Essential Facts About Fertility and Infertility
New research reveals that every woman should take steps today to protect her fertility, regardless of whether she has babies on the brain or can't imagine being a mom for a while (or ever). This step-by-step plan will not only help you have a healthy family, it'll keep you strong and fit for years to come.
What every woman should do now
Yes, fertility does decline with age, but your lifestyle and your environment have a huge impact on your pregnancy potential. "If you're proactive about protecting your heart and your brain, you're also safeguarding your reproductive health. It's a nice bonus," says Pamela Madsen, founder and executive director of the American Fertility Association in New York. "We call it 'Lifestyles of the Fit and Fertile.' " You may be surprised by how many of the steps on this list you're already taking to stay healthy.
Reach a healthy weight
If you carry extra pounds, you have an increased risk of diabetes, hypertension, and cardiovascular disease; losing weight will improve your health and your ability to conceive. A body mass index (BMI) of 18.5 to 24.9, the best indicator of a healthy weight, is most favorable for fertility. (Calculate yours at shape.com/tools.) A study published in the journal Human Reproduction found that the more weight a woman gained between pregnancies, the longer it took for her to conceive. Being over- or underweight can throw your hormone levels out of whack--and an imbalance of estrogen, the key hormone for ovulation, will reduce your odds of getting pregnant. Once you conceive, an unhealthy weight also makes carrying a baby more difficult-and more dangerous. There's a clear link between obesity and the rise in pregnancy complications, like gestational diabetes, high blood pressure, and prolonged labor. On the other hand, an underweight woman's body may not be prepared to deal with the extra nutritional demands of pregnancy.
Make exercise a priority
Today, fewer than 14 percent of American women get 30 minutes of activity most days of the week, according to a recent study in the journal Medicine & Science in Sports & Exercise; after conception, that number plummets to about 6 percent. The ideal time to start an exercise plan is before you get pregnant. That way, once you conceive, you'll already be in the habit. Regular cardio during pregnancy may help relieve morning-sickness symptoms and reduce water retention, leg cramps, and excess weight gain--as well as boost your energy and endurance. Start with a realistic goal, like walking a few days during lunchtime.
Clear the air
Smoking just six to 10 cigarettes a day reduces your chances of getting pregnant during any given month by 15 percent, according to a study in the American Journal of Epidemiology. The 4,000-plus chemicals in cigarette smoke have been proven to lower estrogen. "Smoking also seems to reduce the quality and quantity of a woman's egg supply, meaning that it speeds up the natural process of egg loss that occurs as women age," says Daniel Potter, M.D., author of What to Do When You Can't Get Pregnant. Smoking during pregnancy accounts for 20 to 30 percent of low-birth-weight babies and for about 10 percent of infant deaths, according to the U.S. Surgeon General.
Nonsmokers should also take steps to minimize their secondhand exposure--it can lead to abnormal lung function in a developing fetus and low birth weight. And after you deliver, a child exposed to cigarette smoke is especially vulnerable to ear infections, allergies, and upper-respiratory infections.
Take a multivitamin every day
Even women who eat a healthy diet don't always get enough nutrients to ensure a healthy pregnancy. A vitamin-mineral supplement helps you cover all your bases. Iron, in particular, seems to bolster fertility: A recent study of more than 18,000 women published in the journal Obstetrics & Gynecology found that women who took iron supplements cut their odds of infertility by 40 percent. So opt for a multi with iron--especially if you're a vegetarian or you don't eat much red meat.
Another key nutrient, folic acid, won't improve your chances of conceiving, but the B vitamin will drastically reduce a developing baby's risk of neural tube defects--often fatal birth defects of the brain and spinal cord like anencephaly or spina bifida. Taking folic acid now is key because these systems develop during the first few weeks after conception--before many women realize they're pregnant--and if you have a deficiency it can cause irreversible damage. Experts recommend you begin taking 400 micrograms of folic acid a day for at least four months before you get pregnant.
