Trying to Get Pregnant? 10 Things That May Trigger Fertility Problems

Having trouble getting pregnant? These 10 common obstacles – from vitamin A to personal lubricants – may be to blame. Plus, find out how to boost your fertility. Getting pregnant is a snap, right? You’ve got the partner, it’s the right time of life (and month) – so let the baby-making begin! Not so fast. Experts say fertility problems – such as advancing age, a history of sexually transmitted diseases, weight issues and a low sperm count – can put the brakes on reproduction. So while conception is a slam-dunk for some, many others struggle to get pregnant. “A healthy 20-year-old has only a 20%-25% chance of getting pregnant each cycle,” says John Norian, M.D., a fertility specialist at Loma Linda University’s Center for Fertility in California. In fact, among married women ages 15-44, 2.1 million (or 7.4%) were infertile in 2002, the latest period for which the Centers for Disease Control and Prevention (CDC) has statistics. And an impressive 9% of U.S. women ages 18-44 received fertility services, such as drugs, artificial insemination, embryo freezing and in vitro fertilization, that same year. Here are the top 10 fertility missteps: 1. Waiting too long You’re approaching 40 and still holding off on motherhood, wanting to climb one more rung on the career ladder. Besides, even women at age 55 bear children (with someone else’s eggs, in most cases). So what difference does a few more years make? A lot. Although you may be as fit as a teenager – exercising and eating healthfully – by age 42, your eggs are on life support, fertility experts say. As a woman ages, her number of eggs and their quality drop dramatically, says fertility specialist Mousa Shamonki, M.D., director of in vitro fertilization and assisted reproduction at University of California - Los Angeles' School of Medicine. Conception by the time a woman is in her late 30s and early 40s is difficult, and it becomes nearly impossible after age 45, Shamonki says. “Their bodies aren’t designed evolutionarily to get pregnant as easily later as when they’re in their teens and 20s,” she says. Usually, conception happens when an egg cell is released from a woman’s ovary, travels through a fallopian tube, and is fertilized by a man’s sperm. The fertilized egg undergoes many cell divisions on its way to the uterus, where it implants and grows. Embryo quality, however, diminishes as mothers-to-be age, while the possibility of chromosomal abnormalities increases, says Shari Brasner, M.D., an obstetrician and gynecologist affiliated with Mount Sinai Medical Center in New York. “Biologically, Mother Nature doesn’t care what your reasons are for delaying childbearing,” says Barry Brock, M.D., assistant clinical professor at UCLA’s department of obstetrics and gynecology. His advice: “If you’ve found your life partner and want kids, don’t wait.” 2. Sexually Transmitted Diseases (STDs) Oh, those college liaisons. So spontaneous, so passionate, so unprotected. Many produce an unwelcome outcome: STDs. Genital human papillomavirus, or HPV, is the most common sexually transmitted infection. It can result in cervical dysplasia, an abnormal growth of cells, and cancer, if undetected, says Shamonki. By the end of college, 70% of students have been infected with HPV, adds Shamonki. That can increase the risk of developing dysplasia. Procedures to remove those abnormal cells sometimes make it difficult to get pregnant or carry a baby to term. Chlamydia is another fertility ne’er-do-well. About 2.8 million cases of chlamydia and 718,000 cases of gonorrhea, which can co-exist with chlamydia, occur each year in the U.S., according to the CDC. Untreated, about 10%-15% of women with chlamydia develop pelvic inflammatory disease (PID), which can damage the fallopian tube and tissues in and near the uterus and ovaries, according to the CDC. As many as 93% of women who’ve had a fallopian-tube abscess due to PID cannot become pregnant afterward. Chlamydia also can cause fallopian-tube infections without any symptoms, permanently damaging the tubes, uterus and surrounding tissue. Other women may face a potentially life-threatening ectopic, or tubal, pregnancy. Even more STDs can affect labor and delivery, says Brasner. “Women with active herpes infections at the time of delivery need cesarean sections,” she says, because the mother’s disease can lead to potentially fatal infections in babies. Vaccines are available to protect girls and women against the types of HPV that cause most cervical cancers and genital warts. They are recommended for girls and women up to age 26, according to the CDC. “The HPV vaccine for pre-adolescents and adolescents should be a very high priority,” says David Soper, M.D., director of the Division of Gynecology and General Obstetrics at Medical University of South Carolina in Charleston. 3. Sperm count Fertility doesn’t depend on women alone. Men’s sperm must pass muster too. A low sperm count – fewer than 20 million sperm per milliliter of semen – means that the fluid the man ejaculates during an orgasm has too few sperm. A normal ejaculation should contain at least 39 million sperm, according to the Mayo Clinic. Some causes of a low sperm count: Infection: Chlamydia, gonorrhea and other infections can cause scarring in the testes that prevents passage of sperm. Hormone imbalances: Low testosterone, the result of abnormalities of certain glands, may cause infertility. Medications: Long-term anabolic steroid use, certain antibiotics (such as tetracyclines, erythromycin and neomycin) and some ulcer medicines (such as Tagamet) can impede fertility, according to Harvard Health Publications. Don’t worry, though. A woman can get pregnant even if her partner’s sperm underperform. Conception can occur with a low sperm count, but it often takes longer, says Norian. Treating low sperm count with medication (if the problem is hormonal) often helps boost the odds. 4. You can be too thin You’ve decided to take the pregnancy plunge. Fearing the weight gain that comes with it, you hit the treadmill like a college track star before you conceive, and achieve a weight worthy of a magazine cover. Big mistake. Lack of fat can slow production of the hormones needed for ovulation (which includes estrogen), says Norian. “Estrogen and testosterone [the latter of which stimulates sperm production] come from cholesterol,” he says. So, “a little fat is OK.” Plus, “your body tells you when you have weight trouble,” Brock adds. “If you lose your periods, gain some weight.” Ask your doctor to determine your ideal weight to optimize fertility. 