Fertility

Fertility & Infertility: The Most Important Things You Need To Know

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fertility

 

Facts & Figures About Fertility: Is Infertility Common?

As many as 8-12% of reproductive-aged couples are affected by fertility issues worldwide. (1)

Women have optimum fertility up to 25 years old. Yet the stats on infertility rates of women of childbearing age are concerning: (1)(2)(3)

  • Approximately 5-10% worldwide
  • About 6-19% in the US

 

Surprisingly, even female doctors have a high infertility rate. A 2023 JAMA (Journal of the American Medical Association) Network study showed that around 36.8% of female US physicians experienced fertility problems – and about 51.4% underwent IVF (in vitro fertilization) to conceive. (3)

And while it’s true that some still get pregnant in their 50s, the female fertility decline begins at around 25-30 years old, according to a 2018 Clinical Biochemistry study. This study detailed that the average age at last birth (with natural fertility) is 40-41 years. (1)

However, other researchers have a higher estimate, explaining that fertility only begins to decline when a woman reaches her 30s.

It is supported by data reported by the US Census Bureau through the National Center for Health Statistics in the table on fertility rates based on maternal ages in the US below. (47)

(source: marchofdimes.org) (47)

 

The 2023 JAMA study also explained that women who are 43-45 years old may have less than 5% chance of conception. (3)

Yet more women are choosing to delay motherhood and start trying to conceive (TTC) at 30+ years old, which is older than previous expectations. (3)

The US Census Bureau compared fertility trends between 1990 and 2019 – and found surprising results: The fertility and birth rates decreased for younger women but increased for those who are 30+ (see table below): (48)

(source: census.gov) (48)

 

Amazingly, the number of women who got pregnant within the 40-44 bracket had the largest percent change, increasing by 132.45 %. In contrast, the pregnancy rates were reduced by 72.71% for women ages 15-19. (48)

The University of New Hampshire Sociology Professor Kenneth Johnson explains that several factors may have influenced delayed motherhood in recent years. He wrote that changing social, demographic, economic, and cultural factors have likely changed women’s views on marriage, children, and fertility. (49) 

Some reasons that Professor Johnson listed include: (49) 

  • More educational opportunities for women
  • More employment or career opportunities for women
  • The Great Economic Recession (2007-2009) 
  • COVID pandemic (started in December 2019)
  • Higher expenses to raise children
  • Limited child-care options and family leave
  • Changes in cohabitation patterns and reduced marriage rates (fertility rates appear to be higher with married than unmarried women)
  • Immigration

 

So, what is fertility, and why does it decline? Why are some people infertile even in their prime child-bearing age? Are there things you have to give up or change to become pregnant?

Is it alright to worry if you don’t get pregnant after a year of trying, and are there ways to help boost your fertility? What are the common infertility treatment options, and does insurance cover them?

These are just some of the questions we’ll answer below. Keep reading to find out more.

 

Does Infertility Also Affect Men?

Yes. Female infertility is often considered to be the primary reason why couples don’t have kids. However, male infertility is more common than we think. (2)

A Clinical Biochemistry study explains that male fertility issues affect 20-30% of infertility cases. Yet, it can still contribute to as much as 50% of all cases. (2)

 

What Do You Mean By Fertility?

By definition, fertility is a person’s ability to conceive. It can be affected by many factors, including age, health, and lifestyle.

 

What Is A Woman’s Fertility?

A woman’s fertility is her ability to get pregnant, and it is at its peak up to age 25. Then, female fertility declines starting at around 25-30 years old. (1)

Menopause is the end of a woman’s fertility cycle, although some women can still get pregnant at the so-called “menopausal age.”

The average age for menopause is 51, with most women experiencing it at around 40-58 years old. (4)

Menopause is confirmed if a woman stops having her regular menstrual period for at least 12 consecutive months without being pregnant, using birth control, undergoing surgery, or other obvious reasons. (4)

 

Parts Of The Female Reproductive System

To understand fertility, let’s take a look at women’s reproductive system below:

(source: lomalindafertility.com) (5)

 

  • Vagina – The part that the penis penetrates during sex; also called the birth canal
  • Vulva – The outer part of a woman’s sex organs
  • Cervix – The uterus’ narrow, lower end that opens to the vagina; it lets semen into the uterus or blood out at the end of the menstrual cycle
  • Uterus – The hollow, pear-shaped organ (also known as the “womb”) that holds the fetus (unborn baby); it prepares a thick, nutrient-rich lining called an endometrium every month to provide nourishment for the fetus if the woman gets pregnant during the cycle (the lining is shed off during menstruation)
  • Ovaries – Two small, oval-shaped glands on the sides of the uterus; they produce and release estrogen (female sex hormones) and an egg (contains the female sex cells) every month; sometimes, the ovaries release more than one egg, resulting in a fraternal pregnancy
  • Fallopian tubes – The narrow tunnels connecting the ovaries to the uterus

 

Human Reproduction: All About Your Monthly Cycle

Most women have a 28-day menstrual cycle. However, this isn’t absolute, with some having shorter or longer days between their menstrual periods. (6)

Here’s the usual timeline for a 28-day cycle: (6)

(source: lomalindafertility.com) (6)

 

Days 1-5: Menstrual period

Days 6-14: Follicular phase – An egg is prepared and begins to mature in the ovary; the uterine lining thickens as it prepares for the embryo (fertilized egg) to implant

Day 14: Ovulation -The ovary releases the mature egg (usually just one, but can be two or more in rare cases)

Days 15-28: Luteal phase – The egg (whether fertilized or not) travels through the fallopian tubes and down to the uterus 

 

How Conception Happens (Fertilization & Implantation)

Semen is ejaculated into the vagina after unprotected sex. The sperm cells in the semen can swim and propel itself towards the fallopian tubes. (7)

At first, the gel-like semen protects the sperm from the acidic vaginal environment. However, the gel liquifies within 20-30 minutes to allow the sperm to swim up and reach the egg. (7)

During ovulation, your cervix is more “sperm-friendly.” It even provides cervical mucus for better sperm motility (movement). Lucky for the sperm cells, the cervical mucus also extends their survival by acting as their reservoir inside the woman’s reproductive system. (7)

Did you know that the fastest sperm cells can reach the fallopian tube within minutes of ejaculation? However, the first sperm isn’t usually the fertilizing sperm, especially when the egg isn’t ready yet. (7)

Once your egg is released during ovulation, it can be fertilized if sperm is in the fallopian tube. The embryo then travels to the womb and will try to attach to your uterine lining within 5-6 days after fertilization. (6)(7)

If the implantation is successful, you will become pregnant. (6)(7)

 

Timing & The Fertility Window

Although sperm can survive in your reproductive tract for up to five days, your mature egg is only capable of fertilization within 12 to 24 hours. (7)

Fertilization happens in the fallopian tube. So, both the egg and sperm must be present at the right place (inside the fallopian tube) at the right time for conception to happen. (7)

It’s good to remember this if you’re TTC (trying to conceive).

