Here’s one of life’s big ironies for a significant number of adults in the United States: We try to avoid pregnancy for years, and then when we're finally ready to get pregnant and start a family, we can’t. For anyone planning to become pregnant soon, or already trying, now is the time to check in with a physician to discuss any factors that might have an impact on fertility and conception. Here are a dozen of the most common.
12. Heat
Who it affects: Men
Why: The enzymes required for the production of sperm are very sensitive to heat. Men who frequent saunas or hot tubs, wear tight pants, sit at a desk all day, or stand in front of a hot stove may be inadvertently heating their testicles to such a degree that they can’t make sperm and get their partners pregnant. “The reason that the testicles hang out and away from the body is that it’s about 4 degrees cooler than the normal body temperature,” explains Marc Goldstein, M.D., director of the Center for Male Reproductive Medicine and Microsurgery at the New York Weill Cornell University Medical Center in Manhattan. “That cooler temperature is required for sperm to thrive.”
What you can do: Avoid overheating the reproductive organs by staying out of hot tubs and saunas, keeping laptop computers off your lap, etc. If your job requires you to sit for long periods, get up and move around frequently, and don’t sit with your legs crossed. Wear loose-fitting underwear and clothing.
11. Sex at the Wrong Time
Who it affects: Women and men
Why: “If you’re a partner in a two-career marriage, it can be challenging to ‘get together’ during the right time of the month,” says Dr. Goldstein.
What you can do: Chart your body temperature or use an ovulation predictor kit so that you know when you’re going to ovulate. Have sex at least every other day starting at least a week before your ovulation date. “Once the woman ovulates, it’s too late,” says Dr. Goldstein.
10. Medications
Who it affects: Women and men
Why: There are several commonly used medications that can affect fertility. Men who take the ulcer drug cimetidine (Tagamet) or the heart drug digitalis have low sperm counts. A number of drugs used to treat high blood pressure may affect ejaculation, the “motility,” or swimming ability, of sperm, or prevent the sperm from reaching the egg, and the antibiotics sometimes used to treat urinary tract infections can inhibit sperm production. Women who use decongestants may be inadvertently drying up the cervical mucus that is essential for conception (but this is a rare cause of infertility).
What you can do: Tell your ob/gyn about any medications, even over-the-counter drugs, that you and your partner are taking. There may be an alternative medication you can take while you’re trying to get pregnant. Or, as with the decongestants, you may need to temporarily stop using the drug.
9. “Structural” Problems
Who it affects: Women and men
Why: Eggs and sperm need to have a relatively clear path in order to meet. “If the woman has uterine fibroids or polyps, endometriosis, or scarring in any of her reproductive organs, or if the man has a condition such as a missing vas deferens [a congenital abnormality] then it makes it difficult for the sperm and egg to get together,” says Dr. Goldstein.
What you can do: Chances are if you fall into this category, you have sought fertility treatment for your condition. But if you’ve been trying to get pregnant and haven’t, you may have one of these conditions and not know it because you don’t have any symptoms.
8. Cancer Treatment
Who it affects: Men and women
Why: Testicular cancer is the most common cancer in men between the ages of 15 and 45. “Prime fertility years,” says Dr. Goldstein. While the cancer doesn’t lead to infertility, the treatment for it does. “The treatments that cure cancer in men often cause them to become permanently sterile,” he says. (Treatments for some cancers such as leukemia, lymphoma, and tumors often cause only temporary sterility.) The best way to ensure that a man who is being treated for testicular cancer can preserve sperm is to . . . preserve sperm. “Freeze as many samples as you possibly can before treatment,” advises Dr. Goldstein.
Women who have been treated for cancer with surgery, radiation and/or chemotherapy may experience early menopause, which will prevent pregnancy. But advances in freezing eggs and ovarian tissue are now making it possible to get pregnant later.
What you can do: If you’re facing cancer treatment, you should discuss your family plans with your physician so she can take that into account while designing a treatment plan for you. Freezing sperm, eggs, embryos, or ovarian tissue are all ways that cancer patients can become pregnant in the future.
7. Varicoceles
Who it affects: Men
Why: Varicoceles are varicose veins in the scrotum. The enlarged or dilated veins cause blood to pool, which raises the temperature in the scrotum; the heat affects sperm production. “This is the most common cause of male infertility,” says Dr. Goldstein. About 15 percent of men have this condition and many of them don’t know it, he says.
What you can do: Varicoceles are repaired with a minor surgical procedure during which a surgeon “ties off” the varicose veins.
