C. J. and Mark Hager of San Antonio never thought they’d have trouble getting pregnant. Married in their 20s, both were healthy and active, with thriving careers in Washington, D.C.
But after two years of going without birth control and another year of actively (and unsuccessfully) trying to conceive, they were referred to a reproductive endocrinologist (RE), a doctor who specializes in fertility issues.
They were far from alone: Every member of C. J.’s book club had been to an RE; she and a neighbor even carpooled to the specialist together. It wasn’t mere coincidence, either: According to the Centers for Disease Control and Prevention, the number of couples in the United States experiencing fertility issues rose from 6.1 million in 1995 to 7.3 million in 2002 – one in eight couples of childbearing age.
Many Americans are unaware that infertility is so prevalent. A 2005 survey by RESOLVE: The National Infertility Association showed that more than 66 percent of men and 54 percent of women say they don’t think they know anyone who is infertile.
“Infertility is a secret sorority that has more members in it than anyone truly realizes,” says Julie Vargo, coauthor of A Few Good Eggs (HarperCollins, 2005). “It’s probably one of the largest ‘clubs’ in this country that no one talks about belonging to.”
According to RESOLVE (www.resolve.org), infertility is generally defined as the inability to conceive after one year of unprotected, well-timed intercourse (six months if the woman is over age 35) or the inability to carry a pregnancy to live birth. As such, infertility is recognized as a disease by the American Society for Reproductive Medicine and the American College of Obstetricians and Gynecologists (ACOG). But it’s worth noting that this single disease can be caused by a wide variety of factors originating in either the male or female endocrine and reproductive systems.
A couple in good reproductive health has a 20 to 25 percent chance of conceiving in any given month. After three months of trying, 60 percent to 75 percent of healthy couples should conceive. But in reality, things can be a little more complicated: Many couples without diagnosable reproductive problems have challenges conceiving as quickly as they’d like. RESOLVE reports that one in five couples will experience unexplained infertility even after completing a full infertility work-up. Many experts say that at least 10 percent of fertility issues overall are unexplained.
The good news? The majority of those who seek help for infertility issues eventually do have children. And advanced reproductive technologies such as in vitro fertilization (IVF), the most invasive of the treatments, are used in less than 5 percent of patients. Moreover, there are many things a couple can do to optimize their fertility before seeking medical intervention, or as a complement to it.
Even when there is one or more clearly identifiable physiological reason (such as endometriosis or low sperm count) for a couple’s infertility, it can help to look deeper to see whether underlying health, environmental or lifestyle issues might be giving rise to those reproductive challenges, points out Colorado-based naturopath Kimberly Nearpass. “The mind-body connection is so strong,” she says, “it’s all tied together.”
If you’re trying to conceive, or are thinking about having a baby anytime soon, it makes sense to learn as much as you can early on, and to lay whatever healthy groundwork you can. Because while not all causes of infertility are preventable, experts note, many of the risk factors for infertility are. Joseph Isaacs, president and CEO of RESOLVE, puts it this way: “The healthier you are, the more likely you are to achieve family-building success when trying to conceive.”
Cover the Basics
“Get a good physical and dot the i’s and cross the t’s,” advises Jackie Meyers-Thompson, a former fertility patient and coauthor with Sharon Perkins, RN, of Fertility for Dummies (Wiley, 2003). “Make sure there’s not any underlying issue like a thyroid problem.”
Share a complete health history with your doctor, including any prescription medicine you’re taking. Find out and share your family health history, too. Let your doctor know, for example, if your mother took DES (an anti-miscarriage drug) or other potentially problematic drugs when she was pregnant with you.
If you have an existing health issue that makes it more difficult to conceive, your doctor may want to adjust your treatment. Typical concerns include diabetes, hyper- or hypothyroidism, lupus, arthritis, hypertension, asthma, and treatments for abnormal pap smears such as cryosurgery or cone biopsy.
It’s also important to share your sexual history with your doctor, and to get screened for sexually transmitted diseases (STDs), particularly those known to cause fertility problems. If you suspect you have an STD, don’t ignore it. “STDs can cause severe and even permanent damage to reproductive organs,” note Meyers-Thompson and Perkins.
When it comes to conceiving easily, time is most definitely of the essence. Most Americans think that a woman’s fertility starts to decline at age 40 and that a man remains fertile indefinitely.
