Baby Making + Infertility Explained by an Expert
An OB-GYN and reproductive endocrinologist from Spring Fertility busts some myths and offers insights into making sure you can become a parent if and when you’re ready.
Most Nurx patients come to our medical team to prevent pregnancy, but we know many of you hope to become parents one day, and many others aren’t sure — but want to have it as an option. To learn more about preserving fertility and reproductive health, we talked to Dr. Malinda Lee, an expert with Spring Fertility.
Is it true that fertility takes a nosedive around 35 in people with ovaries?
Yes and no, but it isn’t quite so dramatic nor simple. Two things are happening with ovaries as women age: the quantity of eggs is declining (a gradual, linear decline) and the quality of eggs is changing. The quality of eggs declines at a more rapid pace generally after the age of 35 in that the ratio of “good” to “bad” eggs drops.
That said, we see plenty of people who have trouble conceiving at younger ages, and their infertility diagnosis is usually not related to their age; we also see women in their forties who conceive quickly and spontaneously. As a rule of averages however, age is one of the biggest predictors of fertility treatment success because of this age-dependent decline in fertility.
What are some of the factors that explain why some people struggle to get pregnant?
Age as I mentioned above is a big one. Ovulatory status is another. Many people do not regularly ovulate (release an egg) which reduces their chances of conceiving.
Then there’s fallopian tube dysfunction, which can arise from a pelvic infection, prior surgery, endometriosis, or even without risk factors, as well as male factors. involving the quantity and motility of sperm.
These are only a few of the major etiologies of infertility – but all of them can affect how much time it takes to get pregnant.
Do certain birth control methods preserve or hinder fertility?
None that we know of. Sometimes it can take a month or (more rarely, a bit longer) to resume regular ovulation after coming off birth control, but over the long term, no birth control methods will cause infertility.
What about STIs and fertility?
A history of chlamydia or pelvic inflammatory disease can predispose women to having blocked or dysfunctional fallopian tubes, and can negatively affect the uterus and ovaries in certain cases as well. Women with this history are at risk for infertility and ectopic pregnancies (when an embryo implants outside of the uterus, most commonly in the tube), which is why it’s so important to get STI testing whenever you have a new partner. When you catch STIs like chlamydia early you can treat them before any damage is done.
When hetero couples experience infertility is the man or the woman who is more likely to have the issue?
It is pretty split. Male factor infertility occurs approximately one third of the time; female factor infertility one third; and both female and male factor (or unexplained infertility, when no clear cause is found) accounts for one third.
Do you have any advice specific to LGBTQ+ people who may want to be parents one day?
My advice is to feel empowered to ask questions and explore options. Fertility care has come such a long way in the past few decades and family building comes in all different shapes, sizes, and patterns. Reproductive endocrinologists like me are here to help realize your plans.
What are some of the most common myths about fertility, infertility, and conception?
One big one is “If I go to an REI (aka IVF doctor), they will automatically recommend IVF.” Not true! IVF is one of many tools we use. While it is a great option for some, it’s not necessary for all. In some cases patients may simply need medication to balance out hormones, or a relatively simple procedure to open up fallopian tubes. Fertility care is not one-size-fits-all, and finding someone to explore your specific family-building plans is essential.
Another myth is “If I need to use fertility treatment to get pregnant once, I cannot get pregnant spontaneously.” Not true! We have all seen many cases of people needing fertility treatments for baby #1, and have a surprise baby #2 conceived without treatment. Speak to your doctor about your overall prognosis.
And a third is “My mother/sister was very fertile/infertile so I will be too.” This is a common perception and the real answer is – it is sometimes true, and sometimes not at all! Male factor infertility will be a contributor in about half of all hetero infertile couples, so it’s quite possible that mom or sis had infertility that was unrelated to the female side. That said, there are certain conditions that may be heritable and contribute to infertility. Thus, it’s common for fertility doctors to take a family history during the initial consult to assess whether someone is at risk. My best advice is in these situations is to try to understand the etiology of the infertility.
How long should a couple “try” before seeking care of a fertility specialist?
General rule of thumb is 12 months if you are younger than 35. At 35 or older, 6 months. If older than 40, you can seek help immediately. All of these are generally speaking – if you have concern about or symptoms of an underlying fertility problem, you can seek help sooner.
Dr. Malinda Lee is a Fertility specialist and Board-certified OB/GYN, who completed medical school at Harvard Medical School where she also received her Masters of Business Administration. Following medical school, Dr. Lee completed her Obstetrics & Gynecology Residency through Harvard Medical School at Brigham and Women’s Hospital/Massachusetts General Hospital before completing her fellowship in Reproductive Endocrinology and Infertility, also through Harvard Medical School/Brigham and Women’s Hospital. She is passionate about educating women about their reproductive health and fertility preservation, which she does as part of the Spring Fertility Family.
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