 

What Happens If You Don’t Conceive Within The Fertile Period

Your body will prepare for the next cycle if the egg isn’t fertilized or the embryo doesn’t successfully implant during the luteal phase. It sheds off the uterine lining, and the cycle begins again as your menstrual period starts. (6)(7)

Also, not all implantations result in a live birth. Others can lead to: 

  • Chemical pregnancy (the embryo fails to develop and is miscarried within five weeks gestation) (8)
  • Molar pregnancy (the embryo fails to thrive because the placenta develops abnormally or the egg didn’t contain genetic material to help it grow) (9)

 

Other Things To Know About Ovulation

When Does Fertility Start For Women?

Fertility begins at menarche or a girl’s first period. It usually happens at around 11-14 years old. (6)

 

Can You Get Pregnant During Fertility?

Yes. This is the best time to get pregnant. 

Considering the small fertility window discussed above, couples planning to get pregnant need to time intercourse within 11-14 days of a 28-day cycle (start counting on the first day of your last menstruation). (7)(10)

Your health care provider might recommend daily sex, although some might also suggest doing it for an interval of 2-3 days to maximize sperm quantity. (10)

However, it’s impossible to know the exact moment that ovulation will occur. To maximize your chances, you might need to have intercourse within 7-20 days of the cycle. (10)

The highest pregnancy rates can happen within 4 to 6 hours of ovulation. (10)

 

All About Men’s Fertility

Parts Of The Male Reproductive System

Here’s an illustration of a man’s reproductive system: (5)

(source: lomalindafertility.com) (5)

 

  • Penis – The outer part of a man’s reproductive system; designed to enter the vagina and deliver sperm during sexual intercourse
  • Testicles – Two oval-shaped organs that produce testosterone (male sex hormones) and sperm; also known as the testes
  • Scrotum – The sac-like organ that holds the testicles and hangs beside the penis; it contains many nerves and blood vessels
  • Epididymis – The C-shaped tube that stores and transports sperm from the testicles; it’s also the place where sperm matures and becomes capable of fertilization
  • Ductus or vas deferens – The tube from the epididymis to the urethra where the sperm travels before ejaculation
  • Seminal vesicle – The organ that produces fructose (a kind of sugar) that provides energy for the sperm in its swim to meet the egg
  • Ejaculatory ducts – The section where the vas deferens and the seminal vesicles meet; contractions make the ejaculatory ducts send sperm into the urethra
  • Urethra – The tube that ejaculates the sperm during sexual climax; it also functions as the tube that empties urine from the bladder (urine flow is blocked when the penis is erect only to allow semen ejaculation during sex)
  • Prostate gland – The organ that produces a fluid for sperm motility (to help it move more quickly through the woman’s reproductive system)
  • Cowper’s glands – The organ that creates the gel-like fluid that protects the sperm along the urethra

 

Infertility: What Are Fertility Problems?

Infertility is a condition wherein a clinical pregnancy (a pregnancy with a baby that can be detected clinically, such as the presence of an embryo) doesn’t happen within 12 months of regular, unprotected sex. (1)

It doesn’t always happen due to a medical condition. Sometimes, couples don’t conceive because they can’t time intercourse within the woman’s most fertile window.

Still, disease-related conditions and advanced age (especially in women) are among the most common causes of infertility. (1)

Reproductive tract infections are considered a major reason for secondary female infertility worldwide. Genetic factors might also lead to infertility. (1)

However, infertility can also happen in men and may also be caused by disease or genetic factors. 

Some disease-related infertility causes that affect both genders include: (1)

  • Hypogonadotropic hypogonadism (the pituitary gland doesn’t produce adequate hormones to signal sex hormone production in the ovaries for females or the testes (or males)
  • Infections (may also affect sex hormone production)
  • Cancer and cancer treatment
  • Systemic disorders (health conditions that affect one or more of your body’s systems, such as the neurological, circulatory, immunological, or digestive system)

 

Advanced age (both male and female) may also affect fertility. This can be due to semen decline (lower sperm count and quality) in men or early menopause and other problems in women. (1)

Lifestyle factors can also affect fertility for both genders. (discussed below) (1)

 

Signs & Symptoms Of Infertility

Being unable to conceive even with regular sex and not using contraceptives is a tell-tale sign of infertility.

Yet, the underlying causes of infertility might not always show specific signs or symptoms. 

For example, the penis can still function and ejaculate semen during sex, yet the sperm count and quality might be low. However, we can’t tell for sure unless a sperm analysis is done.

 

Possible Causes Of Women’s Fertility Problems & Their Treatment Options

Tubal Infertility (From Damage In Your Fallopian Tube)

Tubal infertility from damage to your fallopian tubes can block the egg from meeting the sperm. It can also affect how the fertilized egg travels to the womb. (5)(11)

This condition affects as many as over 30% of women with infertility. (11)

Possible reasons for tubal damage: (5)(11)

  • The fallopian tube can get damaged (or even removed) in a previous surgery, especially in an ectopic pregnancy (11)
  • Sometimes, the tube may have already ruptured in an ectopic pregnancy, causing irreversible damage (11)
  • Other forms of surgery in the reproductive organs or abdomen can also damage the fallopian tubes because they’re so thin and small. (11)
  • The tubes can also be blocked due to scars from a PID (Pelvic Inflammatory Disease) or other forms of infection (11)
  • Endometriosis (tissues from the endometrium or uterine lining grow outside the uterus) can also block the tubes if the growth is close to them (11)

 

Treatment: Tubal Infertility

Treatment depends on the reason for the damage or problem but can include the following: (11)

