What Is Reproductive Health?
Each year, millions of adults experience fertility problems that make it hard to conceive.
About 85% of couples conceive within 1 year of trying. Often, they’re able to get pregnant within just a few months of trying. The 15% who don’t get pregnant within 1 year of trying have reproductive health or fertility issues, although about half of these couples do conceive within 2 years.
“Usually, when a couple comes to my clinic, they’ve already been trying to get pregnant on their own for 6 months to a year. If you’re over 35, it’s a good idea to come in after 6 months of trying. However, some people don’t like medicalization of their private lives, so they may wait years” to see a reproductive endocrinologist or fertility specialist, says Ruben Alvero, MD, professor of obstetrics and gynecology at Stanford Medical School.
A rule of thumb is to see a fertility specialist if you’ve been trying for a year and haven’t conceived, or after 6 months if you’re a woman age 35 or older.
Before you see a fertility specialist, use an over-the-counter ovulation test to track when you ovulate. This usually happens around the 14th day of the menstrual cycle, Alvero says. Try to have intercourse at least every other day from day 10 of your cycle, because each viable egg only lasts about 12 hours in your fallopian tube.
What Causes Fertility Problems?
For women, age is the most common reason for fertility issues, but there’s a wide variety of reasons why some couples find it difficult to conceive on their own, Alvero says.
“In about 65% of couples with fertility issues, we do find a physical cause and depending on what it is, we can treat it.” Both partners can have a fertility assessment, including:
Common causes of infertility are blocked fallopian tubes, fibroids, low quantity or quality of a woman’s eggs, infrequent ovulation, or in about 35% of men, low quality or quantity of viable sperm, he says. Chronic illnesses like diabetes, celiac disease, lupus, or thyroid problems may lower fertility.
“Obesity can also have a significantly detrimental effect on your fertility,” Alvero says. “In women, low body weight may also have a negative impact on their fertility. My advice for patients is that if you’re overweight or obese, even losing 5%-10% of your body weight can substantially improve your chance of pregnancy and make your pregnancy healthier.”
Men who are obese may have lower sperm production or mobility, so sperm can’t move into place quickly for conception to occur. Men trying to conceive should manage their weight, too.
Environment and Lifestyle
If you’re trying to conceive, watch out for harmful chemicals at work or in your daily life, such as lead or cigarette smoke, that could lower sperm quality. Women’s fertility may be affected by exposure to chemicals, too, says Jaclyn Chasse, ND, a licensed naturopathic doctor with Perfect Fertility in Boston.
“There are many compounds in our environment that can harm your reproductive health. For example, some chemicals used in beauty products or pesticides in our foods, or even BPA, a chemical used in plastics to make drink bottles,” she says. People who may be exposed to chemicals at work should wear protective clothing, gloves, and masks to avoid contact with toxins.
“It’s kind of boring, but start with the basics, such as the foods you eat, your sleep quality, and stress levels.” She measures patients’ sex hormones and tracks ovulation, and suggests ways to improve their nutrition and general health. “I talk with my patients about their smoking, alcohol, or marijuana use as well. People are so stressed these days, so they may turn to alcohol or marijuana as an outlet.” Smoking tobacco or pot may harm sperm or egg quality.
Here are some simple changes you can make to boost your reproductive health:
- Have frequent intercourse, especially 5 days before and after ovulation.
- Don’t smoke.
- Limit alcohol.
- Cut back on caffeine if you’re a woman.
- Stay at a healthy weight. Women who are too heavy or too thin may have reduced fertility.
- Heat exposure can lower sperm count in men, so wear loose underwear, avoid hot tubs, and don’t rest your laptop computer near your scrotum.
- Get plenty of sleep.
- Try to avoid night shift work, which can disrupt hormone production.
- Exercise regularly, but don’t overdo it! Excess exercise can interfere with ovulation. Limit vigorous exercise to 5 hours or less per week if you’re trying to get pregnant.
- Take folic acid supplements to improve ovulation and, if you conceive, prevent birth defects.
- Limit meat in your diet. Eat more fish rich in omega-3 fatty acids or plant-based proteins, which may improve ovulation.
Another tip for couples: Tune out unsolicited advice from family and friends, much of which is wrong, Alvero says.
“One thing I hate to hear from my patients is that a family member will tell them ‘just relax.’ This puts the blame on the couple. It’s not true. Relaxing or not stressing about it won’t really change your fertility,” he says.
Your exam and test results help your doctor customize your treatment plan, Alvero says. First, they may prescribe fertility medication, usually a pill called clomiphene citrate (Clomid). It’s prescribed for women to improve ovulation and for men to increase testosterone. Anastrozole and human chorionic gonadotropin (hCG) are other drugs prescribed to increase male fertility.
Intrauterine insemination (IUI). If medication alone doesn’t result in conception, your doctor may try intrauterine insemination (IUI), a procedure where sperm are placed in your uterus around the time an egg is released, Alvero says. At the end of four ovulation cycles, these treatments together have a cumulative pregnancy rate of 30%-35%.
“If you don’t get pregnant with clomiphene and IUI, we offer in vitro fertilization (IVF), the most aggressive treatment,” he says. “If your fallopian tubes are blocked, we go straight to IVF.”
Surgery. Women with endometrial polyps, scar tissue or fibroids in their uterus, or pelvic adhesions may need surgery to improve chances of conception. Men with a sperm blockage can have surgery to restore normal flow.
Assisted reproductive technology (ART). IVF is the most common assisted reproductive technology. Your doctor will stimulate your ovaries to produce eggs, which are then retrieved and fertilized with sperm in a lab. A few days after embryos are formed, they’re implanted in your uterus.
Other ART techniques that may help you conceive include:
- Intracytoplasmic sperm injection (ICSI), where one healthy sperm is injected into an egg. This may be done if the man’s sperm quality is poor or if you’ve tried IVF a few times without conceiving.
- Assisted hatching, a procedure where the outer part of the embryo is opened or “hatched” to help it implant successfully in your uterus lining
- Use of donor eggs or sperm if either partner’s own cells aren’t healthy enough for conception
Fertility treatments and ART may not be covered by insurance, Alvero says, who is president of the Society for Reproductive Endocrinology and Infertility, a professional association advocating for new laws that expand coverage of these treatments. “Patients don’t always have a lot of time and these insurance barriers delay care.”
Most of all, don’t give up on your dream of starting a family, Chasse says.
“People who come to me may feel that they’re at the end of the road. They feel hopeless,” she says. “Helping couples conceive is the biggest honor for me. It’s very fulfilling.”