What Is Fertility?

What Is Fertility?

Fertility is the natural capacity to conceive a child. Fertility does not come easily to everyone. About 11% of couples will face infertility—the inability to conceive naturally after one year of unprotected sexual intercourse.

Fertility is not only a female health issue. People of all genders can experience infertility, and everyone can take steps to improve their fertility.

Here's a look at what you can do to improve your fertility, increase the odds that you’ll conceive quickly, and reduce your risk of infertility.

Signs of a Fertility Problem

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 don’t have obvious symptoms. However, the following signs might indicate a fertility problem and warrant a call to a healthcare provider:

• You are age 35 or older, and you've been trying get pregnant for six months.
• You're younger than 35 and have had unprotected sexual intercourse for one year without getting pregnant.
• You have had two or more successive pregnancy losses.
• You have any risk factors for infertility.

The most common symptoms of a fertility problem are:

• Irregular menstrual cycles
• Unusually light or heavy bleeding and 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)

Causes of Infertility

Some factors that may reduce your fertility are within your control. 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, age-related fertility decline.

Age

Female fertility peaks from the early to mid-20s, and after age 35, it starts to rapidly decline. Male fertility also declines with age, though not as dramatically. While some men are still fertile after age 50, people with uteruses are completely infertile after menopause.

Chronic Diseases

Even if a disease is not directly related to the reproductive system, it can still impact fertility. Several chronic diseases, along with their treatments, can lead to fertility problems in people of any sex, including:

• Diabetes
• Hypothyroidism
• Periodontal disease
• Untreated celiac disease

Hormonal Imbalances or Diseases of the Reproductive System

Hormonal imbalances can reduce fertility or even cause infertility. For example, endometriosis, polycystic ovary syndrome, and premature ovarian failure (also known as primary ovarian insufficiency) can lead to female infertility. Low testosterone can lead to male infertility.

Infection of the Reproductive Tract

Reproductive tract infections can result in infertility. The most common cause of these infections is sexually transmitted diseases (STDs). This can cause pelvic inflammatory disease (PID) in the female reproductive system. 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.

Medication Side Effects

Some medications may reduce fertility, including:

• Allergy medications, which may dry up cervical mucus
• Antidepressants, which may cause fertility problems for men
• Certain types of cancer treatment (radiation therapy near reproductive organs)

Obesity

Obesity is one of the leading causes of preventable infertility. Even being slightly overweight can reduce female fertility. Obesity can cause ovulation problems and may reduce sperm health.

Reproductive Tract Blockages or Abnormalities

Problems with the ovaries, fallopian tubes, or uterus can cause fertility problems. Issues with the testes, vas deferens, prostate gland, or seminal vesicles can cause male infertility.

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).

Many people are unaware that they have these conditions. They may cause no symptoms and go undetected during routine medical visits. But specialized fertility testing can uncover them.

Unhealthy Lifestyle Habits

Smoking, excessive drinking, and recreational drugs can reduce fertility for people of all genders. Less dramatically, more common unhealthy lifestyle habits like not getting enough sleep, too much stress, and eating an unhealthy diet may slightly reduce fertility.

Unexplained Infertility

About one in four couples never find out why they can’t conceive. This is known as unexplained infertility.

Fertility Basics

There are many steps in the fertility process. This is what needs to happen for a cisgender, heterosexual couple to conceive without assistance.

Egg and Sperm Production

A woman’s reproductive system must produce the hormones that result in ovulation, which is when an egg is released from one of the ovaries. This occurs once per month during the childbearing years.

A man’s reproductive system must produce sperm cells in the testes. After puberty, new sperm cells are generated daily.

Sexual Intercourse

A couple must have sexual intercourse (or semen must come in contact with the vaginal area) during the five to six days prior to ovulation.

During ejaculation, sperm stored in the vas deferens gets mixed together with semen created in the prostate and seminal vesicles. This mixture of sperm and fluid is forced out from the penis by a series of muscular contractions.

Fertilization

After sexual intercourse, semen collects in the cervical area. Next, sperm cells must swim out from the semen and into the cervical mucus, through the cervical opening into the uterus, and on to the fallopian tubes.

The strongest and healthiest sperm (a very small percentage of the total) linger in the fallopian tubes. After an egg is released from one of the ovaries, it enters the fallopian tubes. In the fallopian tubes, one of the waiting sperm cells burrows itself into the egg. This is the moment of fertilization.

Implantation and Pregnancy

After ovulation, the reproductive system releases a new cocktail of hormones that builds up the endometrium, or uterine lining. The fertilized egg (or embryo) goes through a series of cell divisions. As this is happening, the embryo travels down the fallopian tube into the uterus.

