Facts, Diagnosis, and Risk Factors

General Health

The following are factors which can affect your ability to ovulate, conceive, or carry a pregnancy to term:

• excessive, or very low, body fat can affect ovulation and fertility
• chronic diseases, such as diabetes, hyper or hypothyroidism, lupus, arthritis, hypertension, or asthma—tell your doctor about prescription medicines that you are currently taking
• abnormal pap smears which have resulted in treatment such as cryosurgery or cone biopsy
• your mother took DES when she was pregnant with you — tell your doctor so an x-ray can be done to assess the size and shape of your uterus
• hormonal imbalance—periods exceeding six days, cycles shorter than 24 days or more than 35 days apart; irregular, unpredictable cycles, very heavy periods, excessive facial hair, or acne on face, chest, abdomen
• multiple miscarriages—two or more early pregnancy losses
• environmental factors—cigarette smoking or alcohol consumption, exposure to workplace hazards or toxins

Age: Even if your fertility does not seem at risk now, remember that fertility declines with age. A woman in her late 30’s is about 30% less fertile than she was in her early 20’s. See your doctor if you are over 30 and have been trying to conceive for six months or more.

Sexually Transmitted Diseases(STDs): Twelve million cases of newly diagnosed STDs occur in the USA annually, with one quarter of those acquired by teenagers. Some STDs can be asymptomatic. They are transmitted more easily to women, and can lead to pelvic inflammatory disease (PID) in women, and epididymitis in men. Complications are more common in women, including subsequent scarring, miscarriage, adhesions, blocked tubes, and ectopic pregnancy. Ultimately, infertility can be a consequence of STDs.

To decrease this risk:

• consider that people in mutually monogamous relationships with an uninfected partner have the lowest risk of getting an STD
• use latex condoms for contraception
• detect and treat infections early. Both partners should be treated simultaneously if one has an infection

Tubal Disease: Fallopian tube disease accounts for about 20% of infertility cases treated. 

If you are having trouble conceiving, or are worried about your future fertility, be sure to tell your doctor if you have had:

• STDs, such as gonorrhea, syphilis, or chlamydia, pelvic pain, unusual vaginal discharge, bleeding or fever, pelvic surgery for ruptured appendix, ectopic pregnancy, or ovarian cyst
• an IUD for contraception
• two or more abortions

Remember, use of a condom can be effective in preventing the spread of STDs. If you have an infection, your partner must be treated also. A specialist can assess the health of your uterus and tubes with an x-ray known as a hysterosalpingogram (HSG).

Endometriosis: Endometriosis is a disease in which uterine tissue is found outside of the uterus; on the ovaries, fallopian tube, and often on the bladder and bowel. It can occur in menstruating women of all ages, including teens. While the connection between endometriosis and infertility is not clearly understood, early detection may result in successful control and preservation of fertility.

Be sure to report these symptoms to your doctor:

• painful menstrual cramps that may be worsening with time
  extremely heavy menstrual flow
• diarrhea or painful bowel movements, especially around your period
• painful sexual intercourse

Endometriosis runs in families, so it is important to tell your doctor if your mother or sisters had symptoms or were diagnosed with the disease. It may be symptom-less, however, and diagnosis may only be confirmed with an outpatient surgery known as laparoscopy.

Infertility is not solely a women’s problem. About 30% of infertility cases involve male factor problems alone, and 30% of cases involve problems with both partners. Many researchers believe the causes of declining male fertility during this century are environmental; they include pesticide and chemical exposure, drug use, radiation, and pollution.

The following is a partial list of environmental risk factors to male fertility:

• exposure to toxic substances or hazards on the job, such as lead, cadmium, mercury, ethylene oxide, vinyl chloride, radioactivity, and x-rays
• cigarette or marijuana smoke, heavy alcohol consumption
• prescription drugs for ulcers or psoriasis
• DES exposure in utero
• exposure of the genitals to elevated temperatures — hot baths, whirlpools, steam rooms

Medical risks to male fertility include:

• hernia repair
• undescended testicles
• history of prostatitis or genital infection
• mumps after puberty

Many of the risk factors for both male and female infertility are the same.

These include:

• Age: A woman’s age can affect her fertility. By age 40, a woman’s chance of pregnancy has decreased from 90 percent to 67 percent. By age 45, the chance of becoming pregnant declines to 15 percent. Infertility in older women may be due to a higher risk of chromosomal abnormalities that occur in the eggs as they age. Older women are also more likely to have health problems that may interfere with fertility. The risk of miscarriage also is much greater for older women.
• Emotional factors: Depression and stress may have a direct effect on the hormones that regulate reproduction and affect sperm production or ovulation.
• Occupational and environmental risks: Studies suggest that prolonged exposure to high mental stress, high temperatures, chemicals, radiation, or heavy electromagnetic or microwave emissions may reduce fertility in both men and women
• Unprotected sex: Having multiple sex partners and not using condoms may increase the risk of sexually transmitted diseases (STDs) that can cause infertility in both men and women.
• Smoking: Smoking may increase the risk of infertility in women and may reduce sperm production in men.
• Alcohol use: Even moderate alcohol intake – as few as five drinks a week – can impair conception.
• Being overweight: Body fat levels that are 10 percent to 15 percent above normal can overload the body with estrogen, throwing off the reproductive cycle.
• Being underweight: Body fat levels 10 percent to 15 percent below normal can completely shut down the reproductive process. Women at risk include those with eating disorders, such as anorexia nervosa or bulimia, and women on a very low-calorie or restrictive diet. Strict vegetarians also may experience infertility problems due to a lack of important nutrients such as vitamin B-12, zinc, iron and folic acid. Marathon runners, dancers and others who exercise very intensely are more prone to menstrual irregularities and infertility.