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About 9% of men and about 11% of women of reproductive age in the United States have experienced fertility problems.
- In one-third of infertile couples, the problem is with the man.
- In one-third of infertile couples, the problem can’t be identified or is with both the man and woman.
- In one-third of infertile couples, the problem is with the woman.
Studies suggest that after 1 year of having unprotected sex, 12% to 15% of couples are unable to conceive, and after 2 years, 10% of couples still have not had a live-born baby. (In couples younger than age 30 who are generally healthy, 40% to 60% are able to conceive in the first 3 months of trying.)
Fertility declines with age in both men and women, but the effects of age are much greater in women. In their 30s, women are about half as fertile as they are in their early 20s, and women’s chance of conception declines significantly after age 35. Male fertility also declines with age, but more gradually.
Am I at Risk for Fertility Problems?
Risk Factors for Infertility
Men and women are equally at risk for fertility problems. In about one-third of cases, both partners have issues, or doctors can’t find the cause.
Some of the factors that affect a couple’s ability to have a baby include:
Women are born with a set number of eggs. That number drops as they age, making it harder for them to get pregnant after they reach their mid-30s. By 40, their chances of getting pregnant drop from 90% to 67%. By age 45, it’s just 15%. A man is less fertile after age 40.
If you smoke tobacco or marijuana, you’re less likely to get pregnant. Tobacco and marijuana can increase a woman’s chance of miscarriage, and decrease sperm count in men. Smokers also hit menopause about 2 years earlier than non-smokers. It can also cause erectile dysfunction (ED).
Can you lower your risk? Yes. Don’t smoke or use tobacco products of any kind.
Doctors now say there’s no safe amount of alcohol women can drink during pregnancy. It can lead to birth defects. It may also lower your chances of getting pregnant and drinking heavily can decrease sperm count in men.
Can you lower your risk? Yes. Men and women should avoid alcohol when trying to conceive.
Women who are overweight can have irregular periods and skip ovulation. But women who are extremely underweight can also have problems — their reproductive systems can shut down completely. Men who are obese can have lower-quality sperm or ED.
Can you lower your risk? Yes. Talk to your doctor about how to exercise and eat to maintain a safe weight, especially if you’re over age 40. But don’t overdo it and strain your body.
Both depression and lots of stress can affect the hormones that regulate your reproductive cycle. Women dealing with these issues may not ovulate normally and men may have a lower sperm count.
Can you lower your risk? Yes. Try to reduce the stress in your life before and while trying to become pregnant.
Having unprotected sex puts you at risk for STDs. Chlamydia and gonorrhea can cause pelvic inflammatory disease and fallopian tube infections in women, and epididymis blockages that can lead to infertility in men.
Can you lower your risk? Yes. Use a condom every time you have sex to reduce your chances of getting certain STDs.
There may be factors in your everyday life that are reducing your chances of getting pregnant — especially if your job involves toxic substances or hazards. Some dangers include pesticides, pollution, high temperatures, chemicals, or heavy electromagnetic or microwave emissions. Radiation and chemotherapy treatments for cancer can affect both sperm and eggs, too.
There are certain things that apply only to women. Any one of the following could cause problems with ovulation, hormones, or your reproductive organs:
- Fallopian tube disease
- Chronic disease like diabetes, lupus, arthritis, hypertension, or asthma
- Two or more miscarriages
- History of irregular periods
- Early menopause (before age 40)
- An abnormally shaped uterus
- Polyps in your uterus
- Leftover scar tissue from a pelvic infection or surgery
- Uterine fibroids or cysts
- Polycystic ovary syndrome (PCOS)
Some factors are male-only, as well, and could affect sperm count, sperm health, or sperm delivery, including:
- A repaired hernia
- Testicles that haven’t descended
- An inflamed or infected prostate
- Mumps any time after puberty
- Prescription medications for ulcers or psoriasis
- Cystic fibrosis
- Premature ejaculation or a blockage in your testicles
- Enlarged veins in your testes
The main symptom of infertility is the inability to get pregnant. A menstrual cycle that’s too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you’re not ovulating. There might be no other signs or symptoms.
When to see a doctor
When to seek help can depend on your age:
- Up to age 35, most doctors recommend trying to get pregnant for at least a year before testing or treatment.
- If you’re between 35 and 40, discuss your concerns with your doctor after six months of trying.
- If you’re older than 40, your doctor might suggest testing or treatment right away.
Your doctor might also want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, cancer treatment, or endometriosis.
For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are:
- One of the two ovaries releases a mature egg.
- The egg is picked up by the fallopian tube.
- Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
- The fertilized egg travels down the fallopian tube to the uterus.
- The fertilized egg attaches (implants) to the inside of the uterus and grows.
In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of the factors below.
Ovulating infrequently or not at all accounts for most cases of infertility. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland or problems in the ovary can cause ovulation disorders.
- Polycystic ovary syndrome (PCOS). PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It’s the most common cause of female infertility.
- Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
- Primary ovarian insufficiency. Also called premature ovarian failure, this is usually caused by an autoimmune response or by premature loss of eggs from your ovary, possibly as a result of genetics or chemotherapy. The ovary no longer produces eggs, and it lowers estrogen production in women under age 40.
- Too much prolactin. The pituitary gland can cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and can cause infertility. This can also be caused by medications you’re taking for another condition.
Damage to fallopian tubes (tubal infertility)
Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:
- Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
- Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops somewhere other than the uterus, usually in a fallopian tube
Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places. This extra tissue growth — and the surgical removal of it — can cause scarring, which can block fallopian tubes and keep an egg and sperm from uniting.
Endometriosis can also disrupt implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.
Uterine or cervical causes
Several uterine or cervical causes can interfere with the egg implanting or increase the risk of miscarriage:
- Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
- Problems with the uterus present from birth, such as an unusually shaped uterus, can cause problems becoming or remaining pregnant.
- Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.
- Sometimes the cervix can’t produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.
In some cases, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it’s frustrating to get no specific answer, this problem can correct itself with time. But you shouldn’t delay treatment for infertility.
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