Thinking of having another child? You may have less time than you imagine to conceive without difficulty. Still, you may be able to take steps now to improve your chances.
To help judge the state of your fertility, consider these questions:
1. How old are you?
Age is by far the biggest factor in fertility, and even the most advanced infertility treatments aren't always able to turn back the clock. "Women are postponing childbearing until later in life — that's the very reason we see more problems today," says Pamela Madsen, executive director of the American Infertility Association.
Some researchers believe that fertility peaks as early as a woman's late 20s, and there's a consensus that by her early 30s, both the quantity and the quality of her eggs have begun to decline.
It's a gradual process, so there's certainly no need to panic. But if you're 30, you may not want to wait ten years to start trying to get pregnant again. At age 35 about three-quarters of women will be able to conceive without treatment, but by age 40 only half will, says Owen Davis, M.D., director of the IVF Program at Cornell Medical Center in New York City. By age 45 it's under 10 percent.
The risk of miscarriage also goes up with age. At 35, about one in five pregnancies doesn't result in a live birth; by age 42 more than half fail, according to a study of over 500,000 women million women in Denmark. An older egg becomes an embryo that's more prone to genetic damage, researchers believe.
Infertility is traditionally defined as the inability to conceive after one year of unprotected sex. "In my opinion, a woman under thirty-five should try to conceive for that amount of time before she seeks medical help to find out why she's not getting pregnant," says Magdy Milad, M.D., a reproductive endocrinologist and an associate professor of obstetrics/gynecology at Northwestern University Medical School, in Chicago. "Between the ages of 35 and 39, she should try for six months. And after the age of 40, she should try for three months and then see a doctor for an evaluation, just to make sure that nothing's wrong and she doesn't run out of time to try treatment."
2. Do you smoke?
If so, you're hurting your chances of getting pregnant at any age. Exposing your eggs to nicotine will not only affect the quality of your eggs but decrease your ovaries' supply. The more cigarettes a woman smokes daily, the lower her chances of conceiving. Smoking can also speed up the age at which menopause begins, prematurely closing your lifetime window of fertility.
The good news is that quitting now can restore much of your fertility. It's not immediate, though. "Once a woman quits, it can take several months for smoking-related toxins to be cleared from the body," says Dr. Milad.
Passive smoking interferes too: In one study, women exposed to smoke at work or at home were less likely to conceive within a year than peers who were exposed to little or none.
3. Are you at a healthy weight?
Being seriously over- or underweight - for a woman who's 5 foot 4, for instance, being heavier than 175 pounds (a body mass index of 30) or lighter than 105 pounds (a body mass index of 18) — may have a bearing on fertility, but only if it affects ovulation.
If your periods are normal, your weight is unlikely to impact your ability to get pregnant, says Bryan Cowan, M.D., chairman of the department of obstetrics and gynecology at the University of Mississippi Medical Center, in Jackson. But if you're overweight and your periods are irregular, talk to your doctor. On the other hand, if you're very thin or have recently lost a lot of weight and your periods have become irregular or have stopped, gaining weight may be the first step toward fertility.
4. What medications or remedies are you taking?
Thousands of prescription and over-the-counter medications — as well as herbal remedies — can have an effect on fertility. But the main concern is a class of drugs that affect your body's production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) — key players in your ovulatory cycle. These include steroids (for asthma and rheumatoid arthritis), as well as prescription medicines that contain metoclopramide (for gastrointestinal upset) or phenothiazines (for anxiety.) It's always a good idea to talk with your doctor about which medications you are taking — or have taken — that might have an impact on fertility.
Contraceptives may also have an effect. If you've been on the Pill for a long time, it may take two to five months for your body to start ovulating normally once you go off it; that's also true for the newer hormone-based contraceptives like the Mirena IUD or the Nuva ring. "It's a myth that taking the Pill will prevent you from getting pregnant in the future," says Helane Rosenberg, Ph.D., egg donor coordinator at IVF New Jersey, in Somerset "But if you've been taking it for a long time, it could be masking a problem that would make you ovulate irregularly if you weren't taking the contraceptive."
The exception is if you've been treated with Depo Provera - in that case, the wait could be much longer. "Since the drug is injected into muscle, the hormone absorption may be so slow that it could take as long as a year for your fertility to return to normal," says William Gibbons, M.D., chairman of the department of obstetrics/gynecology at Eastern Virginia Medical School, in Norfolk. Norplant, though, has no adverse effect on fertility once it's removed.
If you're using herbal remedies, be wary: They're not regulated, so there's no requirement that their effects on conception and pregnancy be properly researched. Some reports have suggested that popular supplements — Saint-John's-wort, ginkgo, Echinacea — may negatively affect fertility, but other studies have found no effect, so there's no way to tell yet. "If you're having trouble conceiving and you're taking herbal supplements, you might want to stop, just in case," says registered dietitian Paul Thomas, editor of The Dietary Supplement, a newsletter for health professionals and consumers.
More important questions
5. Have you ever had a sexually transmitted disease (STD)?
If it was caught early and treated, an STD will probably not affect your ability to get pregnant. But one that was untreated for a long period of time may cause problems; untreated chlamydia, for instance, can lead to pelvic inflammatory disease, which may make you infertile. Chlamydia and gonorrhea can also cause scarring of the fallopian tubes or low-grade infections that can change how receptive your uterine lining is, says Carolyn Salafia, M.D., director of EarlyPath Diagnostics, a research facility in Larchmont, NY.
