Written By: Carol Wheeler, MD, Women & Infants Hospital's Fertility Center on May 2, 2022
How do you know if you are infertile? Should you be worried about your fertility?
Many women and men spend so many years preventing pregnancy while they are in school or building a career that they worry that when they try to build a family they will not be able. We know that delaying childbearing too long, especially for women, can make it much more challenging to conceive.
Infertility is defined as 1 year of intercourse without pregnancy for a woman under age 35 and 6 months of trying for a woman 35 years and up. But if you haven’t tried to conceive yet, how can you determine if you are at risk for fertility problems? Most adults actually do not have challenges getting pregnant provided they do not have factors that put them at risk.
What about male fertility? Infertility affects men and women equally. Men who have had injuries to their testes, chemotherapy, or radiation may have difficulties with low sperm counts. Certain medications can decrease the chance of fertility in men such as testosterone supplements. Marijuana use can lower sperm counts.
What about young women in their 20s or early 30’s? There are several risk factors that are well known. Women who have had a sexually transmitted disease in the past may have had damage to their fallopian tubes leading to a blockage. Irregular periods which are often due to a lack of ovulation may indicate a problem. Fertility difficulties may be due to a woman having polycystic ovaries or other hormonal problems. Women who have had surgery in their abdomen, a tubal pregnancy or a history of endometriosis may have reduced fertility. They may have chronic pain in the lower abdomen or severe menstrual cramps which could mean there is a problem with the uterus or tubes. Some women may have very heavy periods or a history of fibroids leading to decreased fertility.
Women over the age of 35 years often have difficulty conceiving, but each woman is different in how quickly her ovaries age. When a woman is over age 40, she may have a significant decrease in fertility, so women in this age group should seek an evaluation as soon as is possible.
What can you do to try to maintain your fertility? Both men and women should have a healthy diet, normal weight, and healthy lifestyle to try to increase future chances of a family. Avoiding reproductive toxins such as smoking and marijuana may have a positive impact. If you have concerns about your future fertility, some basic testing can be done by your health care provider to see if you have any reason to be concerned. For a man, this would be a semen analysis and for women blood tests and an ultrasound are suggested. Individuals on long-term medication or with diseases such as diabetes or high blood pressure should speak with their health care provider to make sure they are as healthy as possible and that the medications that they are taking are safe when trying to conceive.
Should a woman in her 20s or 30s freeze her eggs? That is not always an easy question to answer as it is a complicated question and an expensive” insurance policy”. Certainly, we are hearing more and more about egg freezing. Freezing eggs is an involved process and not without risk. A woman who chooses to freeze her eggs may never need them. Nevertheless, it offers peace of mind to women in their mid-30s who do not have a partner or who are not ready to begin their family. If that is something you are contemplating doing, you should see a reproductive endocrinologist (fertility specialist) for a consultation. You will have an opportunity to learn about your fertility potential whether or not you choose to pursue any treatment.
Infertility affects about 10-15% of couples. If you think you may have infertility, speak with your health care provider who can help you determine if you should be concerned. The good news is that there are many treatments available should you have difficulty conceiving.
Carol Wheeler, M.D.
Women & Infants Fertility Center
Professor, Department of Obstetrics and Gynecology (Clinician-Educator)
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