An Overview of Fertility

Fertility is defined as the natural capacity to conceive a child. However, fertility does not come easily to everyone; about 11 percent of couples will face infertility—the inability to conceive naturally after one year of unprotected sexual intercourse.

There are things you can do to improve your fertility, increase the odds that you’ll conceive quickly, and reduce your risk of infertility. The more you know, the better. Fertility is not only a female heath issue. Both men and women can take steps to improve their fertility, and both men and women can experience infertility.

If you’re facing infertility, you have a reason for hope. The vast majority of couples will be able to get pregnant with the help of fertility treatments, surgery, or lifestyle changes.

For those that don’t conceive even with help, there are alternative options for family building or moving on with your life.

Here’s a very brief overview of what needs to happen for a couple to conceive naturally.

1. A woman’s reproductive system must produce the cascade of hormones that will result in ovulation. Ovulation is when an egg is released from one of the ovaries. This occurs once per month during a woman’s childbearing years.
2. A man’s reproductive system must be producing sperm cells in the testes. After puberty, new sperm cells are generated daily.
3. A couple must have sexual intercourse (or at the very least, semen must come in contact with the vaginal area) during the five to six days prior to ovulation.
4. During ejaculation, sperm in the vas deferens gets mixed together with semen created in the prostate and seminal vesicles. (The male testes create sperm cells, and then those sperm cells are stored in the vas deferens.) This mixture of sperm and fluid is forced out from the penis by a series of muscular contractions.
5. After sexual intercourse, semen (ideally) collects in the cervical area. Next, sperm cells must swim out from the semen and into the woman’s cervical mucus.
6. The sperm then must swim up through the cervical opening into the uterus. From the uterus, the sperm now swim to the fallopian tubes.
7. The strongest and healthiest sperm (a very small percentage of the total) will linger in the fallopian tubes until an egg comes along.
8. After an egg is released from one of the ovaries, it is gently guided into the fallopian tubes.
9. In the fallopian tubes, one of the waiting sperm cells eventually burrows itself into the egg. This is the moment of fertilization.
10. After ovulation, the woman’s reproductive system releases a new cocktail of hormones that builds up the endometrium, or uterine lining.
11. The fertilized egg (or embryo) goes through a series of cell divisions.
12. As this is happening, the embryo continues to travel down the fallopian tube into the uterus.
13. Once the embryo reaches the uterus, it eventually implants itself into the uterine lining, or endometrium. This occurs about four to 10 days after fertilization.
14. After implantation, the embryo creates both fetal cells and placental cells. The hormone human chorionic gonadotropin (hCG), or "the pregnancy hormone," will begin to be produced.
15. About one week later, or approximately 14 days after ovulation, there is enough circulating hCG for a pregnancy test to give a positive result.

Assuming you and your partner are fertile, there are things you can do to get pregnant faster.

Number one is to optimize the time you have sex. You want to have sexual intercourse during your fertile window.

The fertile window lasts between five and eight days, and it occurs just before ovulation. There is a misconception that ovulation occurs on day 14 of the menstrual cycle. The truth is that the day of ovulation varies from woman to woman. Some may ovulate as early as day 10, others as late as day 22.

You are most likely to get pregnant if you have sex one to two days before you ovulate. Your odds of conceiving the day before ovulation are between 21 percent and 34 percent. Compare that to four days before ovulation, when your odds are between 8 percent and 17 percent.

There are many methods and signs for detecting this very fertile time. The best two methods are checking your cervical mucus (easier than it sounds) or using ovulation predictor tests (also pretty easy, but you’ll need to buy test strips.)

You could also:

• Chart your body basal temperature
• Check for cervical position changes
• Tune into your body’s sexual desire (Your libido is higher when you’re in fertile-mode.)

You can further optimize your fertility by having frequent sexual intercourse, using sperm-friendly lubricants, and avoiding douching (a good practice regardless).

For women trying to conceive, every month is split into two time periods: before ovulation, when you’re trying to have sex before the egg is released, and after ovulation, when you’re waiting to take a pregnancy test.

The time period between ovulation and your expected period is known as the two-week wait.

The ideal time to take a pregnancy test is one day after your period is due. For example, if your cycles are usually 30 days long, you will want to take a pregnancy test on day 31 or later.

