Debunking fertility myths

There is an abundance of misinformation surrounding reproductive science, especially on the internet. When it comes to fertility, people who want to conceive often feel overwhelmed distinguishing between fact and fiction. Dr. Alexa Sassin, assistant professor of obstetrics and gynecology at Baylor College of Medicine, provides the facts behind common fertility myths.

Myth: Fertility is only a woman’s issue

Truth: Challenges with fertility can affect all people, regardless of their gender. Infertility is defined as being unable or unsuccessful in achieving pregnancy after 12 months of regular, unprotected intercourse or concerted efforts with insemination.

If you’re unable to get pregnant after a year, working with a healthcare provider is a good place to start. At maternal ages over 35, the risk of aneuploidy (missing or duplicating entire chromosomes) starts to rise, so it is recommended that this population seeks help with conceiving after six months.

While identifying a cause of infertility can be challenging, evaluating both male and female partners is important. Fifty percent of fertility challenges can be attributed to the male partner. Male factors are solely responsible in about 20 percent of opposite-sex couples’ infertility.

There are several benefits to seeking your provider’s input in the preconception period beyond just fertility treatment. Not only can pregnancy outcomes be optimized, but also chronic medical conditions which lead to maternal and infant morbidity can be treated and managed. This includes very common conditions, like chronic hypertension, obesity/poor nutrition, diabetes, anemia and chronic gut or autoimmune disorders. Chronic conditions, which can lead to fertility challenges, are important to treat as soon as possible to shorten the window to pregnancy.

Other reasons to seek care with your provider earlier than the 12-month mark include irregular periods without hormonal contraceptive use, thyroid issues, endometriosis, polycystic ovary syndrome (PCOS) and a history of ectopic pregnancies. Physicians and healthcare providers can also assist same sex couples, transgender men and nonbinary patients with their family planning goals.

Myth: You cannot get pregnant after age 35

Truth: While both maternal and paternal age can be a factor in pregnancy outcomes, the female fertility window continues until menopause. Fecundity (or giving birth, which is a combination of pregnancy occurrence and successful delivery) in women peaks within the ages of about 20 to 24 and decreases gradually by 30 to 32, with a more noticeable decline at 35 to 40.

The latter ages are not just due to fertility challenges but also include aneuploidy risks. Among 30-year-olds trying to become pregnant during one monthly menstrual cycle, approximately 20 percent will be successful. By comparison, a 40-year-old’s success rate in one cycle is about 5 percent. This should not discourage individuals over the age of 35 from discussing their options with their provider. There are successful pregnancies after the age of 35, as well as treatment options to aid them in trying to conceive.

Myth: Age only affects women’s fertility

Truth: The effects of aging on the reproductive system are less studied in males compared to females. However, advancing paternal age also affects male reproductive function and outcomes. Men generate new sperm on a regular basis, but the quality of the semen in male fertility, as well as androgen production and testosterone production, decrease gradually as age increases.

With respect to birth outcomes, paternal age over 40-45 years is associated with multiple birth anomalies such as heart, cleft lip and palate and limb. Development disorders can later develop, and those range from ADHD to autism to schizophrenia.

Myth: Diet impacts fertility

Truth: Studies have not shown specific foods related or linked directly to fertility or infertility. It is recommended that all people trying to become pregnant have a nutritious, well-balanced diet that is rich in iron, folic acid and other key micronutrients.

Minimizing alcohol and avoidance of second-hand and direct tobacco/marijuana use are known to improve a person’s fecundity. Consuming a daily, prenatal vitamin with 400 micrograms of folic acid is encouraged for people planning pregnancy.

Myth: Contraceptive medication causes infertility

Truth: Studies show that effective contraception does not affect fertility, and planned pregnancies have better outcomes. Most people who stop taking oral contraceptives resume their ovulatory cycles within the first month.

Pregnancy rates in the first year after stopping oral contraceptives or removing an implant or intrauterine device are about the same. Unintended pregnancies, particularly among those with chronic medical conditions and health problems, are more likely to experience poor pregnancy outcomes. Intentional pregnancy planning is optimal for both maternal and child health.

Myth: Irregular menstrual cycles are linked to infertility

Truth: While irregular menstrual cycles (when no hormonal contraceptive is being used) do not cause infertility, they can signal that the reproductive hormonal function is impaired.

Irregular menstrual cycles may signal that an individual is not ovulating or releasing an egg every month, or that the fertility window may be earlier or later than expected. People with irregular menstrual cycles, bleeding in between their cycles or absent menstrual cycles should see their primary care provider for further evaluation and assistance in predicting ovulation.

Myth: Regular menstrual cycles signal fertility

Truth: A regular menstrual cycle is a good indicator that a person is ovulating or releasing an egg every month in a predictable window, which can help rule out anovulatory infertility (infertility due to being unable to ovulate) as a cause of an opposite sex couple’s infertility.

Ovulatory dysfunction accounts for about 15 percent of infertility in females, meaning that it is only a minor factor contributing to infertility.

Myth: If you have given birth, it’s easy to get pregnant again

Truth: Being able to achieve one pregnancy often predicts future success, but it does not always guarantee it. Studies show that about 30 percent of infertility is secondary infertility – the inability to conceive or have a full-term pregnancy after previously conceiving spontaneously or without assistance. Numerous patients experience secondary infertility.

Myth: Stress leads to infertility

Truth: Infertility is a disease of the reproductive system and not the nervous system. Relaxation methods, such as meditation, can lead to improved mental and heart health. However, there is no evidence that relaxation itself can increase the chances of intentional pregnancy.

By Homa Shalchi