5. Too much weight Don’t start eating for two before conception. Overweight women may also face problems getting pregnant. Why? Extra pounds can throw off normal hormone production, explains Brasner. That’s because too many fat cells lead to estrogen overproduction, resulting in irregular ovulation. Also, obesity may increase the risk of miscarriage. In overweight men, sperm motility (or movement) may be slowed and sperm count may go down because testes become too warm due to the additional weight, says Norian. Try to lose weight before trying to conceive, Shamonki advises. “The sweet spot is a BMI between 19 and 24,” Norian says. To learn your level, use our Body Mass Index calculator. Very obese women should lose 5% of their body weight, he adds. Even that small amount can start ovulation. 6. Over-exercising Yes, exercise is good for you. But running 40 miles a week? That won't help you if you're trying to get pregnant. Women who over-exercise risk losing body fat that helps produce estrogen, which spurs ovulation. They may experience infrequent or light periods, or their periods stop altogether. Exercising 4-5 days per week for 30 minutes, maintaining a heart rate of 120-130 beats per minute, is appropriate, says Norian. Men who exercise too much may also raise the internal temperature of their testicles (which should be 96°), causing sperm to die. Over-exercise can also affect sperm shape, a prime predictor of infertility, doctors say. 7. Dietary supplements Sometimes even a good thing, such as vitamins, turns bad. Too much vitamin A – stored in the body and sometimes taken in excess by women seeking to boost their antioxidant intake – can lead to birth defects, liver abnormalities and other disorders, according to the CDC. Women 19 years and older should take no more than 5,000 IU daily, of which at least 50% comes from beta-carotene, typically the amount in a multivitamin. “Black cohosh, an herb used by some women to treat menopause symptoms or boost fertility, is a definite no-no,” Norian says. The supplement is not regulated and could be harmful. Folic acid, on the other hand, is recommended. This B vitamin helps prevent neural-tube defects, such as spina bifida. Take only the daily recommended dose of any supplement. A daily multivitamin covers most women’s needs. Read supplement labels carefully. Some have hormones that “defeat the purpose of getting pregnant,” Norian says. For example, some women take dehydroepiandrosterone (DHEA) – a hormone produced naturally, and chemically in laboratories – to boost their fertility. It should be taken only under the supervision of a physician. Remember, too, that the Food and Drug Administration (FDA) doesn’t regulate herbs and vitamins. “So you don’t know the actual dosage you’re getting,” Brock says. “The contents in a bottle of vitamins may contain 0%-95% of what they say is in them.” 8. Lubricants What adds to your sexual pleasure may put you on a slippery slope to infertility. “Almost every lubricant can [harm] sperm,” Brock says. Check the label to make sure the liquid doesn’t contain a spermicidal ingredient. Nonoxynol-9, or N-9, for example, often is used by couples thinking they’re killing bacteria responsible for some STDs. In fact, it doesn’t protect against STDs, but it does kill sperm. If you must use a lubricant, choose a water-based – not petroleum-based – gel or cream, says Norian. That’s because petroleum slows down sperm. Put simply: The fewer barriers you put between sperm and egg, the easier it is to conceive. 9. Douching Don’t do it, doctors say. The old yarn about douching to produce the gender you want (acidic environment for girls and alkaline for boys) is unproven, and that tactic may do harm. “Our bodies weren’t designed to have stuff flushed backwards,” Norian says. Since the vagina isn’t sterile, it’s better not to inject contents back into the uterus and fallopian tubes, he explains. 10. Everything else Tobacco: Heavy smoking can damage your cervix and fallopian tubes, age your ovaries and deplete your eggs prematurely. Nicotine may also interfere with estrogen production and predispose your eggs to genetic abnormalities. Plus, smokers start menopause 2 years earlier than non-smokers. Butts out, doctors advise. Alcohol: Heavy drinking – more than 4 fluid ounces of wine or 10 ounces of weak beer at least three times a week may increase the risk of ovulation disorders. Although the American College of Obstetricians and Gynecologists (ACOG) advises women to avoid all alcohol during pregnancy, some doctors believe an occasional glass of wine or beer will not harm the fetus, according to a large University College of London study. Caffeine: Too much may damage fallopian tubes and contribute to endometriosis. A good rule of thumb is to start safe caffeine habits before trying to conceive, researchers say. ACOG recommends that pregnant women consume no more than 12 ounces of coffee (200 mg of caffeine – that means green tea and soda, too!) a day. Keep in mind that some Starbucks 12-ounce cups of coffee contain 320 mg of caffeine. Jacuzzis: All that hot water can put sperm in, well, hot water. Testicles sit outside the body for a reason, to remain cooler. “Anything that increases body temperature can have a negative impact on sperm quality,” Brasner says. When to see a doctor Doctors advise seeing a fertility specialist if: You’re older than 39 and haven’t conceived after three months You’re 35 or older and haven’t conceived after six months You’re under 35 and haven’t conceived after 12 months Also, if you have a history of fibroid tumors or bleeding between cycles, or if you’ve had trouble conceiving previously, get a physical exam before you start trying, Shamonki says. The good news: Following these tips, 85% of women find themselves starting a family after just one year. Women’s Health: How Much Do You Know? As a woman, your health concerns are as unique as your body. How you take care of yourself has a huge impact on your future, affecting everything from your ability to have children to your risk of heart disease. There's no substitute for good health, and when it's gone, it's often gone for good.