Fertility can be a sensitive subject. Every woman and every couple’s journey to pregnancy looks different. No matter where you are in your journey, we hope that we can provide you with information on fertility and infertility that can help you make informed decisions.
Understanding fertility is important if you hope to reproduce or to prevent reproduction. It’s a stepping stone to make educated choices about your body and can help you know what to look out for if you’re having a difficult time getting pregnant.
There are many factors that can affect fertility, including:
- Genetics: These can indicate your level of fertility and other reproductive-related things, such as when menopause may occur for you, or fertility issues family members struggle with.
- Hormones: These play a crucial role in your body getting and staying pregnant. If your hormones are imbalanced, then it can affect how your body handles conception and pregnancy.
- Anatomy: Your anatomy, specifically your reproductive organs, can affect your ability to reproduce. If they are damaged from an injury, a disease, or you have congenital structural abnormalities (differently-shaped uterus or Fallopian tube defects), then you have a higher risk of infertility.
- Medical history: Unfortunately, some medical procedures that solve one problem can lead to another. For example, having surgery on your ovaries or receiving chemotherapy or radiation can affect your ovarian reserve.
- Lifestyle: There are certain lifestyle choices that can deplete your ovarian reserve or cause chromosomal damage to your eggs, leading to infertility or issues during pregnancy. These include weight, smoking habits, alcohol consumption, medications, and drugs.
- Age: Aging is the most important factor in a woman’s fertility (and a man’s!). We cover this more in detail later.
Understanding Your Fertility
If you want a fairly accurate idea of your level of fertility, there are blood tests that can estimate the amount and quality of your eggs (your ovarian reserve). An ultrasound can also sometimes detect the number of follicles. Unfortunately, there isn’t a test that can measure your ovarian reserve perfectly.
When it comes to testing a man’s fertility, a semen analysis can examine the number, shape, and movement of his sperm to determine his ability to reproduce.
If you’re worried about your fertility, don’t! You can’t know for sure until you discuss your health with your doctor and have tests run. Plus, there are medical strategies available that can help maximize your chances of conceiving. They all focus on getting the sperm and egg together at the best time for you to conceive. Jump to the section on improving fertility through infertility treatments to learn more.
Aging and Fertility
Since the 1980s, the birth rate in women over the age of 35 has increased by nearly 60%. While it was more common before the 80s to have children during a woman’s earlier years, much of that had to do with culture. Cultural norms have changed and more women are in the workforce than ever, and many of those women are choosing to wait to conceive until later in life. But at what cost?
A woman’s peak reproductive age is her late teen years into her late 20s, with 1 in 4 women getting pregnant in any single menstrual cycle. Around the age of 30, even in prime health, her fertility starts to decline and she starts becoming less able to reproduce. During her mid-30s, her fertility declines much more rapidly, and she will have between a 10-20% chance of getting pregnant each time she tries. A woman around the age of 40 has about a 1 in 10 chance of getting pregnant in any single menstrual cycle. By the age of 45, the chance of a woman getting pregnant naturally is highly unlikely.
Check out our blog on the six things to know about age and fertility to learn more.
Why Women Become Less Fertile as They Age
A woman is born with a certain number of eggs, and as she ages, those eggs diminish in number and viability. Every month, a woman loses about 1,000 (immature) eggs, and with each period, one egg that had developed during ovulation is released during her menstrual cycle because it wasn’t fertilized during ovulation. Older women have fewer eggs, but they also run the risk of having eggs with a higher likelihood of abnormal chromosomes. Women also have a higher risk of disorders that can affect their fertility as they get older.
Unfortunately, there isn’t currently a medical technique that can help preserve your fertility for when you are ready to conceive. If you would like to have children later in life, you can always consider in vitro fertilization (IVF), which we cover later on. However, the chances of conceiving with IVF decrease with age just as the chances of natural conception do.
Misconceptions about the Effects of Birth Control on Fertility
Many misconceptions around birth control and fertility stem from outdated information. Others may be based on fears that aren’t founded on science.
