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How Your Past Could Affect Your Fertility Today

Most women embark on baby-making hoping to hit the jackpot without much trouble, and willing to do whatever it takes for their children to be born healthy. That means eating right, exercising, forgoing alcohol and tobacco. But even current paragons of virtue have pasts, and many women trying to conceive today may have nagging worries about the beer they drank in college, the cigarettes they snuck in high school, the crazy diets they went on as teenagers, etc. Could any of these past “indiscretions” come back to haunt them now? What about past illnesses or surgeries? If months pass without as much as a glance between sperm and egg, that anxiety can increase. Something in the past must be to blame, right?

Wrong. The truth is, it’s unlikely that former habits, lifestyle choices, or health crises have any bearing on current fertility. So before guilt and regret become all-consuming, get the facts straight on the following fears.

Past Smoking and Drinking . . . Fertility Today
As long as you’ve quit, it’s not likely that having lit up or imbibed excessively in the past will compromise your fertility. And moderate drinking while you’re trying to conceive (obviously not while you’re pregnant) shouldn’t interfere with conception.

However, in some cases women who smoked very heavily over a long period of time can suffer irreversible effects on ovarian function. Research indicates that cigarette smoke can interfere with the ovaries’ ability to produce estrogen and also ups the incidence of miscarriage, and of genetic abnormalities in the eggs. It’s also known that heavy smokers reach menopause earlier, suggesting that smoking has an aging effect on a woman’s eggs.

But quitting smoking not only improves natural fertility, it also ups your chances of conceiving with in vitro fertilization (IVF), says Richard Leach, M.D., director of the division of reproductive endocrinology and infertility at the University of Illinois in Chicago. “People who smoke during IVF treatment decrease their chances of getting pregnant by 50 percent,” he says. According to one study, stopping for at least two months prior to treatment significantly increased the likelihood of conception.
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Past Drugs, X-rays, and Environmental Toxins. . . Fertility Today
Recreational drugs can interfere with ovulation, but, as with smoking and drinking, a past fling with them shouldn’t affect your fertility now.  A recent study at the University of Buffalo School of Medicine and Biomedical Sciences in New York found that when men smoked marijuana, their sperm had difficulty reaching the egg.  Abstaining from the drug for three months allowed healthy sperm to regenerate. But the most surprising aspect of the study was the researchers’ opinion that the same effect on sperm would be noticed even if it was the woman who had smoked the marijuana, because THC–the active ingredient–would be present in her reproductive fluids.

No definite link exists between chemicals or pollutants and infertility, though it’s suspected that extensive exposure to pesticides, solvents (like those used in dry cleaning and paint thinners) and heavy metals (cadmium, lead, mercury), could cause menstrual irregularities or infertility.

Low-dose radiation, used in X-rays, has not been shown to cause problems, but wearing an abdominal shield during a mammogram or other X-ray procedure is a good idea. High-dose radiation and chemotherapy for cancer treatment, however, can sometimes cause infertility by triggering early menopause in women. For that reason, many women who are facing cancer treatment now and think they may want to become parents some day are offered the option of freezing eggs and/or ovarian tissue for future use.

Past Eating Disorders . . . Fertility Today
In order to ovulate and maintain a pregnancy, a woman needs to have 17 percent body fat (and 22 percent body fat to begin menstruating as a girl), says Marian Damewood, M.D., immediate past president of the American Society of Reproductive Medicine. Many women with eating disorders–especially anorexia, which results in severe weight loss–have a lot less. However, if you’ve licked the disorder and regained weight, there should be no lasting effects. [For more information on the link between body weight and fertility,  see the story, “The Weight to Be Pregnant,” page 36.]

For women with former eating disorders, infertility often brings back the psychological issues they struggled with–specifically, the need for control. “They want their bodies to do what they want them to do,” says Harriette Rovner-Ferguson, a psychotherapist in Smithtown, New York, who specializes in infertility. Rovner-Ferguson, who co-authored the book, Experiencing Infertility (W.W. Norton, 2000) notes that such women often transfer that need to fertility treatments.

“I felt like there was something wrong with me that had to be fixed by me,” says Eileen Garvin, of Susanville, California, who suffered from anorexia as a teenager and later experienced years of unexplained infertility.  “Just as anorexia was an obsession, so was becoming pregnant. When I was anorexic, everything that went into my mouth had a number of calories attached to it,” Garvin recalls. “When I was trying to conceive, I knew my body temp before I got out of bed, knew exactly when I was ovulating and on which side, and knew what every little headache and body ache meant.” Garvin eventually became pregnant through artificial insemination.

