By Kamilia Smith, MD
Founder, Charleston House Gynecology, Dallas, TX
Member, Ms.Medicine Provider Executive Group
What is infertility?
In general terms, a woman is considered “infertile” if she has been sexually active monthly for more than a year without achieving pregnancy. “Infertility issues” refer to the inability to achieve conception, achieve a viable pregnancy after conception or maintain a developing pregnancy. So much focus is on the ability to conceive, but the term “infertility” pertains to everything from a woman’s ability to ovulate, conceive and maintain a pregnancy.
Is infertility an issue in both men and women?
Both partners can be contributors to the inability to achieve pregnancy. Some causes of infertility are easily identifiable, but most are not. When it is caused by the female, it can be due to inability to ovulate, PCOS (polycystic ovarian syndrome), fallopian tube damage, or endometriosis, and is what we refer to as “female factor”. Nearly one-third of the time of the time, it is attributable to the male partner, or “male factor,” which can be low sperm counts or testicular issues. Finally, nearly one-third of the time, it is what we refer to as “unexplained infertility” where no obvious cause has been identified.
What causes infertility?
Conception is truly a miracle as so many events need to occur perfectly on a molecular level for a successful pregnancy to occur. While conception is seemingly easy for so many women, we know it can be difficult for other women especially as they begin to enter their late 30s. I like to think of it as our reproductive system is under environmental influence or “stressors”. Some of these environmental factors are external stress — diet, alcohol and medications — and some of these environmental factors are internal and can greatly affect the reproductive system, like hormone imbalances. Both the external and internal environment plays a role.
When is the right time to get a fertility evaluation?
At every annual appointment, regardless of a woman’s age, it is appropriate to address a woman’s long-term desires for fertility.
What can I do on my own to increase my fertility naturally? Any non-medical approaches?
Absolutely! And this is where every woman should start! You should approach pregnancy with your absolute best foot forward and at your healthiest state. As discussed previously, anything a woman can do to minimize adverse environmental factors by making lifestyle modifications, she should start there. If a woman is over her expected BMI, by losing 10% of her body weight can “wake up” her ovaries and resume ovulation. As we know, ovulation is where the process starts, so I encourage women to understand the reasons why they may not be ovulating. Also moving your body with a consistent weekly exercise program – such as walking 3-4 times a week — decreases the effects of insulin resistance if you are overweight, and this can improve ovulation.
What risk factors affect fertility? Age? stress?
As a woman ages, her fertility declines. I know that statement alone is quite frightening for women. I encourage my patients to be aware but know that waiting until their mid to late 30s does not mean that they will not achieve a successful pregnancy. The time to conceive can take longer, and this is known as a women’s “fecundity rate” which is affected by age. My patient’s and I discuss what their anticipated timeline might be, and we discuss their “fecundity rate” or ability to achieve a pregnancy at their particular age. Many women are unclear about how that rate changes over time.
Stress is one of the environmental factors that can greatly impact a woman’s fertility and deserves more credit that it receives. Large amounts of stress from an acute event, or long-standing chronic periods of stress can impact the brain’s ability to produce the necessary hormones, or gonadotropins, to stimulate the ovaries to ovulate. The brain produces these hormones. If the brain is under large amounts of stress, it will not function properly.
Who should freeze their eggs?
Oocyte preservation is a very personal decision for a woman. Women who are diagnosed with cancer and require chemotherapy should consider preservation of their eggs before receiving treatment. Other scenarios include women who have chosen to delay pregnancy because of careers, lack of partner or whatever the reason may be. It is always worth having the conversation with a specialist to see what your options are.
What can I do to preserve my fertility?
Stay healthy, aim for a normal BMI, reduce stressors and stay positive! All of these things are in YOUR control.
Can infertility be prevented/cured?
We can take measures to prevent some known causes of fertility but as previously mentioned, much of infertility is due to unknown causes. Acquiring STDs can lead to damage of the fallopian tubes, where fertilization occurs. Many women are not aware that this damage has occurred to much later in life when they have an ectopic pregnancy (where the pregnancy implants outside the uterus, often in the fallopian tube) or they cannot get pregnancy despite normal ovulation because the fallopian tubes are blocked and the sperm can reach the egg to fertilize it.
When should I start taking prenatal vitamins?
Any women of reproductive age (any woman who menstruates) that is sexually active and not actively using contraception, should be on a prenatal vitamin. I always tell my patients, if you aren’t actively preventing pregnancy with contraception or abstinence, then you are actively planning for pregnancy! Prenatal vitamins have so many positive benefits — women should take the time to find one that they like and practice taking them on a regular basis before they conceive. Folic Acid is vital to an early developing pregnancy
What is the best way to find a fertility specialist in my area?
Ask your girlfriends in your community if they saw a fertility specialist, the pros and cons of their practice style. It is ok to do a “meet and greet” with a doctor to see if it’s a fit. This is a very vulnerable and scary time for a woman. You need to find someone that you feel comfortable with and would trust to deliver you the hard news and cheer you on in the victories! Be picky and take the time to find the right doctor for you!