For example, many women believe that the longer they are on birth control, the less likely they are to get pregnant because it will be more difficult for their body to conceive. The truth is that once you discontinue hormonal contraception, your level of fertility quickly returns to what it would have been without medication. So, if you experience a long wait time before you get pregnant, or you are experiencing infertility after having been on birth control, this means that your body would have naturally experienced these issues even if you hadn’t been on birth control.
Another prime example is related to IUDs. The Dalkon Shield IUD is to blame for the misconception that IUDs lead to infertility. It was a commonly used IUD in the 1970s that was known for causing severe pelvic infections and infertility. However, modern IUDs do not have the same side effects or harmful results as IUDs in the 70s. They have updated designs and have been tested and refined to ensure they don’t harm women or affect their ability to reproduce.
Statistics on Birth Control and Conception
Studies have shown that:
- 21% of healthy women are able to get pregnant within one cycle of discontinued birth control use
- 79% of healthy women are able to get pregnant within one year of discontinued birth control use
- Women over the age of 35 have a more difficult time getting pregnant, but that’s due to age, not the use of birth control
If you were on birth control and aren’t able to conceive, it’s likely that your body was always going to experience that struggle, even if you hadn’t used birth control. Sometimes, birth control can disguise irregular menstrual cycle patterns and underlying issues that aren’t made apparent until you discontinue the use of birth control.
Infertility Treatments and Other Alternatives
Thanks to modern medicine, infertility is not always the end of a woman’s reproductive journey. There are more effective and safe infertility treatment options than ever, from medication to surgical procedures to assisted reproductive technology. If you’ve been trying to conceive for over a year, or you have not been able to carry a baby full term, fertility treatment may be right for you.
The first step toward answers and a solution will be to get a fertility evaluation. Through this diagnostic testing, your provider can build out a personalized treatment plan that’s right for you and your partner. The types of treatment or reproduction methods they may prescribe or advise you to pursue include:
- Fertility medication: Infertility can be caused by hormonal imbalances, which fertility medication can usually aid. Many times, fertility medications are combined with another fertility treatment method, such as intrauterine insemination.
- Insemination: There are two types of insemination that are commonly prescribed by providers to treat infertility in couples dealing with low sperm counts or poor sperm motility.
- Intrauterine Insemination (IUI): This fertility treatment is a type of artificial insemination where the sperm has been washed and a concentrated amount of them are placed directly in a woman’s uterus around the time her ovary releases eggs to be fertilized.
- Artificial Insemination (AI): Artificial insemination is a type of fertility treatment where sperm (whether from a partner or a donor) is placed inside a woman’s reproductive tract during ovulation.
- In Vitro Fertilization (IVF): Considered to be the most effective fertility treatment available, IVF uses assisted reproductive technology. In this process, the woman’s eggs are removed from her ovaries through an outpatient procedure under anesthesia and then are fertilized with sperm in a lab. Once fertilized, the embryos are allowed to develop in the lab for 5-6 days, and then they are transferred back to the woman’s uterus for her to carry to term.
- Donor Eggs: If a woman doesn’t have viable ovaries or eggs, she can receive a donor egg from a fertile woman. This egg is fertilized with the sperm of their partner or a sperm donor and then it is implanted into the woman’s uterus, similarly to IVF.
- Surrogacy: Surrogacy involves a woman (the surrogate) carrying a child for another woman or for a same-sex couple. The parents will undergo IVF and the embryo is implanted in the surrogate’s uterus, where she will then carry it to term. Both parents will typically have a genetic tie to the baby, but the surrogate will not.
- Freezing Eggs: If a woman decides to freeze her eggs, she will undergo a similar procedure to IVF to have 10-20 of her eggs retrieved. The eggs are then flash-frozen and stored until a later date when the woman is ready to have a baby or donate her eggs. The eggs will then be thawed, fertilized, and implanted into a woman’s uterus.
- Surgery: Typically only recommended if a woman has certain health conditions.
Every woman and every couple is different, which means the fertility treatment you could be prescribed could vastly differ from another woman or couple. The best way to determine which course of fertility treatment is right for you is to talk with your provider.