Infertility is the failure of a couple to become pregnant after one year of regular, unprotected intercourse. The fertility process is complex in both men and women, and the inability to conceive affects nearly 10% of couples trying to have a baby. About half of these couples will be able to achieve pregnancy with treatment. This may involve treatment of the woman, the man, and sometimes both partners.
When attempting conception, one has to keep in mind that even the most fertile couples only have around a 20-25% chance of conception per cycle. Most couples who are attempting pregnancy will achieve a pregnancy within 6 months and about 85% will within 12 months.
It is estimated that in the U.S. over 10% of women between the ages of 15 to 44, or about 6.2 million women, have impaired fertility. What are some of the contributing factors?
As a woman gets older, her fertility declines. Infertility in older women appears to be mostly due to a higher risk for chromosomal abnormalities occurring in her aging eggs. Older women may also have health problems that interfere with fertility. Fortunately, when fertilization occurs, older, healthy women are generally able to successfully bear a fetus to term, even though they have a higher risk for miscarriage and complications of pregnancy. A recent analysis of pregnancy rates based on conception on the day of ovulation suggested that women between the ages of 19 to 26 have twice the pregnancy rates as those between 35 to 39. However, infertility treatment can still be successful for women in their late 30's and early 40's.
Thirty percent of our estrogen is produced in fat cells by a process that transforms circulating adrenal male hormones into estrogen. Since a normal hormonal balance is crucial for conception to take place, it's no surprise that a woman whose body weight is either too high or too low is likely to have a harder time getting pregnant. Body fat levels that are at least 10% to 15% above normal can contribute to infertility, since an overload of estrogen can throw off the reproductive cycle. Body fat levels that are at least 10% to 15% below normal often shut down the reproductive process completely.
Women at risk include:
- Women with eating disorders such as anorexia or bulimia and even women with a history of an eating disorder
- Women on extremely low-calorie or restrictive diets, especially if their periods are irregular
- Vegetarians not getting enough important nutrients, such as vitamin B12, zinc, iron, and folic acid
- Marathon runners, dancers, and other athletes and performers who exercise very intensely
- Any of the following may present a risk factor that inhibits fertility:
- Smoking one or more packs a day or starting to smoke before the age of 18
- A correlation has been found between caffeine consumption and infertility, especially coffee
- Even moderate alcohol intake (as little as five drinks a week) can impair conception and have adverse effects on the developing fetus
- Vaginal douching and the use of vaginal lubricants may also impair fertility
- Having multiple sexual partners, not using condoms, and having intercourse during menstruation all increase the risk for sexually transmitted organisms that can cause pelvic inflammatory disease (PID), that may lead to infertility
There are a number of approaches available for enhancing fertility, depending on the cause. These may include:
- Making lifestyle changes that encompass healthy choices such as stopping smoking, decreasing alcohol intake, and maintaining a normal body weight
- Planning sexual activity with ovulation cycle
- Being aware of stress levels and seeking treatment for anxiety or depression
- There are numerous treatments for infertility, depending on the diagnosis, which may include:
- Surgery to treat endometriosis, fibroids, pelvic adhesions, blocked fallopian tubes, or uterine polyps
- Use of a pill called clomiphene to induce ovulation in women with ovarian dysfunction
- Injectable medication to induce the development of multiple follicles, which contain eggs
- Treatment for male factor infertility, including surgery, medications, or uterine insemination of sperm
The higher-tech treatments, called the ART's (Advanced Reproductive Technologies) include in vitro fertilization (IVF) and various variants of IVF, such as intracytoplasmic sperm injection (ICSI), which is used to treat severe male factor infertility. IVF and its variants involve more complicated treatment protocols, but the success rates tend to be far higher than for the other treatments.
If you are under the age of 35 and have no relevant medical issues (such as a history of endometriosis, a ruptured appendix, or irregular or absent ovulation, or your partner has a history of undescended testicles), you should see an infertility specialist after a year of trying. If you or your partner do have some relevant condition, or if you are 35-40, see a specialist after only six months. If you are over 40, see a specialist after 3 months of trying.
Key points:
- Infertility is far more common that most people think
- It is just as likely to be caused by the man as by the woman
- Age is a major contributor to female factor infertility
- Lifestyle habits can cause or contribute to infertility
- There are many forms of infertility treatment, some are simple and inexpensive.