  • Tubal cannulation – Laparoscopic procedure wherein doctors insert a catheter to find and remove the blockage or damage in the tubes; the procedure is guided by ultrasound, x-rays, or a tiny camera (11)
  • Salpingostomy – A new opening is created in the fallopian tube near the ovary to allow eggs to travel through; however, this can also cause blockage in the future from the healing scar tissues 
  • Fimbrioplasty – Creates a new opening like the salpingostomy but also helps rebuild the fimbriae (tissues near the ovaries)

 

Uterine Abnormalities (Problems Affecting The Womb & Cervix)

Endometriosis In The Reproductive System

  • Tissues from the uterine lining (also called the endometrium) grow outside the uterus, possibly interfering with the embryo’s implantation and development (5)(11)
  • Endometriosis can cause severe pain, bleeding, and fatigue (5)(11)

 

Uterine Fibroids & Polyps

Both are usually non-cancerous growths inside the reproductive system. They can affect implantation or the embryo’s growth process. The difference lies in the the tissues they’re made of: (5)(12)

  • Polyps – Made of tissues from the endometrium (the uterine lining)
  • Fibroids – Made of connective tissue and muscle cells (5)

 

They can also cause abnormal bleeding and pain. (5)(12)

 

Uterine Or Pelvic Adhesions From Scar Tissues

  • Scar tissues from infection, previous surgery, or other forms of trauma can bind parts of your reproductive system together (13)
  • Pelvic binding can interfere with fertilization, implantation, or the embryo’s growth (13)

 

Problems With Your Cervical Mucus

Remember that sperm swim in the cervical mucus to reach your egg. Abnormalities or problems with the cervical mucus can affect the sperm cells’ movement and even prevent them from reaching the egg. (14)

Thankfully, abnormal cervical mucus rarely causes infertility unless you have cervical stenosis (a closed or narrowed cervical canal from scar tissues) or chronic cervical infection. (14)

 

Treatment: Uterine Abnormalities

Treatments for these uterine problems can depend on their root cause. Some examples include: (15)

  • Surgery to remove the tissue growth for polyps, fibroids, and endometriosis (12)(15)
  • Hormonal treatments to suppress the growth of endometriosis, polyps, and fibroids (15)
  • Adhesiolysis – Removal of scars and tissues that cause pelvic binding (13)
  • Surgery to widen the cervix in cervical stenosis (14)

 

For extensive damage from endometriosis, polyps, and other growths, your doctor might recommend a hysterectomy (removal of the uterus, cervix, fallopian tubes, and/or ovaries). However, this is an irreversible procedure and will treat the conditions but will also cause permanent infertility. (12)(15)

Also, the tissues removed from your reproductive organs undergo a biopsy. Depending on the results of the biopsy, you may undergo further treatment, including radiation or chemotherapy for cancerous tissues and antibiotics for infections. (12)(15)

 

Ovulation & Menstrual Cycle Problems

Amenorrhea (No Period For 3+ Months)

Amenorrhea is defined as having no period for 3+ months for women who already started having periods. It can also be defined as a condition wherein a woman hasn’t reached menarche (first period) at 15 years old. (6)

It’s not a disease. However, it can still affect fertility because your body isn’t producing the hormones and eggs needed for fertilization. (16)

Because your body doesn’t go through the menstrual cycle during this period, it can also lead to infertility. (6)

Note that pregnancy is also considered a form of amenorrhea because you stop having periods until your baby’s delivery. (6)

Possible causes of amenorrhea include the following: (6)

  • Extreme weight loss
  • Obesity
  • Eating disorders
  • Stress
  • Excessive exercise
  • Medical conditions that need treatment
  • Breastfeeding

 

Hormonal Imbalances Affecting Ovulation

Hormones play a major role in reproduction as they help prepare your body for ovulation, implantation, and pregnancy. However, there are times when problems can occur, leading to hormonal imbalances that may affect fertility: (1)(17)

  • Hypogonadotropic hypogonadism – The pituitary gland doesn’t produce enough hormones to signal sex hormone production (1)
  • Hypothalamic dysfunction – The hypothalamus (a part of the brain) controls the pituitary gland, leading to problems with sex hormone production if it fails or has problems (17)
  • Hyperprolactinemia – Increased prolactin levels (a hormone that stimulates breast milk production), which can affect estrogen production (18)

 

Hormonal imbalance can also reduce testosterone production in men, leading to decreased fertility and low sperm count. (19) 

 

PCOS (Polycystic Ovary Syndrome)

Among the most common hormonal imbalances affecting women’s fertility, PCOS affects about 6-12% of women of childbearing age in the US. (20)

PCOS is caused by increased levels of androgens (male sex hormones) than normal levels in women. Note that these hormones are normally found in women but are supposed to be less than female sex hormones. (20)

Your ovary still produces eggs, but hormonal imbalance prevents them from maturing. So, your body doesn’t release a mature egg during ovulation. Instead, the eggs turn into cysts (usually non-cancerous). (20)

As the number of cysts increases in the ovary, it creates a further imbalance, which worsens the situation. (20)

 

Treatment: Ovulation & Menstrual Cycle Problems

Hormone replacement treatments are often used to manage ovulation-related concerns and issues that are caused by the imbalance. (6)(17)(20)

Because hormonal imbalance can also be influenced by lifestyle and environmental factors, your doctor might also recommend changing your habits. Examples include: (20)

  • Healthier diet
  • Regular exercise (but avoid strenuous activities)
  • Avoid smoking

 

Early Menopause Vs. Primary Ovarian Insufficiency (Before You Turn 40)

Early Menopause

Menopause is defined as having no period for at least one year (except due to pregnancy). It can be natural or induced by treatment, such as radiation or chemotherapy. (4)(21)

All women will reach menopause at some point – most will experience it at around 40-58 years old. The menopause age average is 51. (21)

However, some ladies experience menopause even before they turn 40 – this is called early menopause. (4)(21)

Often, women no longer get pregnant once they’ve reached menopause. (4)(21)

 

Primary Ovarian Insufficiency (POI)

Women with primary ovarian insufficiency can still have occasional periods. However, their ovaries stop working before they turn 40. This can happen even in their teenage years. (21)

