Fertility and Getting Pregnant: What You Need to Know
Fertility, of course, is essential to the ongoing survival of the human species. And yet surveys have shown that a fair number of people still don’t fully understand the realities of conception and fertility.
For example, consider research that surveyed 1,000 women between ages 18 and 40 in the United States. The researchers reported that while 40 percent of the participants expressed concerns about their ability to conceive, one-third of them were unaware of adverse effects that sexually transmitted infections (STIs), obesity, or irregular periods could have on their ability to procreate, and 40 percent were unfamiliar with the ovulatory phase. (1)
“It is still very common for women to have basic misunderstandings about fertility in terms of pregnancy/family planning,” says Toni Weschler, MPH, the author of Taking Charge of Your Fertility and Cycle Savvy.
One of the most prevalent myths about fertility, Weschler says, is that ovulation always occurs on day 14. The truth is, the timing of ovulation can vary from one woman to another, even from one cycle to the next in the same woman. But that doesn’t mean that a woman can spontaneously ovulate at any time in the cycle, as some people believe, Weschler says. “Once a woman ovulates [in a particular menstrual cycle], there are usually about two weeks before her next cycle starts with a period and it is not possible for her to ovulate again until the following cycle.”
The reason: Once ovulation occurs, the hormone progesterone is secreted in the second half of the menstrual cycle, and progesterone suppresses the release of other eggs until the following cycle, Weschler says. Meanwhile, women are fertile for only a few days around ovulation, which is another thing many women don’t fully understand, so once that baby-making window has closed, it remains shut until she next ovulates.
Some people also don’t realize the extent to which age can affect a woman’s fertility. In a small study from 2013, researchers interviewed 61 women who delivered their first child after age 40 through in vitro fertilization (IVF). They found that 30 percent of the women expected their fertility to decline gradually until menopause, around age 50, and 31 percent said they expected to get pregnant without difficulty at age 40. What’s more, 44 percent said they were “shocked” and “alarmed” to discover that their understanding of the time frame for age-related reproductive decline was inaccurate. (3)
The reality: “Age delivers the harshest blow to fertility, causing a mild decline at age 35, a precipitous drop at age 38, and another whopping one at 40,” notes Joseph A. Hill, MD, a reproductive endocrinologist and infertility specialist at the Fertility Centers of New England in the Boston area. During these time spans, the majority of a woman’s chromosomally competent eggs disappear. A female is born with all the eggs she will ever have — approximately one to two million — and the number declines to 300,000 to 500,000 at puberty. ( 4) After that, fertility continues to drop, hitting a dramatic slide in a woman’s late thirties.
RELATED: What to Say (and NOT to Say) to Someone Living With Infertility
Beyond age, though, STIs like chlamydia and gonorrhea can damage fertility — for both women and men. (5)
Learn More About STDs: What They Are and Who Gets Them
Another major fertility spoiler is smoking, which is toxic to eggs and embryos and increases the risk of miscarriage, Dr. Hill says.
Being significantly overweight or underweight also can decrease a woman’s chance of getting pregnant by disrupting her proper balance of hormone levels; so can excessive exercise or athletic training and heavy alcohol use. (6)
When you’re having trouble getting pregnant, going to a fertility clinic can be an overwhelming experience. Besides being stressful in its own right, infertility comes with a whole vocabulary that may sound foreign to you. It helps to read about the journey before you go through it: tests, drugs, or treatments that may be recommended for you, depending on the suspected root cause of your problem, as well as the potential costs.
Learn More About Essential Facts About In Vitro Fertilization and Other Fertility Treatments
It’s easier said than done, but it is important to keep an open mind, manage stress, and manage expectations.
Because a woman is born with all the eggs she will ever have, “even if a woman eats well, exercises, and is a healthy weight, her eggs will still be as old as her chronological age,” Weschler says. “This reality can be incredibly frustrating and more than a tad inequitable when it comes to female fertility. So there really is a biological reason why women should try to have children before 40, and realistically even earlier, if possible.”
Medical Conditions and Disease Symptoms May Compromise Fertility
In addition, underlying medical conditions such as poorly controlled diabetes, certain thyroid disorders, and celiac disease can compromise a woman’s fertility, notes Mary Ellen Pavone, MD, an associate professor of obstetrics and gynecology at the Northwestern University Feinberg School of Medicine in Chicago. The same is true of endometriosis and polycystic ovary syndrome (PCOS). (5,6)
RELATED: What Is Silent Endometriosis?
Figuring out your fertility status, as well as how to safeguard and maximize your fertility, can be a confusing proposition. These resources can help make it easier.
American College of Obstetricians and Gynecologists (ACOG)
ACOG is a go-to source for research-supported fertility, conception, pregnancy, and women’s health news and best practices. In fact, Everyday Health writers and editors make a point to attend ACOG’s annual meeting to learn about the latest breakthroughs in these areas. We also love that ACOG’s website has a special section just for patients that’s packed with FAQs, infographics, and more.
ReproductiveFacts.org is the patient-centered arm of the American Society for Reproductive Medicine. This well-respected, one-stop shop for all thing fertility offers concise and thorough brochures and booklets on assisted reproductive technology, the Zika virus, sexual dysfunction, and other key reproductive health issues. It’s also a great resource for the latest in fertility news and research breakthroughs.
The Office on Women’s Health is part of the U.S. Department of Health and Human Services (HHS), and its website is packed with the most up-to-date facts on such topics as the weight and fertility connection, male infertility, and more.
Resolve: The National Infertility Association
Resolve is a national patient advocacy organization that provides free support services in more than 200 communities. The organization not only points you to in-person support but also offers a help line (866-NOT-ALONE) where you can connect with exactly the trained volunteer you need. For instance, if you’ve been newly diagnosed with infertility, you’re advised to press 1; dealing with male factor infertility, press 5; secondary infertility, press 8.
Reproductive Health Access Project
This organization offers comprehensive fact sheets about miscarriage and its treatment options, along with related subjects. They also spearhead the Miscarriage Care Initiative, which works to expand access to evidence-based, patient-centered miscarriage care in a primary care settings.
In 2015, Jessica Zucker, PhD, a clinical psychologist who specializes in reproductive and maternal mental health, launched her Instagram account in order to highlight how common pregnancy loss is — and to offer a community of support. Today, it has more than 35,000 followers.
Society for Assisted Reproductive Technology
On SART’s website you can find fertility clinics by ZIP code, state, or region — and you can locate each clinic’s latest success rate statistics by clicking “Success Rates and Clinic Details.” The SART site also features a quiz to help determine if IVF treatment will be successful for you.
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