Find answers to common infertility questions

Infertility affects 10-15% of couples. However, there is not enough focus on preventing infertility, or said another way, proactively managing fertility.

By comparison, diabetes affects about 10% of US adults, and most diabetes is adult onset. Diabetes prevention focuses on risk factors and preventive measures like eating a healthy diet, exercising, managing weight and offering screenings for at-risk patients. Yet, with infertility, little attention is given to preventing it.

Like prevention of many diseases and accidents, infertility prevention involves people being aware of basic fertility facts and knowing the risk factors for infertility. By making this effort, patients can then seek timely evaluation of their fertility. Armed with knowledge about their reproductive potential, they can then decide if they want to take steps to reduce their chance of experiencing infertility and conceive sooner rather than later.

One critical fact is the importance of a woman’s age, or more importantly the age of her ovaries, affects fertility. Ovaries contain 1-2 million eggs on average when a girl is born. This number constantly declines until menopause. Most eggs reabsorb rather than being released during ovulation, but the constant decline leaves around 25,000 eggs by age 37.

Due to the decline in egg quantity and quality, the monthly natural pregnancy rates of 20-25% decline starting at around age 35. By age 40, the rate is roughly 10% and there is little chance for a natural pregnancy after age 42. This is what people refer to when they talk about the “biological clock.”

Also, chromosomal abnormalities in eggs become increasingly common after 35. This leads to an increase in trisomy 21 (Down syndrome) and other chromosome conditions in babies as well as increased miscarriage rates.

Unfortunately, no. At this point, ovarian aging can’t be reduced, so patients need awareness of female age and how it affects pregnancy rates. Although female and ovarian age may have an inconvenient relationship to a woman’s social life, relationship status and/or financial stability, the age of the ovaries and eggs has a fundamental effect on the ability to conceive. As such, it should be considered when making informed conception decisions.

Yes, there are. Conditions associated with early ovarian decline include endometriosis and related surgeries for it, multiple ovarian surgeries, a history of smoking, a family history of early menopause (before age 45) and having experienced chemotherapy or pelvic radiation.

Understanding these conditions and their impact on fertility allows patients to seek reproductive evaluation and counseling in a timely manner, before the ability to conceive is lost.

Increasing age and ovarian decline are difficult to overcome because ovarian decline becomes more severe as women age. For example, per CDC data, the IVF pregnancy rate per embryo transfer for women under 35 years old is about 50%. For women ages 41 to 42, it’s about 25%. With women ages 43 or older, it’s just over 10%.

For women with earlier ovarian reserve declines, infertility treatment success rates decline at earlier ages than normal. Given these reasons, women need to be aware of how age impacts fertility and the risk factors for early ovarian decline so that they can seek timely evaluation.

The following women can all benefit from a reproductive evaluation and fertility management.

• Those who are planning to have children at 35 years or older.
• Women with a history of smoking throughout their lives.
• Patients with endometriosis.
• Those who have had pelvic surgeries, especially repeated surgeries on the ovaries.
• Women with a family history of early menopause or early ovarian failure.
• Patients with prior infertility.
• Those who have had prior chemotherapy or pelvic radiation.

Similarly, male partners can benefit from reproductive evaluation and fertility management when they have histories of prior chemotherapy or pelvic radiation, prior pelvic, testicular or prostate surgery, prior undescended testes, testosterone or anabolic steroid use, low libido, and/or low testosterone levels.

We start with the patient’s reproductive, medical and surgical histories as well as a physical exam. A pelvic ultrasound can assess ovarian volume, follicle counts and the uterus. With bloodwork, we will test hormone levels, including cycle day 2-3 FSH (follicle-stimulating hormone) and AMH (anti-Mullerian hormone) to estimate ovarian reserve and egg quality. Collectively, this data provides reasonable guidance for a patient. Initially, a man’s reproductive potential is evaluated by his medical history and a semen analysis.

For women, good health habits are important. Smoking increases the rate of decline in ovarian reserve. Not smoking is best. Alcohol use while trying to conceive should be no more than three drinks per week.

Weight management is important. Being overweight or obese is associated with infrequent ovulation or not ovulating. It is also associated with less responsiveness to ovulation inducing drugs and mildly lower pregnancy rates even in IVF.

Dr. V knows weight loss is not easy, as he personally has struggled to keep his weight down his entire life. However, for women with moderate or severe obesity, proactively losing weight before attempting pregnancy can improve ovulation, mildly improve pregnancy rates in IVF and reduce rates of diabetes of pregnancy.

It’s also worth mentioning that women with risk factors for endometriosis, including a family history, especially painful periods and pelvic pain with intercourse, should consider an evaluation for endometriosis. Knowing one has endometriosis can allow for better decisions regarding how soon to conceive. The same is true about uterine fibroids.

Finally, another step women can take is in their premarital years. By practicing safe sex and knowing their sexual partners well, women can avoid gonorrhea and/or chlamydia. These infections can often damage or block the fallopian tubes.

For men, smoking impairs sperm quality and mildly increases partner miscarriage rates, so stopping smoking is important when the couple is trying to conceive. More than three alcohol drinks per week reduces sperm quality, so limits here are important.

Many males are using testosterone supplementation for fatigue and “low T.” Doing so suppresses sperm production, which can be permanent if done long enough. A similar effect is being seen with anabolic steroid use such as by some body builders.

With being overweight or obese, mild and moderate increases in rates of low sperm counts are seen. As such, weight management is good for sperm quality and fertility too.

Knowledge is power, as the saying goes. When women or couples learn what their reproductive potential is, their actual potential may be quite different from what they had thought it was. With this information, they can then make more informed decisions about when and how to conceive. They can also choose better lifestyle habits to reduce accelerated fertility loss over time.