Surprisingly, women with POI can still get pregnant, although the condition can also affect their fertility. (21)

 

Treatment: Early Menopause & Primary Ovarian Insufficiency

Since they’re affected by the lack of certain female sex hormones, it’s not surprising that these conditions are primarily treated with HRT (hormone replacement therapy). (21)

 

Vaginal Microbiome & Dysbiosis (Imbalance)

A 2024 Research Square study showed that women with infertility might have a different vaginal microbiome and more microbial diversity than fertile women. (22)

It had similar findings to a 2020 Applied and Environmental Microbiology study on women’s reproductive microbiome. (23)

The studies found that women in the infertility group had the following microbial levels (compared to the fertile group) in their vagina: (22)(23)

  • Lower levels of Bifidobacterium, Leuconostoc, and Lactobacillus
  • Significantly higher levels of Atopobium, Aerococcus, Bifidobacterium, Pseudomonas, Burkholderia, and Prevotella

 

Outcomes of ART (Assisted Reproductive Technology) were also affected by increased levels of Mobiluncus and Varibaculum. (22)

The researchers also noted that women in the infertile group who experienced recurrent implantation failure had more abundant levels of the following microbes: (22)

  • Mobiluncus
  • Prevotella
  • Peptoniphilus
  • Varibaculum 

 

Reasons For Vaginal Dysbiosis

According to a 2022 Frontiers in Microbiology study, the diversity of your vaginal microbiome is affected by several factors, including the following: (24)

(source: frontiersin.org)

 

Because the vaginal microbiome appears to be influenced by women’s health, treatment for the imbalance may include changing your lifestyle and developing healthier habits. 

The study also found that vaginal douching is among the main reasons for increased risk of vaginal dysbiosis. (24)

Other reasons include: (24)

  • Unhealthy diet, especially consumption of processed foods rich in fat and carbohydrates
  • Poor personal hygiene
  • Smoking 
  • Increased psychological stress
  • Urbanization (i.e., environmental toxins)

 

Surprisingly, the 2022 Frontiers in Microbiology study also found that genetics can play a role in vaginal microbiome diversity. (24)

For example, women from a certain ethnic group (e.g., black or African-American) can have different microbiome diversity than those from another group (e.g., Asian or American). (24)

 

Treatment: Diversity In Vaginal Microbiome Dysbiosis

While you can do nothing about genetic factors, you can manage the other causes through lifestyle changes.

Lactobacillus is among the most abundant probiotic bacteria in the body and many food products. Considering that women in the infertility groups of the studies mentioned above had lower Lactobacillus levels, it makes sense to consider increasing your intake of this probiotic to help improve fertility. (24)(25)

It’s still under research and clinical trials, but vaginal microbiota transplant (VMT) is currently being considered for promoting a balanced and healthier microbiome. It involves a direct transplant of a healthy donor’s vaginal microbiome into the affected person. (25)

According to the study, the clinical trials have shown promising results, with recipients showing a similar microbiome as their donors within a month after the transplant. (25)

 

Sterilization (Such As Tubal Ligation)

Many women undergo tubal ligation for personal or medical reasons. (11)

Depending on certain factors, the ligation can either be done through the following: (11)

  • Your fallopian tubes are cut, and the ends are tied to prevent leakage of fluids into your abdominal cavity. 

 

Treatment: Sterilization Reversal

Although considered a permanent contraceptive procedure, it can be reversed in some cases. (11)

Tubal ligation reversal reconnects the tied or cut fallopian tubes. (11)

Before the procedure, your doctor will assess whether you’re a good candidate for the reversal. You may have better chances of a successful ligation reversal if your tubes were only blocked by tubal clips or rings. However, the process can still be done for cut tubes. (11)

Note that this surgical procedure can increase your risks for an ectopic pregnancy, scarring (which can also cause blockage), and bleeding. (11)

 

Taking Certain OTC, Prescription, & Herbal Medicines

Some medications can affect your reproductive health, cause a miscarriage and stillbirth, or lead to birth defects. 

For example, the following medications might interfere with hormone production, leading to an imbalance or ovulation disruption: (26)

  • Steroids
  • Antidepressants and antipsychotics
  • Anti-inflammatory medicines for rheumatism and arthritis
  • Asthma medications

 

Even common OTC (over-the-counter medications), herbal medicines, essential oils, and alternative therapies can also potentially cause fertility and pregnancy problems. (26)

 

Treatment & Remedies: Infertility Issues From Medications

Instead of taking more drugs to counter the effects of your medications, you might need to stop using them to reverse their effects. (26)

It’s important to always consult your OB/GYN or health provider before taking any medication if you’re TTC (trying to conceive) or pregnant.

 

Cancer Treatment

There are several ways that cancer can affect fertility: (1)(27)

  • Cancer in any part of the reproductive system
  • Chemotherapy kills cells that divide rapidly, which can include cells called oocytes, where hormones like estrogen are made
  • Hormone therapy to treat certain types of cancer might also affect the production of sex hormones
  • Surgery to remove parts or sections of the reproductive system or nearby organs
  • Radiation treatment around the pelvic area can damage your ovaries and destroy some or all the eggs, leading to early menopause
  • Radiation treatment to the brain can affect the pituitary gland, affecting its function to signal the production of sex hormones

 

Chemotherapy drugs linked to higher risks of female infertility include the following: (27)

  • Doxorubicin
  • Cisplatin
  • Mitomycin-C
  • Mechlorethamine (Nitrogen mustard)
  • Busulfan
  • Carboplatin
  • Carmustine
  • Chlorambucil
  • Cyclophosphamide
  • Cytosine arabinoside
  • Ifosfamide
  • Lomustine
  • Thiotepa
  • Melphalan
  • Procarbazine
  • Temozolomide
  • Vinblastine
  • Vincristine

 

Remedies & Treatment: Infertility Due To Cancer Treatment

It’s complicated. Sadly, some cancer treatments can cause permanent infertility. However, sometimes, it is possible to reverse infertility from cancer with hormone replacement therapy. (27)

If your ovaries are damaged but your uterus is fine, you might still become pregnant through assisted conception methods. However, cancer often increases the risks of miscarriage, stillbirth, birth defects, and other pregnancy complications. (27)

Discuss pregnancy plans with your doctor, especially because some cancer treatments can affect your body for months. (27)