Actually, fertility for women drops sharply after age 35 as the quality of their eggs declines. Men experience a slower decline starting around age 40 when sperm begin showing the effects of age. Bottom line: You can conceive later in life, but it may not be nearly as fast or easy as you think.
“I discovered, to my surprise, at age 36, that I couldn’t conceive on cue,” Vargo says. “There were so many movie stars and high-profile people in their 40s having babies, I just assumed I had all the time in the world.”
After age 40, women have just a 5 percent chance of becoming pregnant in any given month. After age 45, that percentage drops to less than 1 percent. The older your eggs, the greater the chance they’ll have chromosomal abnormalities. That makes the risk of miscarriage go up, too.
That’s why you should see a doctor after a year if you haven’t gotten pregnant if you’re under 35; after six months if you’re over 35; and before you even start trying if you’re over 38.
One of the most essential steps you can take in optimizing your fertility is to optimize your health in general. Cleaning up and balancing your diet is a great start. Unexplained fertility problems are sometimes the direct result of nutritional deficiencies, but the other byproducts of poor eating habits – excess or low body weight, inflammation, low vitality and an overtaxed detoxification system – can be equally powerful enemies.
Twelve percent of all infertility can be linked to weighing too much or too little, according to RESOLVE. Anorexics and compulsive overexercisers can develop amenorrhea, a condition marked by a lack of periods. According to a study published in the British Medical Journal in 2000, very obese women are half as likely to conceive as those who maintain a healthy weight. Weight-related conditions like polycystic ovary syndrome (PCOS) and diabetes can further complicate matters.
Either way, getting your weight into a healthy range may make your fertility issues a thing of the past: Body-fat levels just 10 to 15 percent above normal can upset estrogen levels enough to disrupt reproductive cycles, and 70 percent of women with extreme weight issues conceive once they achieve a normal weight.
Stay away from fad diets, though: They can worsen macronutrient, vitamin and mineral imbalances. Instead, engage in moderate exercise (proven helpful in improving fertility in men and women), cut back on junk food, and start eating a more varied, plant-based menu of whole, natural foods.
“You can definitely optimize fertility by being as healthy as possible,” says Lynn Westphal, MD, associate professor of obstetrics and gynecology at the Stanford University School of Medicine. “The best thing you can do nutritionwise is be at a healthy weight and eat a well-balanced diet.”
Such an approach can help normalize menstrual cycles and hormone balance in women and maintain healthy sperm in men. If you are getting fertility treatments, you can optimize their effect by making sure you’re maintaining a healthy lifestyle, including proper nutrition.
Folic acid and other supplements, including vitamins E, B6 and B12, as well as minerals iron, magnesium, zinc and selenium, can solve deficiencies linked to infertility in both men and women, if taken in correct doses. Antioxidants may help reduce free-radical damage and diminish the effects of aging on ova, sperm and reproductive organs, Westphal says.
Women should limit caffeine to 300 mg (about three cups of coffee per day). Many studies have associated drinking more than that with a decrease in fertility, as well as an increase in endometriosis (abnormal uterine tissue growth) and miscarriage. Finally, both men and women should curtail their use of alcohol and any recreational drugs, all of which can reduce fertility. According to RESOLVE, as few as five drinks a week can impair conception.
Calm Your Nerves
“You can worry yourself sick,” Nearpass says. “One of the biggest obstacles to fertility is stress. If a potential mom is running from work to the bank to the grocery store, on an energetic level – where is there room for a baby?”
More pointedly, she notes, depression and stress may have a direct effect on the hormones that regulate reproduction and affect sperm production or ovulation. For example, the adrenal glands, which are directly affected by stress, in turn affect the ovaries.
While it’s certainly possible to conceive while under stress (as many wartime generations will attest), it’s also clear that prolonged exposure to mental stress can reduce fertility in both men and women. New studies also support the theory that reducing stress helps women who are undergoing infertility treatments to conceive.
Stress may cause some women to stop ovulating, a condition called stress-induced anovulation. A 1997 study by Sarah Berga, MD, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta, showed elevations in cortisol, the hormone associated with stress, in women with no other discernible physiological reason for not ovulating.
There is, however, evidence that anovulation can be reversed with cognitive behavior therapy (a.k.a. talk therapy): According to a 2003 study by Berga, which was published in Fertility and Sterility, women were more likely to start ovulating after participating in a cognitive behavioral therapy intervention program, which included focus on improving coping skills and managing stress.
