Photo credit: Julie Legge
CSP Team Note: We recently talked about infertility with Dr. Michelle Matthews, an OB/GYN and the medical director at Carolinas Medical Center Women’s Institute. This is such an important topic for all of us to learn more about as 1 in 10 couples will experience infertility. A big thank you to Dr. Matthews for taking the time for this interview.
I’m having a hard time getting pregnant. At what point do I need to seek help?
First, it’s important to know that the chance of becoming pregnant is often lower than most couples realize. The likelihood of conceiving each month is approximately 25 percent for a woman in her 20s or early 30s, and no higher than 5 to 10 percent for a woman in her early 40s. Based on those probabilities, it’s considered normal for it to take up to 12 months to get pregnant.
A couple should seek help if they haven’t conceived in one year. If the woman is 35 years or older, it’s recommended to seek help after 6 months.
You should see a healthcare provider sooner if you have:
– A family history of early menopause
– Irregular menstrual cycles
– Prior ovarian surgery
– Any risk of blocked fallopian tubes from prior surgery or pelvic infections
– A partner with a health issue that may decrease sperm counts
What is infertility?
Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. Notice that the definition of infertility doesn’t mention anything about how long you’ve formally been ‘trying’ to conceive.
Women often define ‘trying’ to conceive as tracking menstrual cycles and timing intercourse around ovulation by using apps, ovulation predictor kits, temperature charts, and cervical mucus. Medical professionals define ‘trying’ as regular intercourse a few times per week without using birth control, regardless of whether the couple is intentionally tracking ovulation or timing intercourse.
Is infertility as common in men as it is women?
Approximately 10 to 15 percent of couples will experience infertility. About one-third of fertility issues are related to the woman, about one-third to the male, and one-third of couples may have a fertility issue with both partners.
The female reproductive system is a bit more complicated than the male system. Women need to ovulate and release eggs properly. The fallopian tubes, which pick up and transport the eggs, need to be open and functioning properly. The uterus, or womb, needs to be able to receive the fertilized egg and sustain the pregnancy.
Male fertility issues are generally related to difficulties either ejaculating sperm or producing a normal number of motile sperm (or sperm that can move). Some health problems can increase the risk of fertility-related issues in men, such as obesity, smoking, diabetes, high blood pressure, and testosterone use.
How much do genetics play a role?
Some infertility problems can be genetic. For instance, gynecologic conditions may be more common in women in the same family, including some hormone imbalances such as polycystic ovarian syndrome (PCOS) and another condition, endometriosis.
Some male infertility may also be genetic – and sons of men with infertility may be at a higher risk of having fertility issues themselves.
The link between genetics and infertility is an area of active research.
How much does age play a factor?
It’s estimated that approximately 1 out of 5 couples are over the age of 35 before they attempt their first pregnancy. Delaying pregnancy until the 30s or later is common due to school, careers, and a desire to become established before building a family.
Fertility declines in women as a result of normal age-related changes in the ovaries. Women are born with all the eggs they’ll ever have – approximately 1 million. A woman will often first recognize changes in her menstrual cycle, which is an indication that her egg supply is diminishing. This generally will occur in her early 40s, as menstrual cycles start occurring a little earlier each month. Over time, a woman may start occasionally skipping menstrual cycles until they eventually stop completely. The reason eggs are gradually lost over time isn’t completely understood, but most eggs aren’t depleted during ovulation. Both egg supply and egg quality decrease with age, and the loss of fertility is related not just to egg loss, but also to deterioration in egg quality.
Male fertility tends to decline later than for women – generally in the mid to late 40s. While most age- related fertility issues in couples have traditionally been attributed to the woman, there’s increasing evidence that men also have age-related changes to their sperm health. There’s also some research supporting a higher risk of genetic and developmental problems in children born to fathers in their 40s, 50s and older.
What medical resources do we have locally dedicated to infertility care?
There are several local options for infertility evaluation and treatment. The CMC Women’s Institute, part of Atrium Health, has the full spectrum of fertility-related services and is the region’s only center where all physicians are board-certified in reproductive endocrinology and infertility.
It’s important to tailor the testing and treatment to the individual or couple. A common initial treatment to increase the chance of pregnancy per month may include fertility medications to enhance ovulation – this is often combined with intrauterine insemination, which is the placement of sperm into the uterus. A more advanced treatment is in vitro fertilization (IVF), a series of procedures where the egg and sperm are combined outside of the body.
Women can also freeze their eggs for the future. This is becoming more common as women are becoming more aware of the role age plays in fertility. Other services include gestational surrogates to carry pregnancies if needed, and genetic testing of fertilized eggs (embryos) is also available to assess age-related risks of genetic abnormalities.
Are there support groups in Charlotte for couples facing infertility?
We’re fortunate to have very skilled local fertility counselors that specialize in the challenges experienced by individuals and couples facing infertility and pregnancy loss. In addition, Resolve is a national organization with local chapters of peer-led support groups. More information can be found on their webpage at Resolve.org. Patients also often participate in chat rooms and forums they find online. Any of these options provide an opportunity for you to connect with others struggling with similar issues. It can be extremely helpful and empowering to have the support of people who understand the challenges of infertility and what you’re going through.