Fertility: 12 things you didn’t know (and 1 to never ask)

By Katrina Mark, MD

1. Fertility naturally declines as we age

That alone doesn’t mean you should start to worry. The general advice I give a woman is if she has been trying to become pregnant for a full year with no luck, she might consider a fertility evaluation. For a woman over age 35, she might consider it after six months. If a woman is younger and has irregular periods, it’s likely she isn’t regularly ovulating, so she might want to be evaluated sooner.

2. Sometimes there’s a reason for infertility – and sometimes, there’s not

There are some things we know cause infertility. About 20 percent of the time, we find no reason for it. For a woman, infertility can be due to a condition that causes you to not ovulate regularly such as diabetes, thyroid disease and polycystic ovaries. It can also be caused by blocked fallopian tubes or a history of ectopic pregnancy. For men, it can be due to semen issues such as a low sperm count.

Early menopause in women under the age of 40 is rare, but it can run in families and cause infertility. Lifestyle factors such as smoking and obesity contribute to infertility in both women and men.

3. Taking birth control for long periods of time does not hurt fertility

No, taking birth control stops you from getting pregnant, but it doesn’t hurt fertility once you stop taking them.

4. If you are having trouble conceiving, consider these culprits:

  • Lifestyle factors: If you smoke, try to quit. If you are obese, try to lose weight. Vigorous exercise and low body weight can also cause ovary issues. Marathon runners and gymnasts have this issue frequently. Luckily, increasing body fat percentage or decreasing exercise a small amount can often correct it.
  • Chronic conditions: If you suffer from a chronic condition such as diabetes or hypertension, make sure you are managing it and keeping it under control.
  • Ovulation issues: For women who aren’t ovulating regularly, the first line is usually Clomid, a pill that makes a woman’s body produce eggs and ovulate each month. Many OB-GYNs will prescribe this, so you don’t necessarily need to see a fertility specialist.

If there’s no known reason trouble conceiving, your OB-GYN may refer you to a fertility specialist for treatment. Fertility specialists and even some OB-GYNs perform intrauterine insemination (IUI), where sperm are placed directly in the uterus around the time the ovary releases one or more eggs to be fertilized. In vitro fertilization (IVF) is when the sperm and egg fertilize outside the woman’s body and then the fertilized egg is implanted in the uterus.

5. Your OB-GYN can often provide some fertility assistance

If a woman is trying to conceive, she should share this with her OB-GYN. If she is having trouble, an OB-GYN can provide a general evaluation to look for causes, as well as provide education, which often is very helpful.

6. Don’t worry if it’s been a month or two and you’re not pregnant

Ninety percent of couples get pregnant within a year. Don’t worry if it’s only been a few months. This is normal and usually there’s nothing wrong with you.

7. The overall rate of infertility hasn’t changed

Although more are seeking treatment. In this age, more women may be delaying fertility because of better access to education and career opportunities. The average age of a woman when she has her first child has gone up over the last few decades. Delaying childbearing increases the likelihood for a woman to experience fertility issues. There also may be more people pursuing fertility treatment now because there is better access to treatment.

8. Egg freezing is much better than it used to be

Typically, egg freezing is recommended for those who desire it when a woman is between the ages of 35 and 38. If a woman is interested in having eggs frozen, she should speak with a fertility specialist. This technology has gotten better in the last several years and there has been better success. Fertility specialists can now freeze eggs without having to fertilize them. Insurance generally doesn’t cover egg freezing unless there is a medical reason.

9. Fertility treatments have come a long way

Overall, fertility treatment has high success rates these days. In vitro fertilization (IVF) has a very high success rate. Even for women who have premature ovarian failure, which is loss of ovary function before the age of 40, can opt for a donor egg and carry a pregnancy. Sometimes it depends on what a person is willing to go through and what you can afford, although many insurances cover some fertility treatment. Most don’t cover everything and it can be expensive.

10. There are reasons not to consider fertility treatment

Some treatments can be quite expensive. Some people may have moral objections. In some cases, a woman may have a chronic condition that it wouldn’t be recommended or safe to pursue pregnancy, such as certain heart conditions. Sometimes if either partner has a genetic disorder that is hereditary, they may not want to risk passing it along to a child. If a couple chooses not to pursue fertility treatment but still wants to have children, adoption or a donor egg are also options.

11. Fertility treatments aren’t just physically demanding

They’re also mentally draining. There have been studies that have shown a woman going through fertility treatments may experience the same level of depression as someone going through cancer treatment. The psychological aspect of fertility treatments is under-recognized. We view pregnancy as a positive thing because you get a baby at the end, but fertility treatment can make a person anxious and terrified – while trying to conceive and also during pregnancy and after the baby is born. Some women are traumatized from the experience and develop an anxiety disorder. Women often go through these struggles in private because they often don’t want to tell anyone. The same is often true with miscarriages. Many women experience very real grief and depression during these times. It’s important to make sure people are getting counseling because a lot of times they aren’t even talking to their friends or family about it. If you have breast cancer, people bring you food. There is no greeting card for infertility.

12. Don’t shy away from a friend who’s having trouble conceiving

If you someone close to you who is going through fertility issues, don’t completely ignore it or become distant. Be a friend, act normal and open yourself up to the person for conversation if he or she wants to talk. A lot of times people want to talk about it but don’t know how. Give them the hope and space to talk as much or as little as they want. Everyone deals with a loss and struggles differently; some are private about it and don’t want to talk about it, but others do.

Don’t ever ask a woman when she’s going to have a baby

For someone who is going through fertility treatment, being constantly asked when they’re going to have a baby can be devastating. You don’t know what someone may be going through.

Dr. Katrina Mark is an OB-GYN at University of Maryland Medical Center and Assistant Professor of Obstetrics, Gynecology and Reproductive Sciences at the University of Maryland School of Medicine.