 

Psychological, Neurological, & Mental Health Reasons

A 2018 Archives of Psychology review detailed that several studies have been done on fertility and mental health, neurological, and psychological reasons. (2)

Some of the studies reviewed found links between infertility and the following mental health problems: (2)

  • Anxiety
  • Depression
  • Bipolar disorder
  • Disturbed eating behavior, such as anorexia nervosa (a severe fear of gaining weight, leading to food or calorie restriction and excessive exercise)
  • Autism
  • Psychotic disorders (e.g., schizophrenia and bipolar disorder)

 

Some studies also showed that these conditions could affect men’s and women’s fertility to varying degrees. For example, one of the studies reviewed had the following results in terms of fecundity (a person’s ability to have many children): 2)

  • No fecundity reduction in women diagnosed with lifetime depression
  • Small fecundity decrease in men with depression, men and women with bipolar disorder, men and women with substance abuse, and women with anorexia nervosa
  • Strong fecundity decrease in men with anorexia nervosa, men and women with schizophrenia, and men and women with autism

 

The researchers also noted that infertility can also cause anxiety, depression, and other forms of emotional stress in couples trying to conceive. (2)

 

Treatment: Mental Health Reasons

The root cause of these individual problems must be treated to reduce their effects on fertility. (2)

 

STDs & Other Medical Conditions

Sexually transmitted diseases (STDs) can directly or indirectly damage parts of the reproductive system. They’re also called STIs (sexually transmitted infections). (28)

These are the most common STDs that can affect fertility: (28)

  • Gonorrhea
  • Chlamydia

 

They can cause PID (pelvic inflammatory disease), which may damage the fallopian tubes, increasing the risks of blockage or ectopic pregnancy. (28)

Other STDs that might also have some effect on fertility:

  • Syphilis
  • Herpes simplex virus (HSV)
  • Human papillomavirus (HPV)

 

Treatment: STDs

Treatment plans can vary, depending on the disease. Examples include: (28)

  • Antibiotics for chlamydia and gonorrhea
  • Penicillin (also an antibiotic) for syphilis
  • No cure (because viruses cause them), but prescription medicines can alleviate the symptoms of HPV and HSV

 

Risk Factors That Can Affect A Woman’s Fertility

Advanced Age

  • Female fertility is at its peak up to age 25 but can decline to start at around 25-30 years old in some studies or 30+ years in others. (1)(47)
  • Some people also experience early menopause before age 40. (4)(21)

 

Weight & General Health Status

Extreme weight loss can lead to amenorrhea (no menstruation), which can lead to infertility. (6)

On the other hand, obesity can also cause infertility due to the following: (29)

  • Hormonal imbalance (hormone dysregulation)
  • Insulin-related disorders, such as diabetes, can have varied effects on women’s health
  • Increased levels of androgens (male sex hormones)
  • Low sex hormone binding proteins
  • Increased oleic acid levels in follicular fluid, which can lead to embryo fragmentation (and subsequent early miscarriage)

 

Stress & Trauma

Studies regarding the impact of stress and trauma on fertility have conflicting results, according to a 2018 Dialogues in Clinical Neuroscience review. (30)

In the studies reviewed, assisted conception outcomes were affected because the more stressed the women, the less likely the treatment worked. However, other studies found no significant difference between subjects experiencing stress and the stress-free controls. (30)

Still, it’s better to be safe than sorry. As much as possible, avoid stress.

Note that overexercise and strenuous activities can also be stressors on your body. (6)

 

Unhealthy Lifestyle, Exposure To Toxins, & Other Environmental Concerns

Aside from toxins in the environment (such as smog, pesticides, and VOCs or volatile organic compounds), the following can also expose you to chemicals that can affect your fertility: (31)

  • Smoking and vaping
  • Alcoholic drinks
  • Marijuana, opioids, or certain drugs and substances

 

Possible Causes of Men’s Fertility Problems & Treatment Options

Poor Sperm & Semen Quality

Exposure to environmental toxins, including cigarette smoke and endocrine-disrupting chemicals, can reduce sperm and semen quality. (1)(31)(32)

Damage to the testicles (testes) and other parts of the reproductive system can also affect sperm quality. (32)

Surprisingly, sperm quality might also be affected by heat exposure to the scrotum. (32)

Other possible reasons for low sperm quality include: (32)

  • Certain medications
  • Hormonal imbalance
  • Genetics
  • Lifestyle choices (e.g., smoking, drinking, use of recreational drugs, etc.)

 

Note that smoking can affect sperm DNA and size, making them smaller and slower than usual. (32)

 

Azoospermia (No Sperm In The Semen)

Azoospermia, characterized as the absence of sperm in the semen or ejaculate, is a condition that affects about 15% of infertile males. It might also be due to blockage of certain parts along the tract in the reproductive system. (33)

 

Treatment: Sperm-Related Infertility Issues

Lifestyle changes might be necessary to reduce the risks of sperm damage. (32)

The doctor might also recommend hormone replacement therapy (for male sex hormones). (32)

Surgery might be required if azoospermia is due to blockage (see below). (32)

 

Damage To Organs In The Male Reproductive System

Damaged Testicles

Male infertility can be due to testicular problems, damage, or deficiencies. (1)

 

Varicoceles (Abnormally Dilated Veins In The Scrotum) & Other Forms Of Blockage

When veins in the scrotum are abnormally dilated, sperm growth can be affected because they block proper blood drainage. This can also make the scrotum warm, creating an environment that isn’t ideal for sperm production. (32)

Surgery, repeated infections, developmental defects, and swelling can also lead to blockage. (32)

 

Treatment: Organ Damage In The Male Reproductive System

Options can vary, depending on the reason for the blockage: (32)

  • Surgical operation to remove epididymal blockage 
  • Minor surgery can be done to fix the swollen veins in the varicoceles

 

Low Testosterone Due To Hypogonadism & Hypothalamic Dysfunction

Sperm production might be reduced due to hormonal imbalances caused by pituitary gland or hypothalamus issues. (17)(32)

It might also be due to hypogonadism, a condition wherein the gonads (testes) don’t make enough sperm. (32)

 

Treatment: 

  • Possible hormone replacement therapy (32)

 

