by Patricia Mendell, L.C.S.W.
As a psychotherapist working in the field of reproductive medicine I have counseled hundreds of women and men about fertility-related issues, from preserving one’s fertility and contraception to problems with conceiving and pregnancy. It is rare to find individuals who do not have mistaken ideas about their fertility. Numerous times women believe that looking youthful will translate into extending their biological clock, while men often think that age plays no role in their ability to reproduce. As more is known about fertility, age, lifestyles, and environmental influences, the importance of educating the public grows.
This article was written to include both the most common misconceptions about fertility and the most frequent and mistaken beliefs that often lull men and women into a false sense of security about their fertility choices and treatments. There are many myths about fertility. Almost everyone knows someone who was not getting pregnant but then did and is convinced it was due to the actions that they took. So, what should one believe?
Myth One—Just Relax and You Will Get Pregnant
Although most medical research points to the fact that stress in general is not good for your body, there is no clear-cut evidence that stress prevents pregnancy. What most people do not know is that a healthy woman who is 30 years of age and trying to conceive will have a 20% chance each month of conceiving, while a healthy woman who is 40 years of age will have only a 5–10% chance of conceiving each month. Age and health are the key factor in a woman’s ability to conceive. As many of my patients experiencing fertility issues have said to me, “If I had a dime for every time I went on vacation to reduce my stress and relax to get pregnant, I would have money for fertility treatments and maybe even the down payment on my house.” Although the rigors of long-distance running or military training are stressful enough to reduce fertility by preventing ovulation, infertile women with regular menses and normal ovulation should be reassured that stress is probably not what is causing their difficulty conceiving.
Myth Two—The Majority of Fertility Problems Are Related to Women
The reality is that the causes are almost equally distributed across male and female lines. The facts are that 35–40% of all fertility issues are male and 35–40% of all fertility issues are female. Too often, when a man is told that his sperm is ‘good enough’ for the couple to undergo in vitro fertilization, the man hears that his sperm is not the problem and assumes that if they do not get pregnant his partner is to blame. The woman will also assume that it is her fault even though the sperm may have needed help from a skilled embryologist to fertilize her eggs. Many times, even if the problem is due to the sperm, the female partner must undergo fertility treatments for the
couple to become pregnant. If a man has low sperm count (total sperm count), poor motility (how the sperm move), or poor morphology (a large percentage of misshaped sperm), this will affect the ability of the sperm to fertilize the egg. It is often important for a couple to realize that whatever the fertility issue is, they must work as a supportive team if they are going to create a child together.
Myth Three—Using Birth Control Pills Will Preserve Your Fertility
Regardless of whether a woman birth control or not, her egg reserves will continue to decline each month of her life. Although birth control is considered 99% effective in preventing unwanted pregnancies, it will not protect a woman from sexually transmitted diseases (STDs), which can damage her fertility. The most surprising piece of information, often not known by many women who use birth control pills, is that the use of antibiotics while taking the pill will lower the effectiveness of the birth control by as much as 30%.
Myth Four—All Condoms Are Effective in Preventing Unwanted Pregnancies and the Transmission of Sexually Transmitted Diseases
The truth is that all condoms are not created equal. While they all help prevent pregnancy when used correctly, they do not all prevent STDs. The most effective condom for that is made of latex, but there are a growing group of people who are allergic to latex and, in recent years, other materials have been used to make condoms that do not cause these problems. There is also a third type of condom, the oldest, known as natural or lamb skin. While these will work for unintended pregnancies, they cannot stop STDs from spreading. Several studies clearly show that condom breakage rates in the US are less than 2%. Most of the breakage is likely due to incorrect usage rather than poor condom quality. Using oil-based lubricants can weaken latex, causing the sheath to break. In addition, condoms can be weakened by exposure to heat or sunlight or by age, or they can be torn by teeth or fingernails. Statistics are from the fact sheet ‘The Truth about Latex Condoms,’ developed by the Sexuality Information and Education Council of the US (SIECUS).
Myth Five—A Previous Pregnancy Is an Indication of a Person’s Fertility
While producing a child does indicate that a person was fertile at one point in his or her life, it does not guarantee that he or she will be fertile in subsequent attempts to become pregnant. In fact, the largest group of infertile people is made up of those who are suffering from secondary infertility. Secondary infertility is the inability to conceive a child or carry a pregnancy to term after conceiving and delivering one or more children. This group is usually older and has a higher possibility of medical and/or sexually transmitted diseases, which causes a decline.
Myth Six—A Woman Who Practices a Healthy Lifestyle Through a Good Diet with Moderate Exercise Will Be Able to Conceive into Her 40s
Unfortunately, although a healthy lifestyle and genetics do play some role in a woman’s ability to conceive, it is her age that plays the biggest factor in her life. Yes, it is important that a woman does not drink alcohol excessively or smoke cigarettes, because that will also decrease her chances in becoming pregnant. Nevertheless, by
the time a woman is 45 years of age she will have less than a 5% chance of conceiving and over a 70% chance of miscarrying even if she does conceive with her own eggs. The truth is that age cannot fool fertility.
Myth Seven—A Man’s Age Will Not Affect
His Partner’s Chances of Becoming Pregnant and Carrying a Baby to Term Although men believe this to be true, the reality is that studies have begun to increasingly show that men over 40 years of age are at an increased risk for producing children with more chromosomal abnormalities that can cause a higher rate of miscarriage for their partner. While many of the studies are yet to be totally conclusive, it appears that autism and schizophrenia are also increased in children fathered by men over 40 years of age.
Myth Eight—A Woman in Good Health Who Conceives at 45 Years of Age with A Donated Egg from a 25-year-old Will Have the Same Chance of Miscarrying as a Woman at 45 Years of Age Who Conceives with Her Own Eggs
The rate of miscarriage for a 45-year-old woman using a donor egg is according to the age of the egg and not the age of the woman carrying that egg. While a 45-year-old woman will have a 60–70% chance of pregnancy loss with her own eggs, a 45-year-old woman using a 25-year-old donor egg will have a 15% chance of loss due to the age of the egg that she is carrying.
Myth Nine—All Fertility-related Problems Can Be Diagnosed
While there is treatment for many fertility problems faced by both men and women, 20% of these couples will be given a diagnosis of ‘unexplained infertility.’ Although this does not mean that a couple will not be able to conceive, it does make it frustrating for both the couple and the physician treating the couple. Often treatments may
be suggested that the doctor hopes will help despite being unsure of what the real problem is. Even when a treatment works for the couple with unexplained infertility, the problem will still remain a mystery. For a number of these couples it will never be clear why they were unable to conceive. If they have struggled over a number of years with this unexplained label, they may find it hard to accept that now age is also part of the factor for them.
Myth Ten—If You Try to Adopt, or Do Adopt a Child, You Will then Become Pregnant
Everyone knows someone who has adopted and then subsequently became pregnant. The implication is that if you stop wanting it so badly you will then reduce your stress and it will ‘just happen,’Although the exact number of mothers who become pregnant after adopting is not known, many studies indicate that it is somewhere between 3 and 10%. Since 15–20% of infertile couples have ‘unexplained infertility’ as their diagnosis, it seems likely that some of these couples will be the ones who become pregnant. A couple should not embark on the journey of adoption as the cure for their infertility. Adopting is the solution to being childless, but not to being infertile.
Patricia Mendell, LCSW, is a psychotherapist in private practice and Co-Chair of The American Fertility Association.