Past Abortions . . . Fertility Today
There’s no reliable evidence that having had one or more surgical first-trimester abortions performed under sterile conditions has any impact on fertility, and no evidence at all linking medical abortion (which terminates a pregnancy with medication rather than surgery) with infertility. As with any surgery, though, if there were complications–such as a post-operative infection or hemorrhage–it’s possible that the fallopian tubes were damaged. Less common second trimester pregnancy losses can sometimes result in problems with the cervix in the  next pregnancy, but even that is not very common, says Dr. Damewood.

More commonly occuring for women who’ve had abortions and are now having difficulty conceiving to be plagued by guilt, convinced that their difficulties getting pregnant are related to that procedure, no matter how long ago. “In fourteen years of working with infertile couples, abortion is absolutely the thing that causes the most pain,” says Rovner-Ferguson. “Women think they’re being punished or that they should have had a baby when they had the chance. It takes a while for it to sink in that millions of women who’ve had abortions have gone on to have babies and that a decision made at age 16 doesn’t affect their bodies at age 34.”

Past Sexually Transmitted Diseases (STDs). . . Fertility Today
Chlamydia, a sexually-transmitted bacterial infection, is the most common STD in the U.S., with about three million new cases occurring each year. While it’s usually easily treatable with antibiotics, only about 30 percent of women actually know they have it. There may be no symptoms at all, or the kinds of symptoms–like fever and aches–that can easily be chalked up to something else, such as the flu. Often, symptoms resolve themselves but the infection remains.

“Chlamydia may not be diagnosed until a woman is trying to get pregnant,” says Dr. Damewood. “If it’s silent, it’s possible for a woman to have low-grade or moderate damage to her fallopian tubes, which can cause infertility.” A recent Swedish study also showed that chlamydia in men (which rarely causes any symptoms) has a negative effect on sperm.

Gonorrhea, the other major STD, affects about 700,000 people per year and usually causes no symptoms in women. Like chlamydia (which often accompanies gonorrhea), it can result in tubal damage.

An additional and serious risk inherent in either of these diseases is the possibility of Pelvic Inflammatory Disease (PID), a secondary infection of the uterus, fallopian tubes and/or cervix; 90 percent of PID infections are initially caused by chlamydia or gonorrhea, and 20 percent of women with PID experience infertility due to scarring of the fallopian tubes. PID is sometimes silent, but often causes lower abdominal pain, fever and vaginal discharge.
{loadposition frboost} Fortunately, chlamydia and gonorrhea can be prevented with condom use, and chlamydia is usually screened for during routine gynecological exams. That way, the disease can be detected and treated early, before there is damage to the fallopian tubes. If either STD has caused tubal damage, the tubes can often be repaired with microsurgery. When damage is significant, IVF may be needed to achieve pregnancy.

Past Surgeries . . . Fertility Today
When Lisa McClintick of St. Cloud, Minnesota, started trying to get pregnant at age 27, she was assured by numerous doctors that neither her Crohn’s disease (a chronic inflammatory disease of the gastrointestinal tract) nor the surgery she’d had for it would present a problem. But after two years of trying to conceive with no success and being told to “be patient,” she underwent testing, which revealed a misaligned ovary due to scar tissue that built up after the surgery; the misalignment made it harder for the egg to reach the fallopian tubes. In vitro fertilization might have worked, but she and her husband instead decided to adopt a child. They are currently in the process of adopting a second child.

The formation of scar tissue or adhesions (where scar tissue adheres to or joins together other organs) is not uncommon after abdominal or pelvic surgery, but it doesn’t always cause fertility problems. When it does, the problem can often be remedied by surgery to remove the tissue; IVF can bypass tubal problems completely. Other procedures capable of causing fertility problems are cone biopsies–used to diagnose cervical cancer–and dilation and curettage (D&C), which is done to remove excess tissue from the uterus after a miscarriage or abortion.

“People find it hard to accept that they have no control over fertility difficulties,” says Rovner-Ferguson. “When a crisis like infertility hits, there’s a natural tendency to look for a guilty party, something to point a finger at.” The important thing to know is that despite the decisions women made and the things they may have done before they were ready to become mothers, few of those past activities will come back to haunt them in their quest for parenthood.

A version of this article originally appeared in the Spring 2005 issue of Conceive Magazine.