Ejaculation Problems

Retrograde ejaculation happens when the muscles and nerves in the bladder don’t close during ejaculation, causing sperm to go backward into the body instead of out of the penis. (32)

Sperm quality and quantity might still be high for those with this problem, but they can be infertile because the sperm fails to reach the vagina. (32)

This condition can be due to medications, surgery, or nervous system problems. (32)

 

Treatment: 

Finding and treating the underlying cause can help solve this problem. Examples can include: (32)

  • Surgery such as TURED (Transurethral Resection of the Ejaculatory Duct) might be required if ejaculation is prevented by blockage 

 

Certain Drugs & Medications

Some medicines or drugs that can affect male fertility: (32)(34)

  • NSAIDs (nonsteroidal anti-inflammatory drugs) for treating pain and inflammation (e.g., ibuprofen)
  • Steroids in medicines and supplements
  • Some antihypertensives (such as calcium channel blockers such as amlodipine)
  • Antidepressants
  • Proton pump inhibitors (e.g., omeprazole to treat peptic ulcer disease and gastroesophageal reflux disease)
  • Medications for treating prostate enlargement (also called BPH or benign prostatic hyperplasia), such as prazosin
  • Immunosuppressants (to treat autoimmune diseases)

 

These medications can affect fertility through the following: (34)

  • Affected sperm quality and quantity
  • Erectile dysfunction (making it difficult to deposit sperm into the vagina)
  • Decreased libido

 

Treatment: Infertility From The Use Of Certain Drugs & Medications

It might be necessary to stop using these medications to reduce infertility risks for those trying to conceive. 

However, because they also treat important medical conditions, intake shouldn’t be stopped without your doctor’s recommendation.

 

Cancer Treatment

  • Testicular cancer can directly cause male infertility (32)(35)
  • Treatment for other forms of cancer can affect hormone production (27)(32)

 

Remedies & Treatment: Cancer-Related Infertility

  • Hormone replacement therapy might be necessary after the cancer treatment is over (27)(32)
  • Check with your doctor about how soon you can try to conceive after cancer treatment because the procedures and medications can have long-term effects on the body; they also increase the risks of birth defects and miscarriages (32)

 

Other Medical Conditions

Diseases that aren’t directly related to the reproductive system can also cause infertility, such as: (1)

  • Disorders of ciliary function
  • Infections (can affect hormonal production)
  • Systemic diseases (conditions that affect several body systems)
  • Obesity and lifestyle-related factors

 

Treatment: Other Medical Conditions

  • Diagnosis and treatment of the underlying condition (1)(32)

 

Autoimmune Conditions

In rare cases, sperm production and release might be affected by autoimmune conditions that cause the body to attack its own systems. Sperm might be prevented from working normally, and they may fail to reach the fallopian tube. (32)

 

Treatment: Autoimmune Conditions

  • Diagnosis and treatment of the underlying condition (32)
  • Immunosuppressants

 

Sterilization (Such As A Vasectomy)

Similar to tubal ligation, a vasectomy permanently blocks the sperm from getting released by either cutting or tying (clamping might also work) the ducts. (32)

 

Treatment: Sterilization

  • Microsurgical vasovasostomy – Microsurgery that reverses vasectomy by reconnecting the cut or clamped parts (32)

 

Genetics

  • Klinefelter syndrome (Y chromosome microdeletion or an extra chromosome is present) can affect sperm production (32)

 

Treatment: Genetics

  • No treatment for genetic causes

 

Risk Factors That Can Affect A Man’s Fertility

Does Age Also Affect Men’s Fertility?

Yes. Advanced male age can lead to semen decline (lower sperm count and quality). However, age doesn’t predict male fertility as much as it does with women. (1)(36)

Older men also experience andropause. It’s the equivalent of menopause but isn’t as defined as women (because they don’t have a specific indicator such as periods stopping). (36)

Some factors affecting male fertility during andropause: (36)

  • Sperm cell production slows down in the testes
  • Tubes that carry sperm can become less elastic (this can also affect ejaculation)
  • Organs like the seminal vesicles, prostate gland, and epididymis can have reduced function
  • Erectile dysfunction

 

Unhealthy Weight & Obesity

Obesity can: (29)

  • Affects semen and sperm quality
  • Leads to hormonal imbalances, such as the conversion of androgen (male sex hormones) to estrogen (female sex hormones), which can reduce testosterone levels

 

Unexplained Fertility Problems

According to the American Society of Reproductive Medicine, here are the stats on infertility cases: (32)

  • About ⅓ is due to female infertility
  • About ⅓ is due to male infertility
  • About ⅓ is due to a combination of reasons, with 20% of these cases caused by unexplained fertility problems

 

Tips For Boosting Fertility

Improve Your Health & Wellness

  • Eat healthy food
  • Workout & exercise (but don’t overdo it)

 

Aim For A Healthier Weight

Because weight (whether underweight or obese) can affect fertility, staying within your healthy weight range makes sense.

 

Reduce STD Risks

  • Practice safe sex
  • Avoid unprotected sex with a stranger
  • As much as possible, practice mutual monogamy
  • Get vaccinated (such as for HPV)

 

Things & Activities To Avoid Or Limit

  • Limit intake of coffee & other caffeinated drinks or food
  • Quit smoking & vaping
  • Avoid drinking alcoholic drinks
  • Exposure to toxins & other potentially harmful chemicals
  • Reduce night shifts or staying up late, if possible
  • Avoid stress (physical, mental, & emotional)
  • Avoid strenuous exercise
  • Limit medications that can affect fertility & consult your doctor

 

Seek Preventive Care (For Women)

  • Annual gynecologic screenings 
  • Pap smear (cervical cancer test) at least once every three years

 

Avoid Hot Baths & High Temperatures (For Men)

  • Heat can affect sperm production, so it’s best to limit or even avoid hot baths

 

Diagnostic Tests For Infertility

For Women

  • PE (physical examination)
  • Blood work – Tests to check for ovulation 
  • Abdominal or transvaginal ultrasound scan – Checks for abnormalities or problems in your reproductive system
  • Hysterosalpingogram (X-ray procedure) – Checks for blockage in your fallopian tubes
  • Laparoscopy test – Checks for blockage in your cervix, fallopian tubes, and ovaries
  • STD tests – Checks for chlamydia, gonorrhea, etc.
  • AMH (Anti-Müllerian hormone test) – Tests whether your ovaries are aging too quickly and the number of eggs in your ovaries

 

For Men

  • Semen analysis – Tests for sperm count and quality
  • STD tests – Checks for chlamydia, gonorrhea, etc.