In a 2000 study, Alice Domar, PhD, author of Conquering Infertility (Penguin, 2002) and executive director of the Domar Center for Complementary Healthcare in Waltham, Mass., found that 55 percent of women who went through a 10-session course of relaxation training, cognitive restructuring and stress reduction, and 54 percent who participated in standard support groups, conceived within one year compared with only 20 percent of a control group.
Visualization, meditation, guided relaxation and other mind-body techniques may all prove helpful in reducing stress and the stress-induced hormones that are antithetical to conception. That said, telling someone who’s trying to conceive to “just relax!” is anything but helpful. “I found it very stressful to hear that, when I was doing everything I could,” Meyers-Thompson says.
Keep in mind, too, that stress isn’t always a deal breaker. The cycle in which Meyers-Thompson conceived her daughter was one of the most stressful months of her life. Still, she recommends working on relaxation as a tool for better physical and psychological health.
Fertility patient Debra DeHaven’s period started the night after her first acupuncture session. DeHaven, who had been diagnosed with PCOS, says that adding acupuncture to the fertility drugs Femara (also known as Letrozole) and Follistim was “the missing link.” Meyers-Thompson did acupuncture and listened to meditation tapes, and while she’s not convinced it helped her conceive, it did help reduce stress and improve her overall well-being.
A growing number of people are seeking out holistic, alternative and integrative fertility methods, in part because they can often represent less expensive, less invasive solutions that improve health and vitality overall.
Traditional Chinese Medicine (TCM), for example, employs acupuncture, nutrition and herbal treatments to correct endocrine and energetic (Qi) imbalances within the body. Both alone and in conjunction with conventional therapies, TCM has become a popular and proven option for many couples seeking a more holistic solution for modern-day fertility challenges. In 2002, the medical journal Fertility and Sterility cited evidence that acupuncture could be teamed with IVF to significantly improve pregnancy rates.
If you do embrace TCM or other alternative methods in conjunction with conventional fertility therapies, be sure to let all your practitioners know your complete treatment plan. Some herbal remedies can interfere with certain drugs or may even be dangerous when unintentionally combined.
Clear the Chemicals
While the rising incidence of infertility is sometimes glibly attributed to increased diagnosis, or to a generational preference for delayed childbearing, a 1998 report of the U.S. National Survey of Family Growth notes that the rate of “impaired fecundity” (difficulty conceiving or carrying a child to term) rose significantly between 1982 and 1995 across all reproductive age groups, with the largest rate increase – 42 percent – occurring in women under 25 years old.
According to Karen Moore, RN, RESOLVE’s Director of Medical Information, there’s a significant body of evidence to suggest that manmade environmental toxins may play a ?very real and disconcerting role in dwindling sperm counts,lower sperm quality and many other health conditions negatively affecting fertility in both genders.
In a paper titled “The Impact of Environmental Factors, Body Weight and Exercise on Fertility,” prepared by RESOLVE in conjunction with a grant from the Collaborative on Health and the Environment, the authors cite lab studies proving that “many manmade chemicals cause fertility-related damage in animals, sometimes at very low doses.” They conclude: “Given the exposures humans face, it isn’t implausible manmade chemicals are influencing trends in some human reproductive health conditions.”
In the absence of long-term human studies, the authors note, this area of scientific inquiry will remain controversial, but because even low-level toxic exposure can negatively affect hormones that determine genetic expression, “reduction of chemical exposures generally may be important for safeguarding reproductive health in future generations.”
In other words, better safe than sorry. Unfortunately, with thousands of industrial and agricultural chemicals pervading our air, water, soil, homes and the products we interact with every day, avoiding many of these chemicals is impossible. Reducing their prevalence in our environment will require collective will and major changes in regulatory policy. But there are steps you can take to reduce your personal exposure in the meantime:
- Check the quality of your water by contacting your county’s water authority. If it’s not up to standard, filter your drinking, cooking and bathing water.
- Control the type and amount of fish you consume. Avoid species with high levels of pesticides, mercury, dioxin and polychlorinated biphenyls.
- Eat organic whenever possible; wash and peel nonorganic fruits and veggies. Trade pesticides and herbicides for nontoxic alternatives for home, lawn, garden and pet care.