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.

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. About one week later, or approximately 14 days after ovulation, there is enough circulating hCG for a pregnancy test to give a positive result.

How to Boost Fertility

While some causes of infertility can't be overcome without treatment, you can increase your odds of conception with these simple strategies.

Avoid Douching

Vaginal douching can wash away the valuable cervical mucus you need to get pregnant. Douching can also wash away good bacteria, leading to an increased risk of vaginal infection. 

Choose Lubricants Wisely

Personal lubricants, like Astroglide and KY Jelly, are harmful to sperm. However, there are sperm-friendly options, including mineral oil, canola oil, or hydroxyethylcellulose-based lubricants such as Pre-Seed and ConceivEase.

Optimize the Time You Have Sex

You want to have sexual intercourse during your fertile window, which lasts between five and eight days, and occurs just before ovulation. However, keep in mind that the day of ovulation varies; it could be as early as day 10 or as late as day 22. Your odds of conceiving the day before ovulation are between 21% and 34%, and between 8% and 17% four days before ovulation.

Assuming you and your partner are fertile, there are many methods for detecting ovulation so you can determine your fertile window, including:

• Charting your body basal temperature
• Checking for cervical position changes
• Checking your cervical mucus
• Tuning into your body’s sexual desire (your libido is higher when you’re most fertile)
• Using an ovulation chart, calendar, or calculator

Have Sex More Often

If you have sex every other day or every two days, you're likely to have sex at least once or twice during your most fertile time. Many people think having sex daily is helpful, but sperm takes one or two days to fully mature and regenerate. So if you have sex every day, sperm may be immature.

Improve Your Overall Health

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. For example, if your fallopian tubes are blocked, your diet isn’t going to help you conceive naturally.

Consider both making lifestyle changes and getting medical care. Some things you can do that may improve your fertility include:

• Eating a wholesome diet, with lots of antioxidant-rich vegetables and fruits, healthy fats like olive oil and nuts, and healthy protein
• Exercising, but not over-exercising
• Getting enough sleep at night, at the right hours (night-shift workers may be at a higher risk of miscarriage and infertility)
• Maintaining a healthy weight—not too heavy or too thin
• Practicing mind-body and relaxation techniques
• Taking a folic acid supplement
  

Fertility Testing and Treatment

If you are concerned that you might have a fertility problem, the first person you should speak to is your gynecologist or urologist.

These doctors can perform some basic fertility testing, such as:

• An hysterosalpingogram (HSG), which is a special kind of x-ray used to evaluate the uterus and fallopian tubes
• Blood work to measure hormone levels
• Semen analysis

Depending on your age and the results of your fertility testing, your doctor may try to treat you with low-tech fertility treatments (like Clomid, a medicine that helps stimulate ovlulation), or refer you to a reproductive endocrinologist.

A reproductive endocrinologist is a physician with special training as a fertility specialist. They 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, and may include:

• Assisted reproductive technologies (ART): In vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT)
• Injectable fertility drugs: Gonadotropins (Gonal-F, Follistim, Ovidrel)
• Insemination: Intracervical insemination (ICI), intrauterine insemination (IUI), intratubal insemination (ITU), intravaginal insemination (IVI)
• Oral fertility drugs: Arimidex (anastrozole), Clomid (clomiphene), Femara (letrozole)
• Surgery: Laparoscopic surgery, ovarian drilling
• Third-party reproduction: Using an egg donor, embryo donor, sperm donor, or gestational carrier
• Treatment of an underlying medical condition, or tapering of any medications causing reproductive side effects
• Weight loss and other lifestyle changes

Coping With Infertility

Coping with infertility is not easy. 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.

To help manage this stress, consider joining a support group. Connecting with others who understand the unique frustrations and grief of infertility can help you and your partner feel less isolated.

Self-care is also important. In addition to eating healthy, exercising, and getting enough sleep, self-care also means managing stress. Mind-body therapies like yoga and acupuncture can help reduce fertility stress.

You might also want to get involved in the life of a child, whether through friends or family or with a volunteer group. While being around children may be painful during the early days of infertility, over time some people find involvement with kids to be a healing experience.

You should also feel empowered to seek professional help if you need it. A trained infertility counselor can help you better navigate the anxiety and depression that often accompany infertility.

A Word From Verywell

If you’re facing infertility, you have a reason for hope. The majority of couples will be able to get pregnant with the help of fertility treatments, surgery, or lifestyle changes. For those who don’t conceive even with help, there are alternative options for family building or moving on with your life.

Whatever you do, 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. Loved ones want to help, so let them.