It’s better if you avoid taking tests before your period is due. If you take the test early, you’re unlikely to get a positive result even if you are pregnant. Plus, it can increase your stress levels.

You’ve likely spent time looking up early pregnancy symptoms online, trying to figure out if you’re pregnant before pregnancy test day.

The truth is that you can’t tell if you’re pregnant just by how you feel. Sometimes, women feel pregnant when they aren’t—and sometimes they don’t feel pregnant when they are.

Research has found that some healthy lifestyle habits may lead to improved fertility or at least a reduced risk of infertility. Making lifestyle changes may or may not impact actual infertility, and it shouldn’t be considered as equally effective as fertility treatments. You should consider both making lifestyle changes and getting medical care.

For example, if your fallopian tubes are blocked, your diet isn’t going to help you conceive naturally. Diet may or may not improve your odds of fertility treatments working, but there’s currently no research to prove this.

Some things you can do that may improve your fertility include:

• Make sure you’re at a healthy weight—not too heavy or too thin.
• Eat a wholesome diet, with lots of antioxidant-rich vegetables and fruits, healthy fats like olive oil and nuts, and healthy proteins.
• Avoid emotional eating or junk food binges.
• Get enough sleep at night, at the right hours. (Night-shift workers may be at a higher risk of miscarriage and infertility.)
• Exercise, but don’t over exercise.
• Take a folic acid supplement.
• Practice mind-body and relaxation techniques.

Learn more about how you can boost fertility:

• 8 Bad Habits to Drop to Improve Your Fertility
• 10 Ways Men Can Improve Their Fertility

You should be concerned about your fertility if any of the following three apply to you:

• You have had unprotected sexual intercourse for one year without getting pregnant.
• You have worrisome symptoms or any risk factors for infertility.
• You have had two or more successive pregnancy losses.

You should contact your doctor if any of the above relates to your experience.

Also, if you are age 35 or older, then you should see your doctor if you don’t get pregnant after six months. This is because your fertility is naturally declining more rapidly.

The most common signs and symptoms of a fertility problem are:

• Irregular menstrual cycles
• Unusually bad menstrual cramps
• Unusually heavy periods or abnormal menstrual bleeding
• Pelvic pain or pain during sexual intercourse
• Sexual dysfunction (including erectile dysfunction or low libido)

Not every person will experience symptoms or signs of a fertility problem, however. In fact, it’s common for a couple to only discover they have a fertility issue after they have tried to get pregnant unsuccessfully for a year. Many causes of infertility are “silent” and don’t have obvious symptoms.

There are some things that may reduce your fertility that you have control over. For example, smoking reduces fertility in men and women, so quitting is advised (for this and, of course, many other reasons).

Other causes for reduced fertility are not within your control. For example, fertility goes down with age. While you might be able to try and have kids at a younger age, you really can’t do anything to stop the age-related fertility decline.

Here are some causes of reduced fertility or infertility:

• Age: Female fertility peaks in a woman’s early to mid-twenties, and after age 35, starts to rapidly decline. Male fertility also goes down with age, though not as dramatically. While some men are still fertile after age 50, women after menopause are completely infertile.
• Obesity: Obesity is one of the leading causes of preventable infertility. Even being slightly overweight can reduce female fertility. Obesity can cause ovulation problems in women and may reduce sperm health in men.
• Unhealthy lifestyle habits: Smoking, excessive drinking, and recreational drugs can reduce fertility. This is true for men and women. Less dramatically, more common unhealthy lifestyle habits (like not getting enough sleep or eating an unhealthy diet) may slightly reduce your fertility.
• Infection of the reproductive tract: Both men and women can become infertile after a reproductive tract infection. The most common cause of these infections is sexually transmitted diseases (STDs). In women, this can cause pelvic inflammatory disease (PID). Men can also become infertile after contracting an STD. However, not all reproductive tract infections are caused by STDs. For example, some medical procedures can cause an infection.
• Reproductive tract blockages or abnormalities: Problems with the ovaries, fallopian tubes, or uterus can cause fertility problems for women. Issues with the testes, vas deferens, prostate gland, or seminal vesicles can cause problems for male fertility. Blockages or abnormalities may be present from birth (congenital abnormalities), the result of an injury or medical procedures, or occur after a disease or infection. Most commonly, blockages are caused by adhesions (scar tissue).
• Hormonal imbalances or diseases of the reproductive system: Hormonal imbalances in both men and women can reduce fertility or even cause infertility. For example, endometriosis, polycystic ovarian syndrome, and premature ovarian failure (also known as primary ovarian insufficiency) can lead to female infertility. Low testosterone can lead to male infertility.
• Underlying disease or disorder: Even if a disease is not directly related to the reproductive system, it can still impact fertility. Some untreated disorders and diseases may lead to infertility in men or women. For example, celiac disease can lead to infertility if the man or woman is eating gluten. Untreated diabetes or a thyroid imbalance can also cause infertility.
• Medication side effects: Some medications may reduce fertility in men and women. For example, allergy medications may dry up cervical mucus. Some antidepressants may cause fertility problems for men.
• Cancer treatment: Speaking of side effects, cancer treatment can reduce fertility or cause infertility in men and women. It depends on the cancer treatments used. It may be possible to freeze sperm, eggs, or embryos before cancer treatment.
• Unexplained causes: About one in four couples never find out why they can’t conceive. This is known as unexplained infertility.

