When Satin Patel, M.D., speaks with couples concerned about fertility, he shares this: "The best advice I can give couples about avoiding infertility is not to delay childbearing, because female age is your worst enemy."
Dr. Patel, who specializes in reproductive endocrinology and infertility, is the founder of North Texas IVF at Texas Health Presbyterian Hospital in Dallas. He says that if a couple comes to him to discuss fertility challenges, the first thing he does is get a detailed history and physical, which clue him into any problems that may be hampering conception for the couple. Then he performs a fertility evaluation, which involves testing a woman's Fallopian tubes and uterine cavity to ensure there are no structural obstacles. The next step is a hormone analysis, including an anti-mullerian hormone (AMH) test to determine how many eggs a woman has left.
Dr. Patel also conducts a semen analysis on the male partner. He says while a woman's age and "ovarian reserve" is important, infertility isn't just a woman's problem.
"About one-third of infertility cases are due to the male," he says. And men's age can also play a factor.
After all the test results come in, he's able to recommend treatment, which can go a number of different ways.
"If a woman has a low AMH, it may lead her to either accelerate her family-building plans if she's in a relationship, or see a fertility clinic and freeze her eggs to make sure she has options for the future," he says.
If a woman is younger and the problem is that she's not ovulating—most often because of polycystic ovary syndrome, which is a hormonal disorder that can cause irregular or infrequent menstruation—the remedy is often in the form of a fertility pill that causes ovulation.
But in many cases, such as in older women, if the woman has blocked Fallopian tubes or if the man has a low sperm count, he recommends in vitro fertilization (IVF).
"Generally speaking, if a female is over 37, we try to fast-track her to IVF. If younger women have a low egg reserve, we try to fast-track them to IVF," he says. "As you get older, your egg supply continues to diminish, and your body is not able to generate new eggs, unlike the male, who continues to make new sperm throughout his life."
Patel says that diet and overall health are also factors in fertility.
"It's important to get regular exercise and important to maintain a normal weight, to make sure you're not underweight or overweight because either of the two extremes can disrupt a woman's ovulatory cycle and cause her not to ovulate," he says.
Patel adds that newer reports suggest eating a healthy regimen of whole foods and limiting processed foods has been shown to reduce stress in males, enhancing their sperm function and general well-being.