 

Assisted Reproductive Technology (ART) Procedures

Some ARTs that your healthcare provider might suggest to help you conceive: (32)

 

IVF (In Vitro Fertilization)

Some things to know about IVF: (32)

  • The egg is fertilized by the sperm in the lab
  • The fertilized egg is implanted after 3-5 days
  • The ovaries can be stimulated to produce more mature eggs with daily drug or hormone injections

 

Possible reasons for choosing IVF: (32)

  • Blocked tubes
  • Idiopathic infertility (unexplained fertility problem)

 

Possible IVF risks and outcomes: (37)

  • Ovarian hyperstimulation syndrome from fertility medications
  • Increased chances of multiple pregnancies (such as twins, triplets, etc.) 
  • Egg retrieval complications (e.g., internal bleeding, infection, and pelvic organ damage)

 

ICSI (Intracytoplasmic Sperm Injection)

ICSI is an IVF variation but involves the injection of one sperm into the egg. Other things to know about this procedure: (32)

  • Used for severe male infertility (very poor semen quality)
  • Sperm can be retrieved from either the testes or epididymis through surgery
  • The fertilized egg implanted is in the uterus.

 

IUI (Intrauterine Insemination)

A healthcare provider uses a tube to place the sperm into the uterus in this procedure.

Possible reasons for choosing IUI: (32)

  • Retrograde ejaculation (semen backflows into the man’s body)
  • Low sperm count and motility (movement) problems
  • Other infertility causes

 

PGT (Preimplantation Genetic Testing)

This tests for possible genetic defects in the embryo before implantation, including: (38)

  • PGT-A – Tests for aneuploidy (extra or missing chromosomes) – The chromosome abnormalities may result in a baby with Down syndrome or other birth defects
  • PGT-SR – Tests for chromosome structural rearrangements, which can cause serious health issues or a miscarriage
  • PGT-M – Tests for monogenic disorders such as sickle cell anemia, Marfan syndrome, or cystic fibrosis

 

Sperm & Egg Retrieval Operation

ART procedures require an egg and sperm. Collection and retrieval can vary depending on different factors.

Men are usually asked to collect semen in a cup. However, the following are done using a needle and syringe in case of male infertility: (32)

  • TESE (Testicular Sperm Extraction) – Sperm is extracted from the testicle
  • MicroTESE – Higher level of TESE that also checks for areas in the testicles with sperm production (the test is used for men with no or very low sperm count)
  • TFNA (Testicular Fine Needle Aspiration) – A syringe is used to collect sperm from the testicles
  • PESA (Percutaneous Epididymal Sperm Aspiration) – Sperm is collected from the epididymis using a needle
  • MESA (Microsurgical Epididymal Sperm Aspiration) – Sperm is collected from the epididymal tubes using a surgical microscope; it limits harm to the epididymis.

 

Sperm collection can usually be done anytime for men.

Egg collection is more complicated for women, especially because the egg has to be mature and ready for fertilization. Also, the egg is larger than the sperm and has to be collected properly to ensure it’s intact. Plus, you can’t just eject the egg out, unlike in sperm collection.

Still, similar to the clinical sperm retrieval methods above, the egg can be collected using a needle and syringe. (39)

 

Sperm & Egg Donation

Sometimes, couples trying to conceive will need sperm and/or egg from a donor due to varied reasons. The donors undergo any of the procedures for collection (above). Then, the fertilization process is done through IUI, IVF, or other methods.

 

Fertility Preservation For Possible Future Treatments & Needs

Age, cancer treatments, and other factors can affect the quality and viability of the egg and sperm. 

The American Society For Reproductive Medicine recommends that physicians tell their patients about fertility preservation options before they undergo chemotherapy and radiation treatments. (40)

It involves freezing eggs, sperm, testicular tissue, ovarian tissue, or embryos. (41)

 

What Is Sperm Banking?

  • The process of collecting, freezing, and storing sperm
  • Genetic testing can be done before freezing the sperm
  • Sperm is collected using any of the methods listed above

 

Other FAQs

Are Fertility Treatments & Procedures Covered By Insurance?

Yes, depending on your plan, some insurance companies cover fertility treatments. Check with your insurance provider to be sure.

Coverage also depends on your plan and provider. Some plans only allow for diagnostic testing, while others cover everything from testing to IVF treatment and injectable medicines. 

 

Does Age Matter When Seeking Fertility Treatment?

Age can still matter when seeking fertility treatment, especially if you didn’t go through fertility preservation when you were younger. 

Here’s the fertility trend for live births with assisted conception, according to the US National Summary Report for 2022: (42)

(source: sartcorsonline.com)

 

Here’s the data for 2021: (43)

(source: sartcorsonline.com) (43)

 

Can Complementary Therapy & Alternative Medicines Help?

It depends. While some women try to use alternative and complementary therapies such as herbal remedies and essential oils for fertility, it might do more harm than good in certain circumstances. For example, some essential oils can promote contractions and cause a miscarriage. (15)

Currently, studies on alternative therapies and infertility have conflicting reports. (44)

However, there’s also some evidence that certain herbal remedies (but not acupuncture) can help improve fertility and increase pregnancy rates for: (44)

  • Women with PCOS (polycystic ovary syndrome)
  • Women with anovulation (absence of ovulation)
  • Infertile women undergoing ART (assisted reproductive technology)

 

The same study didn’t find any significant difference between the fertility rates of women who went through acupuncture and those who didn’t. (44)

Before starting any complementary treatment, however, check with your doctor to ensure it’s safe for women trying to conceive or are pregnant.

 

Seeking Help

Importance Of Seeking Fertility Treatment

Most infertility problems don’t resolve on their own, but might get worse as you age. It’s ideal to seek fertility help when you’re younger and have fewer complications than those we listed above.

Some of the most common reasons why couples seek help:

(source: kff.org) (46)

 

Fertility Experts & Healthcare Providers

Government Programs & Facilities

The American non-profit organization KFF (Kaiser Family Foundation), formally known as The Henry J. Kaiser Family Foundation, revealed that only a few states offer a medical (Medicaid) program for infertility diagnosis and treatment. Of these states, only New York offers both diagnostic and treatment services.

