Fertile Ground: Many People Don’t Know Fertility Basics

Until Infertility Appears, Many People Don’t Know Fertility Basics

Before we talk about infertility (defined as not being able to conceive after one year of unprotected sex) we need to talk about fertility. Many people’s main source of information about getting pregnant is from as far back as health class, when the emphasis was on “not getting pregnant.”

Prior to actively trying to conceive (commonly referred to online as TTC,) many women don’t spend much time investigating how it works. This means they may miss out on important information about their ovulation cycles, the primary focus for conceiving successfully.

“I began taking birth control in my early 20s and vaguely understood how it prevented pregnancy. We’d been taught in school for years that if you have unprotected sex, you will get pregnant. Both of my sisters had miscarriages, so I was aware there was the possibility it might not go as planned, but I was not the least bit prepared for a yearslong battle with infertility,” says Molly Tanner, 40, from Hampton. Tanner and her husband started trying to get pregnant eight years ago.

Learning the Cycle

A woman’s ovulation cycle generally starts with her menstrual cycle, with an egg being released from one of her fallopian tubes approximately two weeks later. The egg remains in the uterus for around 24 hours, where it must be met by sperm to be fertilized. Knowing when ovulation is occurring is an important clue for people trying to conceive. The “fertile period” actually starts in the days before ovulation, because sperm can live in a woman’s body about four to five days.

Many people don’t get a lot of information about the most important fertility concepts, until they are trying to conceive and it doesn’t seem to be working.

Annie Nowinski, 31, of Virginia Beach, thought she was more knowledgeable than the average person about what needed to happen to conceive successfully.

“I used an app to track my cycle all through college. I didn’t begin my menstrual cycle until junior year of high school and at that time I just marked the date of my last period on my weekly planner while I was still in high school,” she says.

She started charting her cycles closely using basal body temperature and ovulation kits, even before actively trying to get pregnant. After six months of what appeared to be ideal conditions, she began getting frustrated. She was in her late 20s.

“I thought since I was generally healthy and always had a ‘regular’ cycle that my fertility would be high,” Nowinski says.

Looking back, Nowinski says she wishes she would have consulted with a gynecologist sooner, and then seen a reproductive endocrinologist more quickly, too.

Tests and Temperatures

Taking basal body temperature is a method of fertility awareness where a woman tracks her temperature, looking for a slight increase that occurs during ovulation. This uses a special kind of high-accuracy thermometer, but is generally taken orally, and the results are written down or recorded. Ovulation kits track the release of the lutenizing hormone released prior to ovulation, and are generally strips or a stick test that react if the hormone is present in the woman’s urine. Some tests use saliva, instead.

For many women who go on to experience infertility, they learn over time the importance of how to read their body’s fertility. Questions include “How regular are my cycles?”, “Am I ovulating every month?”, “What are the signs my body is giving me?”

“Prior to being diagnosed with infertility, I knew very little about fertility factors. I, like many thought that I would meet a boy, get married and have a kids, you know, what normal couples do. Never did I think I would be going through nearly a decade of reproductive treatment, financial devastation and heartache,” says Candace Wohl, 35, of Suffolk.

Wohl says that she was shocked to find out how common infertility is, and feels that there’s a lack of information about reproductive health.

“We need education on reproductive health as well as sexual education. There is another side of the story that is never told until you become 1 in 8,” Wohl says. Today, she’s an infertility advocate, and that “1 in 8” statistic comes from the Centers for Disease Control (CDC), because infertility affects about 12 percent of women.

The Age Factor

“Young women who are trying to get pregnant generally know about a decrease in fertility with age. The majority believe that it starts after the age of 35,” says Dr. Laurel Stadtmauer, a professor of Obstetrics and Gynecology at Eastern Virginia Medical School in Norfolk and a physician scientist with the EVMS Jones Institute for Reproduce Medicine.

The general recommendation by medical professionals is that couples under 35 should try for one year before seeking a fertility specialist and between the ages of 35–40 should try for six months, and couples over 40 should come immediately. Age-related decrease in fertility starts about the age of 30 and accelerates after the age of 35.

According to the American College of Obstetrics and Gynecology, women who have irregular cycles or who have been diagnosed with PCOS, or with known male or female issues should seek attention immediately. Polycystic Ovarian Syndrome, a common cause of infertility, is caused by hormonal imbalances that can prevent ovulation.

The age of the man also affects fertility, because the quality of a man’s sperm decreases with age.

It Takes Two

Although many people jump to the conclusion that infertility problems are “a female issue,” that is not the case. In fact, it splits evenly 40 percent each, with the remaining causes being unexplained or problems with both partners, according to the American Society for Reproductive Medicine. There are several causes of male infertility, including medical conditions, unhealthy habits and environmental chemical exposure that need to be explored if fertility issues occur. A common cause of male infertility is varicocele, when the veins inside the scrotum become enlarged, potentially blocking or slowing the release of sperm.

Weight, There’s More…

The American Society for Reproductive Medicine says that 12 percent of infertility cases are a result of weighing too little or too much. Eating disorders, such as bulimia or anorexia that cause underweight status, also affect the reproductive system.

Both men and women can improve their fertility with weight loss, and having a normal range body mass index also will contribute to a healthy pregnancy. Like all matters relating to our bodies, every body is different and some of these factors will affect fertility and some won’t. Many couples have more than one factor that affects their fertility. That’s why it’s important to know your body and seek the advice of a professional for additional help.

About the author

Natalie Miller Moore

Natalie runs Moore than Words, a health communications consulting firm in Williamsburg. She loves to learn and write about health, particularly relating to patient experience and research.