That's why it's important to be checked for STDs by your doctor before you try to get pregnant. Your partner should get checked too: STDS can also block production of sperm.
6. Was your last delivery difficult?
Even if you've had a c-section, you won't necessarily find it harder to conceive your next child, unless there was tissue scarring, which can potentially impair fertility. (Nor do the vast majority of abortions affect conception.)
On the other hand, even a problem-free pregnancy doesn't mean it'll be easy to get pregnant the next time. "If your first pregnancy was uneventful, it excludes certain problems in the future, such as specific congenital abnormalities, but it's not a guarantee — other factors, like age, can affect your chances," says Dr. Davis.
7. Is your period regular?
If you have an irregular cycle that is very long (more than 36 days) or short (less than 22 days), it's possible that your ovaries aren't functioning normally, and that could have an impact on the viability of your eggs when you try to get pregnant. Every woman's cycle is different, but see your doctor to rule out possible medical causes, such as thyroid disease or polycystic ovarian syndrome; both can be detected by blood tests and treated. Fibroids, which can cause heavy periods, may also interfere with fertility and are also easily treated. Fortunately, if you are not ovulating normally when you want to conceive, there are a number of medications that can correct the problem.
8. Are you under a lot of stress?
It isn't clear whether daily stress has an effect on one's chances of getting pregnant. Some experts think it may decrease the production of estrogen, but others find no link. It's a bit of a chicken-and-egg issue: Infertility itself is stressful, so it's not surprising that women who seek help may report feeling tense.
Depression is another matter: "A number of studies link depression and trouble conceiving," says Alice Domar, Ph.D., director of the Mind/Body Center for Women's Health at Boston IVF, Harvard Medical School, and coauthor of Conquering Infertility. "If you want to conceive in the future and you're having emotional problems, try to see a mental health professional," says Dr. Domar. But if you're sure that your emotional stress is related to pregnancy worries, you may want to join a fertility support group. It will not only give you a place to talk about your experiences but also teach you coping techniques for stress management and relaxation. To find a group in your area, visit, the website of the National Infertility Association, and click on Local Chapters.
9. Are you a healthy eater?
A well-balanced diet with plenty of fruits and vegetables is always a good idea, but the average American diet provides the necessary vitamins and minerals for fertility, says Dr. Cowan. Of course, every woman of childbearing age should take a multivitamin with at least 400 micrograms of folic acid — it helps prevent neural tube defects only if you take it before you get pregnant.
Caffeine remains controversial. Some studies indicate that it can delay conception, but others show — you guessed it — no effect. Once you do become pregnant, though, caffeine matters: As little as two cups a day can double your risk of miscarriage. Says Dr. Milad, "I give my patients who are trying to get pregnant the same advice I give those who are pregnant - keep caffeine intake in check and take your vitamins."
So, will you be fertile in five years? There's no way to be absolutely sure, of course. The more you know, the easier it is to plan your future. And the healthier your lifestyle, the better your chances will be.
The Dad FactorThe male contribution to infertility has only recently received the scientific attention it deserves. Here are some questions worth asking about the aspiring father:
- Does he smoke? Infertility rates are three times higher in men who smoke compared with those who don't. Just as tobacco use affects a woman's eggs, it can also cause a reduction in the number of sperm as well as damage those being formed. After a man quits, it takes about three months for his sperm to return to normal, says Dr. Davis. If he was a heavy smoker, it can take longer.
- What's his health history? Mumps can cause sterility, according to Dr. Davis. Also, about 1 in 500 men have Klinefelter's syndrome, a genetic disorder that causes them to be born sterile.
- How old is he? Although a man can impregnate a woman into his 70s and older, new studies make it clear that a man's fertility declines with age, beginning around 35. Both the quality and the quantity of sperm are affected.
- Is he okay "down there"? One of the biggest causes of male infertility is varicoceles, which is varicose veins in the scrotum. These affect one in ten men. Some get them around their testicles, which can reduce sperm production. Have him see a urologist for treatment options.
- How's his diet? Men who get enough folic acid, vitamin C and zinc produce more sperm, studies show. The amounts for each in a healthy diet or a standard multivitamin are fine.
- Is he regularly exposed to heat? For men who use hot tubs often or truck drivers who spend a lot of time sitting above a vehicle's engine, there may be a reduction in the number of sperm produced.
- Does he drink a lot or smoke pot? In some men, even moderate drinking affects fertility; some researchers believe men should limit themselves to one drink a day for optimal fertility. Marijuana use can reduce the production of sperm, and heavy use is associated with infertility, says Dr. Davis.
Timing the Test for Pregnancy
If you're using a home pregnancy test, wait at least ten days after your period is due to try it. If you test too soon, the result may signal that you're not pregnant when you really are, says epidemiologist Donna Day Baird, Ph.D. "The fertilized egg may not yet be implanted in the uterus by the time a woman expects her period," she says, "so the test can't detect the pregnancy." – Rachelle Vander Schaaf