Practice safe sex
Using condoms every time you have intercourse will help you avoid unwanted pregnancy and drastically reduce your risk of contracting sexually transmitted infections that can wreck your reproductive health. Diseases like chlamydia and gonorrhea can damage your fallopian tubes and make conception difficult. They have few symptoms and often go undetected for years. The pill, the patch, and other types of hormonal contraceptives don't shield you from STDs, but they can protect you from pelvic inflammatory disease (PID), ovarian cysts, and uterine and ovarian cancer, which can interfere with conception.
Will you be able to have a baby?
You'll never really know if you'll have fertility issues until you try to conceive. But if you're under 35 and have been trying for more than a year, talk with your gynecologist. She may be able to pinpoint a specific problem or refer you to a reproductive endocrinologist who specializes in the diagnosis and treatment of infertility. If you're 35 or older, put yourself on a shorter schedule: Get help if you haven't conceived in six months. For more information or support, go to the National Infertility Association's Web site, resolve.org.
What is infertility?
Most experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile.
Pregnancy is the result of a complex chain of events. In order to get pregnant:
* A woman must release an egg from one of her ovaries (ovulation).
* The egg must go through a fallopian tube toward the uterus (womb).
* A man's sperm must join with (fertilize) the egg along the way.
* The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can result from problems that interfere with any of these steps.
About 12 percent of women (7.3 million) in the United States aged 15-44 have difficulty getting pregnant or carrying a baby to term (2002 National Survey of Family Growth).
What causes infertility?
In only about one-third of cases is infertility due to the woman (female factors). In another one third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.
Infertility in men is most often caused by:
* problems making sperm -- producing too few sperm or none at all
* problems with the sperm's ability to reach the egg and fertilize it -- abnormal sperm shape or structure prevent it from moving correctly
Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.
Infertility in women is most often caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.
Less common causes of fertility problems in women include:
* blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
* physical problems with the uterus
* uterine fibroids
Who is at risk?
Most healthy women under the age of 30 shouldn't worry about infertility unless they've been trying to get pregnant for at least a year. At this point, women should talk to their doctors about a fertility evaluation. Men should also talk to their doctors if this much time has passed.
In some cases, women should talk to their doctors sooner. Women in their 30s who've been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman's chances of having a baby decrease rapidly every year after the age of 30. So getting a complete and timely fertility evaluation is especially important.
Many things can affect a woman's ability to have a baby. These include:
* poor diet
* athletic training
* being overweight or underweight
* tobacco smoking
* sexually transmitted diseases (STDs)
* health problems that cause hormonal changes
The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include:
* environmental toxins, including pesticides and lead
* smoking cigarettes
* health problems
* radiation treatment and chemotherapy for cancer
Maternal age factor
More and more women are waiting until their 30s and 40s to have children. Actually, about 20 percent of women in the United States now have their first child after age 35. So age is an increasingly common cause of fertility problems. About one third of couples in which the woman is over 35 have fertility problems.
Aging decreases a woman's chances of having a baby in the following ways:
* The ability of a woman's ovaries to release eggs ready for fertilization declines with age.
* The health of a woman's eggs declines with age.
* As a woman ages she is more likely to have health problems that can interfere with fertility.
* As a women ages, her risk of having a miscarriage increases.
Health issues that affect fertility
Some health issues also increase the risk of fertility problems. So women with the following issues should speak to their doctors as soon as possible:
* irregular periods or no menstrual periods
* very painful periods
* pelvic inflammatory disease
* more than one miscarriage
No matter how old you are, it's always a good idea to talk to a doctor before you start trying to get pregnant. Doctors can help you prepare your body for a healthy baby. They can also answer questions on fertility and give tips on conceiving.
Sometimes doctors can find the cause of a couple's infertility by doing a complete fertility evaluation. This process usually begins with physical exams and health and sexual histories. If there are no obvious problems, like poorly timed intercourse or absence of ovulation, tests will be needed.
Finding the cause of infertility is often a long, complex and emotional process. It can take months for you and your doctor to complete all the needed exams and tests. So don't be alarmed if the problem is not found right away.
For a man, doctors usually begin by testing his semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.
