The chance that a healthy woman having regular intercourse will conceive in any given cycle is only 20 to 40 percent. Lump in a condition like endometriosis or being severely over- or underweight and you can see how the odds plummet. We asked leading reproductive specialists about the top health issues that affect fertility and what women can do to boost their baby-making potential.
There are plenty of diseases that cause your hormones to run amok. And when hormones are out of whack, fertility is at risk. Thyroid and adrenal disease, for example, contribute to infertility by causing the body to release too much estrogen, testosterone, and even the stress hormone cortisol, thereby interfering with ovulation. Polycystic ovarian disease (PCOD) is another fertility-robbing condition. "Women with PCOD have elevated levels of insulin and the male hormone testosterone, and those things together prevent regular ovulation," says Erika Johnston-MacAnanny, M.D., a reproductive endocrinologist and assistant professor of medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
The fix? Depending on the problem, doctors will typically prescribe drugs that either block the release of pregnancy-quashing hormones like testosterone or boost ovulation, or both.
One hormone-related disease that surprisingly doesn't affect fertility Is diabetes. "Diabetic women who ovulate, take their medicines, watch their diets, and keep their glucose levels in control are no less fertile than other women," says Sandra Carson, M.D., division director of reproductive endocrinology and infertility at Women and infant's Hospital in Providence, Rhode Island.
When it comes to infertility and sexually transmitted diseases (STDs), doctors say chlamydia and gonorrhea are the ones to watch. "Gonorrhea is concerning because it can block the fallopian tubes, preventing the passage of an egg," notes Dr. Carson. "Chlamydia is a biggie because it very rapidly causes pelvic scars that interfere with the ability of fallopian tubes to sweep across the ovary and pick up an egg." If you're diagnosed with an STD, your doctor will first prescribe antibiotics to treat the infection if it's active. Depending on the severity of scarring, your doctor may recommend laparoscopic surgery to remove adhesions or even in vitro fertilization (IVF) if the damage is irreparable.
Essentially a collection of uterine cell tissue that forms for reasons no one is quite sure of, fibroids are most likely to interfere with fertility when they grow inside the uterine cavity, distorting its shape and size. (Fibroids that grow in the uterine wall or outside the uterus have little effect on pregnancy potential, experts say.) It's estimated that up to 80 percent of women will have at least one of these benign masses in their lifetime, but fibroids often grow in groups. For fibroids that are impairing fertility, surgery can excise the clumps; studies indicate that a woman's fertility increases 70 percent after fibroid removal.
A major cause of painful periods and infertility, endometriosis occurs when the lining of the uterus grows outside the uterine cavity, creating scar tissue that makes it difficult for the fallopian tubes to pick up and propel an egg to the uterus. Moreover, endometriosis, even without any scars or adhesions, can cause pelvic inflammation, making the uterine cavity a less than hospitable place for a fertilized egg to implant. Surgery can sometimes remove scar tissue; as a last resort, your doctor may recommend IVF. And, curiously enough, pregnancy can actually abate endometriosis. "During pregnancy the hormone progesterone is high," explains Dr. Carson, "and that causes the endometriosis to change in such a way that it can be reabsorbed by the body."
Weight affects many aspects of your health, and fertility is no exception. "Although we're not sure why, studies show that women who have a body mass index (BMI) of over 35 [what doctors consider obese] have decreased fertility, even if they're having regular cycles," reports Dr. Johnston-MacAnanny. "On the flip side, women with a low BMI--say, 20 or less--very commonly don't ovulate regularly, reducing their chances of conceiving." The good news: Obese women who lose even 10 percent of their body weight give a big boost to their fertility. Underweight women may not be as lucky, as even with weight gain some never resume a regular menstrual cycle. "There may be irreparable damage to the signaling process in the brain that tells the ovaries to stimulate egg production," notes Dr. Johnston-MacAnanny.
Pelvic inflammatory disease (PID) occurs when bacteria move from the vagina into the upper reproductive tract, causing infection. STDs are the leading cause of PID, but there are other, less common, causes, such as complications from the insertion of an intrauterine device, infection resulting from an abortion or miscarriage, or even douching, which can change the environment of the vagina and allow bacteria to more easily penetrate to the upper reproductive tract. Up to 15 percent of women with PID become infertile, but there are steps you can take to reduce your risk. For starters, you can help prevent PID by reducing your number of sex partners and practicing safe sex (both reduce your exposure to STDS). If you notice any symptoms of PID (lower abdominal pain, painful intercourse or an unusual vaginal discharge or odor) get to your doctor right away. The sooner an active infection is treated with antibiotics, the less damage is done to your organs. Surgery--minimally invasive laparoscopic surgery if scarring isn't severe--is another treatment option.
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