If you’re a woman and are concerned that you might have a fertility problem, the first person you should speak to is your gynecologist. Men should see a urologist.

It’s very important that you are both tested. Make sure your doctor orders a semen analysis for your partner and doesn't only test your fertility. Male infertility is either alone or together with female infertility the cause for why a couple can’t get pregnant at least 40 percent of the time.

Basic fertility testing involves blood work, semen analysis for the man, and an HSG for the woman (which is a special X-ray that shows whether or not the fallopian tubes are open.)

If you’re feeling anxious about fertility testing, you’re not alone. Try to remember that testing is the first step to getting help.

Depending on the results of your fertility testing, your doctor may try to treat you with low-tech fertility treatments (like Clomid), or your doctor may refer you directly to a reproductive endocrinologist.

A reproductive endocrinologist is one kind of fertility specialist. They usually work in a fertility clinic, together with other fertility technicians, doctors, and nurses. Once you’re referred to a fertility clinic, further testing may be conducted.

Your fertility treatment options will depend on the cause of your infertility.

Some possibilities include...

• Lifestyle changes
• Weight loss
• Treatment of an underlying medical condition
• Changing medication, if a side effect is reduced fertility; never change or stop taking a medication without a discussion with your doctor
• Surgery
• Oral fertility drugs, like Clomid or letrozole
• Injectable fertility drugs
• Insemination, most common intrauterine insemination (IUI)
• In vitro fertilization (IVF)
• Third-party reproduction (using an egg donor, embryo donor, sperm donor, or surrogate)

Eighty to 90 percent of couples are treated with medications or surgery. IVF is not required for the majority of infertile couples.

The cost of fertility treatment varies and will also depend on your insurance coverage.

While Clomid treatment is relatively inexpensive (between $10 and $50 per cycle for the most basic treatment), an injectable cycle can cost a few thousand dollars, and an IVF treatment cycle costs $15,000, on average.

Fertility treatment can also be stressful. It’s important that you reach out for support and take time for self-care.

Not everyone decides to pursue fertility treatments. Also, some couples will decide to stop pursuing treatment for a variety of reasons.

Options besides fertility treatment include:

• Continuing to try on your own naturally
• Considering foster parenting
• Considering adoption
• Living a child-free life

Not having your own biological children doesn’t mean you can’t be involved in the life of a child. While being around children may be painful during the early days of infertility, over time, some men and women find involvement with kids to be a healing experience.

When you don’t get pregnant as quickly as you expected, it’s normal to experience stress. Research has found that women with infertility experience similar levels of psychological stress as those who face cancer, HIV, and chronic pain.

Coping with infertility is not easy. Be sure to take good care of yourself. Mind-body therapies like yoga and acupuncture can reduce fertility stress, as can seeing a trained counselor.

Also be sure to reach out for support from fellow trying-to-conceivers (who will understand where you’re coming from) and your "fertile Myrtle" friends.

Whatever you do, please don’t keep your fertility problems a secret. There is no reason to be ashamed, and you don’t need to deal with infertility alone. People want to help. Let them.