For a woman, the first step in testing is to find out if she is ovulating each month. There are several ways to do this. A woman can track her ovulation at home by:
* recording changes in her morning body temperature (basal body temperature) for several months
* recording the texture of her cervical mucus for several months
* using a home ovulation test kit (available at drug or grocery stores)
Doctors can also check if a woman is ovulating by doing blood tests and an ultrasound of the ovaries. If the woman is ovulating normally, more tests are needed.
Common tests of fertility in women include:
- Hysterosalpingography, In this test, doctors use x-rays to check for physical problems of the uterus and fallopian tubes. They start by injecting a special dye through the vagina into the uterus. This dye shows up on the x-ray, allowing the doctor to see if the dye moves normally through the uterus into the fallopian tubes. With these x-rays doctors can find blockages that may be causing infertility. Blockages can prevent the egg from moving from the fallopian tube to the uterus and/or keep the sperm from reaching the egg.
- Laparoscopy. During this surgery doctors use a tool called a laparoscope to see inside the abdomen. The doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems.
Infertility can be treated with medicine, surgery, artificial insemination or assisted reproductive technology. Many times these treatments are combined. About two-thirds of couples who are treated for infertility are able to have a baby. In most cases infertility is treated with drugs or surgery.
Doctors recommend specific treatments for infertility based on:
* test results
* how long the couple has been trying to get pregnant
* the age of both the man and woman
* the overall health of the partners
* preference of the partners
For example, if the man is impotent or has problems with premature ejaculation, behavioral therapy and/or medicines may be used. If the man produces too few sperm, surgery may correct the problem. In other cases, doctors can surgically remove sperm from the male reproductive tract. Antibiotics can also be used to clear up infections that affect sperm count.
Various fertility medicines are often used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the risks, benefits, and side effects.
Common medicines used to treat infertility in women include:
* Clomiphene citrate (Clomid). This oral medicine causes ovulation by acting on the pituitary gland. It is often used in women who have Polycystic Ovarian Syndrome (PCOS) or other problems with ovulation.
* Human menopausal gonadotropin or hMG (Repronex, Pergonal). This medicine is often used for women who don't ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
* Follicle-stimulating hormone or FSH (Gonal-F, Follistim). FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
* Gonadotropin-releasing hormone (Gn-RH) analog. These medicines are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or administered by nasal spray.
* Metformin (Glucophage). Doctors use this medicine for women who have insulin resistance and/or Polycystic Ovarian Syndrome (PCOS). This drug helps lower the high levels of male hormones in women with these conditions, aiding in ovulation. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
* Bromocriptine (Parlodel). This medicine is used for women with ovulation problems due to high levels of prolactin, a hormone that causes milk production.
Many fertility drugs increase a woman's chance of having twins, triplets or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early, placing them at a higher risk of health and developmental problems.
Doctors also use surgery to treat some causes of infertility. Problems with a woman's ovaries, fallopian tubes, or uterus can sometimes be corrected with surgery.
Intrauterine insemination (IUI) is another type of treatment for infertility. IUI is known by most people as artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat:
* mild male factor infertility
* women who have problems with their cervical mucus
* couples with unexplained infertility
Assisted reproductive technology (ART) is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman's body, mixing them with sperm in the laboratory and putting the embryos back into a woman's body. ART can be expensive and time-consuming.
Success rates vary and depend on many factors. Some factors that affect the success rate of ART include:
* age of the partners
* reason for infertility
* type of ART
* if the egg is fresh or frozen
* if the embryo is fresh or frozen
According to the 2003 U.S. Centers for Disease Prevention (CDC) report on ART, the average percentage of ART cycles that led to a healthy baby were as follows:
* 37.3% in women under the age of 35
* 30.2% in women aged 35-37
* 20.2% in women aged 37-40
* 11.0% in women aged 41-42
Common methods of ART include:
* In vitro fertilization (IVF). IVF, which is fertilization outside of the body. is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.
* Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer. Similar to IVF, fertilization occurs in the laboratory. But then the very young embryo is transferred to the fallopian tube instead of the uterus.
* Gamete intrafallopian transfer (GIFT). This involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option.
* Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby.
Adapted from the National Women's Health Information Center (www.womenshealth.org)