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Why Can’t I Get Pregnant?

Female Infertility

How Common is Female Infertility?

  • About 11% of women of reproductive age in the U.S. have experienced fertility problems.

    About 11% of women of reproductive age in the U.S. have experienced fertility problems.

  • Women are only half as fertile once they reach their 30s. After 35, a woman’s chance of conception declines significantly.

    Women are only half as fertile once they reach their 30s. After 35, a woman’s chance of conception declines significantly.

  • Female infertility factors contribute to approximately 50% of all infertility cases.

    Female infertility factors contribute to approximately 50% of all infertility cases.

Symptoms of Female Infertility

Female infertility is defined as trying to conceive for at least a year (six months if you’re over 35) with no success. Below are common signs and symptoms that may mean you need help getting pregnant:

  • Irregular, painful, or lack of a period

  • Hormonal fluctuations

  • Increased body weight

  • Advanced age

  • Pain during sex or lack of sex drive

Causes of Female Infertility

  • Polycystic Ovarian Syndrome (PCOS)

    1. A hormonal disorder that makes it difficult to get pregnant.
    2. With PCOS, the ovaries may develop numerous small collections of fluid and, in turn, fail to regularly release eggs and interfere with the development of ovarian follicles.
    3. The most common cause of female infertility is problems with ovulation. Ovulation problems may be brought on by one or more of the following:
      1. Hormone imbalance, tumor or cyst, eating disorders, alcohol or drug use, excess weight, stress, brief/irregular menstrual cycles, thyroid disease, lifestyle and environmental factors

  • Decreased Egg Quality

    1. Poor egg quality, decreased egg quality, or failure for an egg to mature properly can play a part in infertility and drops significantly with age. Most notably, after 35.

  • Tubal Blockage

    Damaged fallopian tubes may be brought on by one or more of the following:

    1. previous infections
    2. polyps in the uterus
    3. endometriosis
    4. previous ectopic pregnancy
    5. scar tissue or adhesions

  • Primary Ovarian Insufficiency

    1. Women with this condition have trouble getting pregnant, but it is not impossible. About 5-10% of women with POI become pregnant without the help of medical treatment.
Pie chart of infertility for women causes

“One of the most common questions that I’m frequently asked is what can I do in order to increase my chances of getting pregnant, and I would say that depends on your general state of health at this point in time.”

 

Treatments for Female Infertility

Female treatment options will depend on the cause of the initial problem, the age of the woman, history of any previous pregnancies, the male factor, and how long infertility issues have been known. Below are some common treatment options when it comes to female infertility:

Hormone Medications:

  • Oral medication that allows the female body to produce more of the hormones that cause the eggs to mature in their ovaries.

Gonadotropins or Human Chorionic Gonadotropin (hCG)

  • Hormone injections that stimulate the eggs growth within the ovaries, leading to successful ovulation.
  • Injections occur during the early stages of menstruation, for 7 to 12 days. As the woman is being treated, a doctor will monitor the growth of the eggs through an ultrasound.

Letrozole

  • An oral pill to help decrease the amount of estrogen a woman is producing, which then will stimulate her ovaries for the release of eggs.
  • Oral medication is taken during the first stages of menstruation, for about 3 days.

Surgical Treatments:

May be necessary when it comes to the following infertility causes:

Disease of the fallopian tubes

  • Surgery can repair or remove blockages.

Ectopic pregnancy, which is when the pregnancy occurs outside of the uterus.

  • Surgery of the fallopian tube is done in an effort to help fix these tubal pregnancies.

Patches of endometriosis

  • Surgery is done to help remove these patches, doubling the chances of a pregnancy.
  • Surgery can also be done in an effort to remove scarring, polyps, or uterine fibroids.

Health Conditions

In addition to medication and surgical treatments for female infertility, treatments to help specific health conditions called assisted reproductive technologies (ART) are available. The most common treatments in this category include:

MALE INFERTILITY

How Common is Male Infertility?

  • 9.4% of males in the U.S. are infertile.

    9.4% of males in the U.S. are infertile.

  • For males between 41-45, fertility declines by up to 7% with every additional year of a man’s age.

    For males between 41-45, fertility declines by up to 7% with every additional year of a man’s age.

Symptoms of Male Infertility

Aside from being unable to conceive a child, other signs and symptoms of male infertility include:

  • Issues with erection, ejaculation, or sexual function

  • Any pain discomfort, or swelling in the testicle area

  • Prior history of testicular, prostate or sexual problems

  • Previous groin, testicle, penis or scrotum surgery

Causes of Male Infertility

  • Medical Causes

    1. Varicocele
      • Swelling of the veins that drains the testicle, reducing the quality of sperm
    2. Infection
      • Inflammation of the epididymis or testicles, and some STDs (gonorrhea and HIV) can hinder sperm production, sperm health, or sperm motility
    3. Hormonal imbalance
      • Low testosterone levels may reduce sperm production
    4. Dificulties with sexual intercourse
      • Erectile dysfunction, premature or retrograde ejaculation, and painful intercourse

  • Environmental Causes

    1. Heat Exposure
      • Increased temperature in the scrotum may reduce sperm count and function
      • “Heat is very dangerous to sperm, that is why the testicles hang outside of the body because your sperm does not need to be at actual body temperature. This can change the shape of the sperm or cause them to not move as efficiently, so keeping the testicles cool avoiding hot baths, not wearing tight underwear, not doing mountain biking or anything where the testicles are compressed for a long period of time.” (Dr. Littman, video transcript)

  • Health & Lifestyle Causes

    1. Drug, alcohol, and tobacco use
      • Regular use lowers sperm production and quality
    2. Weight
      • Obesity can cause hormonal changes that reduce male fertility
      • “If you are technically overweight then the process of losing weight to a BMI of about 25 or less, but between 20 and 25 is most optimal for fertility.” (Dr. Littman, video transcript)
Pie chart of male infertility issues

Treatments for Male Infertility

Hormone Medications and Human Chorionic Gonadotropin (hCG):

  • A medication that prompts the pituitary gland to make the hormones that direct the testicles to produce more testosterone and more sperm.
  • HCG stimulates the testes to produce testosterone and sperm. And sometimes fertility drugs are used with ART treatment.

Surgical Treatments

  • Surgery for a varicocele

Lifestyle Changes

Lifestyle changes including:

  • Diet
    • Eat a healthy and well-balanced diet full of fruits, vegetables, and whole grains
    • “I always encourage my male patients to eat a lot of broccoli, spinach, and asparagus which are all very high in folic acid. And then, to eat blueberries, raspberries, and pomegranates, all of these fruits are very high in antioxidants.” (Dr. Littman, video transcript)
  • Alcohol and drug use
    • Avoid cigarettes and any drugs that may affect sperm count or sexual function
  • Exercise
    • Exercise regularly to reduce risk of obesity, which can be associated with infertility