Interpreting the Red Flags, Flashing Lights and Other Warning Signs
Conventional wisdom has it that if, after a year of unprotected sex, a couple hasn’t produced a pregnancy, they’re officially “infertile.” An OK rule of thumb, if you’ve got a year to wait (many of us don’t) and can tolerate 12 months worth of anxiety and disappointment gracefully (most of us can’t). When you begin to feel the twinge of that common doubt - “Are we experiencing infertility?” - that’s when it’s time to tackle the issue head on.
Let’s start with some basic facts. Infertility is not uncommon. One out of every 10 couples in the U.S. is infertile. That translates to more than six million people running into problems conceiving and bearing a child. Of those 40% will find a male factor, 40% will discover a female factor, 10% will learn that both partners have something going on and the remaining 10% won’t get an answer at all, it’ll remain a mystery.
That’s the statistical landscape. Now you’ve got to plug your individual circumstances into the equation to make an informed decision about if and when to get the help of a reproductive specialist. There are simple and effective diagnostic tools to help you analyze your situation and figure out the best course of action. They key here is to get proactive, take some control and help yourselves make the difference.
WHEN TO RIP UP THE CALENDAR: Reasons To Get Help Now
AGE: Maternal age is probably the single most important element to consider right off the bat (other than establishing the presence of eggs and sperm, that is). The bald fact is that a woman’s fertility diminishes with the years. Its decline begins even before the age of 30, becoming more pronounced after 35 and plunging after 39. The reason is simple. Women are born with all the eggs they will ever have. Over time, that ova supply gets depleted. The remaining eggs age right along with the rest of the body. That means, if the prospective mother is 35 or older, give nature no more than six months before consulting an expert.
Illnesses (past and present), diseases, conditions, surgeries and medications can all pack a powerful wallop to your reproductive systems. So make a detailed medical dossier for both partners. Don’t leave out anything. If you’re putting checks in the yes column, get to a doctor.
Abnormal sexual or reproductive function. Irregular menstrual cycles and difficulty achieving or maintaining erections indicate conception will likely require some form of medical intervention.
Chronic illnesses and syndromes. Diabetes, hypothyroidism, hypertension, even peptic ulcers contribute to infertility. Sometimes it is the disease itself. For example, in women diabetes, hypothyroidism or PCOS often result in ovulatory dysfunction. Untreated, endometriosis (endometrial tissue that grows outside the uterus) leads to scarring and blockages and impairs fertility. Sometimes it is the treatment of a disease which can contribute to infertility: Antidepressants, insulin and thyroid hormone can cause irregular menstrual cycles; Tagamet, used for peptic ulcers, can inhibit sperm production; high blood pressure meds may interfere with the sperm’s ability to fertilize an egg.
Past illnesses, treatments and surgeries. Did he have mumps around the time of puberty? Or radiation treatment for a cancer like Hodgkin’s? Those will have a negative impact on sperm production. Did she have pelvic or abdominal surgery, including an appendectomy? Those cause pelvic adhesions that inhibit conception or result in ectopic pregnancies. Standard D&Cs, even the extended use of an IUD can scar the uterus, with repeated miscarriages a possible consequence.
Sexually Transmitted Diseases. Any STD—gonorrhea, chlamydia or herpes—no matter how long ago—is a trouble sign. STDs compromise male and especially female reproductive systems with scarring of delicate ducts and tissue. Even herpes, which does not cause infertility, co-exists with microorganisms which can compromise the ability of the uterus support a pregnancy.
Environmental and workplace factors. Exposure to radiation, chemicals, particularly pesticides can have a deleterious effect male sexual function and sperm production. Women working with chemical solvents, nitrous oxide, vinyl chloride, for instance, may be at risk for early miscarriage.
HELP YOURSELF: What You Absolutely Need to Know. Do You?
After you’ve taken that inventory and the resulting profile looks good, you still want to do everything possible to stack the odds in your favor. Consider these insights and suggestions. You may have more control than you think.
There are a mere 12 to 24 hours each month when an egg can be fertilized. With such a narrow window, you want to maximize the chances of success.
Calculate your fertile time. A woman’s most fertile period begins a few days before the middle of her cycle. Target your prime time by taking the average length of your menstrual cycle (somewhere between 26 and 30 days for most women, but not all) and subtracting 17 days. That’s your peak. That’s when sex for reproduction counts.
How Often? Have intercourse every other day for four episodes during those fertile days. Healthy sperm can survive inside a woman’s reproductive tract anywhere from 24-to-72 hours. A word of caution: too much sex and the sperm count may go down. So exercise restraint.
Post-coital behavior. Stay still. Don’t get up for at least 10 to 20 minutes. There’s no need for a woman to hang upside down, but you don’t want to work against gravity either. Is it incontrovertible scientific fact? Maybe not. But it sure can’t hurt.
Eat healthful foods, get plenty of rest, tame stress. They’re all common sense efforts that help your body function optimally. Sometimes, though, it’s easy to overlook those habits or inclinations that can get in the way of fertility.
Don’t smoke. Cutting down won’t cut it. You must stop completely. Smoking alters a woman’s estrogen metabolism, increases the risk of tubal (ectopic) pregnancy, boosts the rate of miscarriage, among other things. Male smokers have significantly lower sperm counts and a higher incidence of abnormally shaped sperm than non-smokers.
Forget recreational drugs. Even occasional use of marijuana, cocaine, heroin and all hallucinogens can interfere with ovulation in women and sexual function in men.
Curtail alcohol consumption. A glass of wine is just fine. But even in the short term, drinking can lead to abnormal sperm production; women may suffer menstrual disorders.
Limit caffeine. Current thinking is excessive caffeine impairs reproductive function. The snag is there is no adequate definition of “excessive.” Play it safe and stick to one cup of coffee or caffeine-laced soda per day.
Moderate your exercise regimen. While trying to conceive, women should suspend the heavy-duty workouts (think marathon training) that result in irregular menstrual periods. Both men and women should avoid any activity that gets them overheated. And by all means, everyone must stay well hydrated.
Swear off appearance-enhancing drugs: Anabolic steroids bulk up the body builder, but they’ll also make him impotent. Hair growth formulations such as Rogaine and Propecia may interfere with male reproductive systems. Given that it takes 90-to-108 days make and release a sperm, these treatments could cost a couple three or more months.
You can also boost your chances with any one of the do-it-yourself, over-the-counter fertility predictors.
Reproduction, as you’ve by now deduced, is one of the body’s most subtle and complex functions. Chances are you’ll have questions and specifics you might want to talk over. So please call the American Fertility Association’s toll-free number (888) 917-3777 for the information and support you need and deserve.
Kaylen Silverberg, MD
Texas Fertility Center, Austin, TX
With The American Fertility Association