40% of the time.

Basic fertility testing involves:

• An hysterosalpingogram (HSG), which is a special kind of x-ray used to evaluate the uterus and fallopian tubes
• Blood work to measure hormone levels
• Semen analysis (for the male)

Treatment

Depending on your age and the results of your fertility testing, your doctor may try to treat you with low-tech fertility treatments (like Clomid), or refer you directly to a reproductive endocrinologist.

A reproductive endocrinologist is a physician with special training as a fertility specialist. They work in a fertility clinics, together with other fertility technicians, doctors, and nurses. Once you’re referred to a fertility clinic, further testing may be conducted.

Your fertility treatment options will depend on the cause of your infertility, and may include:ther testing may be conducted.

• Assisted reproductive technologies (ART): in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT)
• Injectable fertility drugs: gonadotropins (Gonal-F, Follistim, Ovidrel)
• Insemination: intracervical insemination (ICI), intrauterine insemination (IUI), intracervical insemination (ICI), intratubal insemination (ITU), intravaginal insemination (IVI)
• Oral fertility drugs: Arimidex (anastrozole), Clomid (clomiphene), Femara (letrozole)
• Surgery: laparoscopic surgery, ovarian drilling
• Third-party reproduction: using an egg donor, embryo donor, sperm donor, or surrogate
• Treatment of an underlying medical condition, or tapering of any medications causing reproductive side effects
• Weight loss and other lifestyle changes

Lifestyle Changes

Research has found that some healthy lifestyle habits may lead to improved fertility or at least a reduced risk of infertility. Making lifestyle changes may or may not impact actual infertility, and it shouldn’t be considered as equally effective as fertility treatments.

You should consider both making lifestyle changes and getting medical care. For example, if your fallopian tubes are blocked, your diet isn’t going to help you conceive naturally.

Some things you can do that may improve your fertility include:

• Avoid emotional eating or junk food binges.
• Eat a wholesome diet, with lots of antioxidant-rich vegetables and fruits, healthy fats like olive oil and nuts, and healthy proteins.
• Exercise, but don’t over-exercise.
• Get enough sleep at night, at the right hours. (Night-shift workers may be at a higher risk of miscarriage and infertility.)
• Maintain a healthy weight—not too heavy or too thin.
• Practice mind-body and relaxation techniques.
• Take a folic acid supplement.

Other Options

Not everyone decides to pursue fertility treatments, and some couples will decide to stop pursuing treatment for a variety of reasons, including cost and emotional stress.

Options besides fertility treatment include:

• Continuing to try on your own naturally
• Considering foster parenting
• Considering adoption
• Living a child-free life

Coping

Coping with infertility is not easy. When you don’t get pregnant as quickly as you expected, it’s normal to experience stress. Research has found that women with infertility experience similar levels of psychological stress as those who face cancer, HIV, and chronic pain.

• Get involved in the life of a child. While being around children may be painful during the early days of infertility, over time some men and women find involvement with kids to be a healing experience.
• Join a support group. Connecting with trying-to-conceivers who understand the unique frustrations and grief of infertility can help you and your partner feel less isolated.
• Practice self-care. In addition to eating healthy, exercising, and getting ample sleep, self-care also means managing stress. Mind-body therapies like yoga and acupuncture can help reduce fertility stress.
• Seek professional help. A trained infertility counselor can help you better navigate the anxiety and depression that often accompany infertility.

A Word From Very well

If you’re facing infertility, you have a reason for hope. The vast majority of couples will be able to get pregnant with the help of fertility treatments, surgery, or lifestyle changes. For those who don’t conceive even with help, there are alternative options for family building or moving on with your life.

Whatever you do, please don’t keep your fertility problems a secret. There is no reason to be ashamed, and you don’t need to deal with infertility alone. Loved ones want to help, so let them.