- Avoid conventional adhesives and solvents, and green your personal-care products. Many contain endocrine-disrupting chemicals, like parabens and phthlalates, linked to serious reproductive health problems in animals.
- Above all, stop smoking and avoid secondhand smoke. Female smokers are 50 percent more likely to miscarry, two to four times more likely to have an ectopic pregnancy, and more likely to have eggs with genetic abnormalities. Male smokers have substantially lower sperm counts, as well as lower sperm quality and motility.
Experts call infertility a major, if silent, life crisis. And too often it’s a crisis couples weather alone. Studies have shown that the depression and anxiety levels of fertility patients are comparable to those of cancer patients. And a 2004 study published in the online journal BioMed Central shows that depression can also contribute to infertility, creating a chicken-or-egg cycle. So don’t hesitate to reach out to loved ones and experts for support.
If you’re having trouble conceiving and you’ve already covered all your basic health bases, consult a reproductive endocrinologist – not your gynecologist. Vargo offers the following tips:
Be your own advocate. Ask questions; spend time finding the right doctor; seek help from multiple sources.
Make a financial plan. The cost of conventional fertility treatments can be prohibitive, and only 15 states require insurance to cover aspects of them. You may find it worthwhile to try out-of-pocket alternative treatments first.
Most important, keep the faith. “If the most important thing to you is to be a parent, infertility is a game you can win,” Vargo says. “You might have to use technology; you might have to use someone else’s sperm or egg; you might have to use a surrogate; you may have to adopt. There are as many ways to put together a family as there are different types of infertility. If you open your mind, you will be a parent.”
After trying conventional fertility treatments for over a year, C. J. Hager was so certain she hadn’t gotten pregnant after her most recent treatment that she went out for a drink with friends. The next day, she called her husband from work. “Hold on,” he told her. The fertility clinic was on the other line.
“He clicked over and said ‘We’re pregnant,'” Hager recalls. “I was so stunned.” Zoe is now a thriving 3-year-old – and the Hagers are trying to conceive a second child.
Interested in the link between fertility and environmental toxins? Then check out the books and Web sites below.
By Sheila Mulrooney Eldred / September 2006
Our Stolen Future: Are We Threatening Our Fertility, Intelligence and Survival? A Scientific Detective Story by Theo Colborn, Dianne Dumanoski and John Peterson Myers (Plume, 1997) — A detailed look at how “industrial pollutants have spread with ease through the web of life,” and how they may be impacting human health, from lower sperm counts to hormone-related cancers and endometriosis.
Generations At Risk: Reproductive Health and the Environment by Ted Schettler, MD, Gina Soloman, MD, Maria Valenti and Annette Huddle (MIT Press, 2000) — A collaboration of public health professionals, physicians, environmental educators and policy advocates that supports the theory that human exposure to some toxic chemicals can have lifelong and even intergenerational effects on human reproduction and development.
Fateful Harvest: The True Story of a Small Town, a Global Industry and a Toxic Secret by Duff Wilson (HarperCollins, 2002) — A true story recounting how the mayor of small Washington town “blew the whistle” on American industries when she discovered were dumping toxic waste that they called “fertilizer” into fields and garden, causing failed crops, sick animals and rare diseases and threatening the health of her children.
Hormone Deception: How Everyday Foods and Products Are Disrupting Your Hormones — and How to Protect Yourself and Your Family by D. Lindsey Berkson (Contemporary Books, 2000) — Learn where hormone disruptors come from and how they affect all of us — adults, kids and the unborn — as well as how to minimize exposure to these dangerous substances.
Hormonal Chaos: The Scientific and Social Origins of the Environmental Endocrine Hypothesis by Sheldon Krimsky (John Hopkins University Press, 2000) — Support and criticism of the hypothesis that a variety of industrial and agricultural chemicals can interfere with the body’s normal hormone functions and cause reproductive, neurological and developmental abnormalities in humans and wildlife.
“Opening the Door to Fertility,” Alternative Medicine (June 2006) — An in-depth look at alternative approaches that may enhance your chances of conceiving.
“Bad Chemistry,” OnEarth (Winter 2006) — This award-winning environmental magazine investigates how hundreds of manmade chemicals may be impacting our ability to reproduce.
www.ourstolenfuture.org — This Web site provides the latest information on the most recent developments and discoveries about endocrine disruption, as well as a link to former Vice President Al Gore’s foreword in Our Stolen Future.