(source: kff.org) (46)

 

Private Fertility Clinics & Healthcare Facilities

Basic infertility services aren’t offered in most government-funded clinics, so many couples go to private fertility clinics for help. (45)

 

When To Consult Your Doctor Or A Fertility Specialist & Get Tested For Infertility?

  • Less Than 35 Years Old – After a year of TTC
  • 35-40 Years Old – After six months TTC
  • 40+ Years Old – As soon as possible

 

What Your Doctor Might Want To Know

  • How long have you been TTC?
  • Prior pregnancy details and how many children you have
  • Contraction use (type and when you stopped using it)
  • Sexual intercourse-related information (such as frequency and ovulation timing)
  • Use of medicines, drugs, and herbal remedies
  • Medical history (especially STDs)
  • Exposure to stress
  • Exposure to toxins and other chemicals or environmental factors
  • Lifestyle and habits (such as smoking, drinking, and use of recreational drugs)

 

Trying To Conceive

Knowing when you ovulate can help you time sexual intercourse to maximize the chances of fertilization. Here are some ways to track your ovulation: (46)

 

Tracking Your Fertility Cycle

Track the start and end of your fertility cycle using a calendar to estimate your most fertile window: five days before ovulation up to about a day later. 46)

 

Using Hormones To Predict Ovulation

You can get an ovulation kit to check if you’re ovulating. It tests for luteinizing hormone (LH) in your urine. The hormone signals the ovary to release the egg. So, a rise in the LH can mean you’re about to ovulate. (46)

 

Using Temperature To Track Ovulation

Checking for basal body temperature (early morning body temperature) also helps you track your cycle. The temperature increases by around 0.5 degrees Fahrenheit approximately 1-2 days after ovulation. (46)

 

Other Information on Pregnancy

 

 

References

(1) https://europepmc.org/article/med/29555319

(2) https://www.researchgate.net/publication/325803859_Mental_Disorders_and_Female_Infertility

(3) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807657

(4) https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal

(5) https://lomalindafertility.com/pregnancy/reproductive-system/

(6) https://lomalindafertility.com/pregnancy/menstrual-cycle/

(7) https://www.ucsfhealth.org/education/conception-how-it-works

(8) https://www.lancastergeneralhealth.org/health-hub-home/motherhood/getting-pregnant/what-is-a-chemical-pregnancy

(9) https://www.pregnancybirthbaby.org.au/molar-pregnancy

(10) https://medlineplus.gov/ency/article/007015.htm

(11) https://lomalindafertility.com/infertility/women/blocked-fallopian-tubes/

(12) https://drlenkliman.com.au/articles/fibroids-vs-polyps-understanding-the-difference/

(13) https://www.tgh.org/institutes-and-services/conditions/pelvic-scar-tissue-adhesions

(14) https://www.msdmanuals.com/home/women-s-health-issues/infertility-and-recurrent-miscarriage/infertility-problems-with-cervical-mucus

(15) https://www.thewomens.org.au/health-information/periods/endometriosis/treating-endometriosis

(16) https://www.yalemedicine.org/conditions/amenorrhea

(17) https://medlineplus.gov/ency/article/001202.htm

(18) https://emedicine.medscape.com/article/121784-overview?form=fpf

(19) https://lomalindafertility.com/infertility/women/hormonal-imbalance/

(20) https://lomalindafertility.com/infertility/women/pcos/

(21) https://medlineplus.gov/primaryovarianinsufficiency.html

(22) https://europepmc.org/article/PPR/PPR834930

(23) https://journals.asm.org/doi/10.1128/msystems.00450-20

(24) https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2022.819958/full

(25) https://www.mdpi.com/2079-6382/10/6/719

(26) https://www.abayomiajayi.com.ng/2020/12/23/medications-can-affect-your-fertility/

(27) https://www.cancer.org/cancer/managing-cancer/side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/how-cancer-treatments-affect-fertility.html

(28) https://lomalindafertility.com/infertility/stds-and-infertility/

(29) https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.14538

(30) https://www.researchgate.net/publication/326041843_The_relationship_between_stress_and_infertility

(31) https://bcmj.org/articles/optimizing-fertility-part-2-environmental-toxins

(32) https://www.urologyhealth.org/urology-a-z/m/male-infertility

(33) https://www.sciencedirect.com/topics/medicine-and-dentistry/azoospermia

(34) https://www.sciencedirect.com/science/article/abs/pii/S2666571923000075

(35) https://europepmc.org/article/MED/38614420

(36) https://medlineplus.gov/ency/article/004017.htm

(37) https://lomalindafertility.com/infertility/women/blocked-fallopian-tubes/

(38) https://fertility.wustl.edu/treatments-services/genetic-counseling/preimplantation-genetic-testing-pgt/

(39) https://med.emory.edu/departments/gynecology-obstetrics/patient-care/patient-education/oocyte-retrieval/index.html

(40) https://www.allianceforfertilitypreservation.org/wp-content/uploads/2021/05/ASRMGuidelines2014.pdf

(41) https://www.yalemedicine.org/conditions/fertility-preservation

(42) https://sartcorsonline.com/CSR/PublicSnapshotReport?ClinicPKID=&reportingYear=2022&fromDisclaimer=true

(43) https://sartcorsonline.com/CSR/PublicSnapshotReport?ClinicPKID=&reportingYear=2021&fromDisclaimer=true

(44) https://www.researchgate.net/publication/347059390_Acupuncture_and_herbal_medicine_for_female_infertility_An_overview_of_systematic_reviews

(45) https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/

(46) https://www.nebraskamed.com/womens-health/pregnancy-birth/how-to-use-ovulation-charting-and-basal-body-temperature-tracking-to-optimize-your-fertility

(47) https://www.marchofdimes.org/peristats/data?reg=99&top=2&stop=2&lev=1&slev=1&obj=1

(48) https://www.census.gov/library/stories/2022/04/fertility-rates-declined-for-younger-women-increased-for-older-women.html

(49) https://carsey.unh.edu/publication/more-us-women-of-childbearing-age-but-fewer-have-given-birth

 

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