6. Irregular Ovulation
Who it affects: Women
Why: The average menstrual cycle is 28 days (but a cycle between 23 and 35 days is considered normal, according to the American College of Obstetricians and Gynecologists). Ovulation, during which an egg moves down one of the fallopian tubes toward the uterus, takes place about 14 days before the first day of a woman’s next period. But there are a number of conditions that can cause irregular ovulation. Polycystic ovary syndrome (PCOS); hyper- and hypothyroidism; hormonal imbalances (for example, having too much male hormone); being over-or underweight; stress; “fad” diets, and perimenopause are common reasons for ovulation problems, says Veronica Ravnikar, M.D., chair of the department of obstetrics and gynecology at South Shore Hospital in South Weymouth, Massachusetts, and vice chair of the department of obstetrics and gynecology at Brighham and Women’s Hospital in Boston.
What you can do: Keep a basal body temperature chart so you can know when you are likely to be ovulating and time sex accordingly. You can also buy ovulation predictor kits that are designed for at-home use. Most work by testing a sample of urine at a certain point in the menstrual cycle; when the test strip detects a surge in leutenizing hormone (LH), it means ovulation is about to occur. Of course, if you’re concerned that a medical condition such as PCOS is affecting ovulation, tell your physician right away since there are several medications (and other treatments) that can help stimulate ovulation and help you get pregnant.
5. Alcohol and Smoking
Who it affects: Women and men
Why: Alcohol is a “gonadotoxin,” meaning it acts like poison in the testicles and adversely affects sperm production. “Men should limit themselves to two drinks twice a week,” says Dr. Goldstein. Women should also drink moderately when trying to conceive, and then abstain completely as soon as they become pregnant.
Both cigarette and marijuana use result in the production of abnormal sperm. (Even smoking marijuana as infrequently as once every two weeks affects sperm.) Women who smoke cigarettes deplete their eggs more rapidly than women who don’t, and smoking also alters a woman’s estrogen production. Estrogen plays an essential role in the production of cervical mucus, which in turn helps deliver sperm to the egg. Nicotine in the cervical mucus of women who smoke also kills sperm, making pregnancy less likely.
What you can do: If you smoke (or use drugs), stop immediately. Limit alcohol consumption to an occasional social drink. Women should stop drinking completely as soon as they know they’re pregnant.
4. Being overweight or extremely underweight
Who it affects: Men and women
Why: Women who are very underweight may not be ovulating normally, and those who are overweight may also have hormonal imbalances, including PCOS. Men who are underweight may have lower than normal levels of testosterone, and being either under- or overweight has been linked with a lower sperm count and concentration.
What you can do: If you’re over- or underweight, make the changes necessary to get yourself to a healthy weight. (If you’re already trying to conceive, make sure your diet remains nutritionally sound.)
3. Stress
Who it affects: Men and women
Why: In men, stress has been shown to affect fertility by both lowering sperm volume and raising the percentage of abnormal sperm. Women who are chronically stressed can produce less gonadotropin-releasing hormone (GnRH), which starts a cascade of hormone-related changes that prevent ovulation, explains Dr. Goldstein.
What you can do: “Learn to manage stress with exercise and meditation,” suggests Dr. Goldstein.
2. Sexually Transmitted Infections (STIs)
Who it affects: Women and men
Why: “Left untreated, STIs such as chlamydia and gonorrhea can cause scarring in women’s fallopian tubes, uterus, and ovaries, which can prevent sperm from getting to an egg, or prevent a fertilized egg from getting to the uterus,” explains Dr. Ravnikar. Scarring in the tubes can also result in a tubal pregnancy. In men, scarring in the ducts of the epididymis, vas deferens, and ejaculatory glands can block the path that sperm must travel to reach an egg and fertilize it.
What you can do: If you or your partner has ever had an STI, be sure to mention it to your ob-gyn, primary care physician, or urologist at your next visit. In many cases scar tissue can be surgically removed, making pregnancy possible.
1. Age
Who it affects: Women and men (women primarily)
Why: By the time a woman is in her middle 30s, she has lost many of her viable eggs through menstruation and natural attrition. “The optimal age for a women to become pregnant, at least in terms of biology, is in her 20s,” says Dr. Ravnikar. And even though men can technically father children well into old age (Dr. Goldstein had one patient who was 87 years old when he fathered a child), the risk of having a child with chromosomal abnormalities, especially Down syndrome, rises after age 35 for men, just as it does for women.
What you can do: If you’re younger than 35, most ob/gyns won’t refer you to a specialist for fertility treatment until you’ve been trying to get pregnant for at least a year. If you’re over 35, though, consider seeing a fertility specialist even earlier. “The sooner you get help, the greater your odds of getting pregnant,” says Dr. Ravnikar.
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