Here's a sobering stat for anyone trying to conceive. Increasingly more couples in the US can't get pregnant, even after a year of trying, according to a recent survey by the National Institutes of Health.
A few years ago, statistics from the US Centers for Disease Control and Prevention put the number of women having difficulty conceiving at approximately 10 percent—roughly 1 in 10. Now, using results from this newest survey, that number appears to be closer to 16 percent—1 in every 6 couples. But, like any stats, there's more than one way to look at the numbers.
The easiest explanation involves age. "As women delay conception, they are finding it more difficult to conceive if they are in their late 30s and early 40s... where the overall likelihood of pregnancy each cycle is decreased," says Kim Thornton, MD, director, Division of Reproductive Endocrinology and Infertility at Beth Israel Deaconess Medical Center in Boston and board member of RESOLVE: The National Infertility Association.
Certain lifestyle factors seem to be coming into play, too. Thornton points to rising obesity rates among men and women—body weight can affect your fertility—and exposure to certain environmental toxins.
However, Alice Domar, PhD, executive director of the Domar Center for Mind/Body Health and an assistant professor of OB/GYN and Reproductive Biology at Harvard Medical School, thinks the numbers could be telling a slightly different story. "It is unclear if more people are actually experiencing infertility or if more people are seeing a doctor for it."
Sejal Dharia Patel, MD, a fertility specialist at the Center for Reproductive Medicine in Orlando, Florida, and former co-director of the Reproductive Endocrinology and Infertility Division at Ohio State University's College of Medicine, agrees. "Environment, diet, and lifestyle are certainly factors, but it's also a higher awareness of fertility. In prior years, couples would go for two or three years before seeking treatment. I now frequently see couples who have only been trying for a few months. Thanks to social media and other news sources, they better understand the options that are available to them."
As for what types of fertility issues doctors are seeing when couples come in for help, Norton cites a study that breaks it down as follows: approximately 21 percent of all infertility cases are related to ovulation, 26 percent are due to semen (a.k.a. male factor infertility), but as many as 28 percent of couples have unexplained infertility. Other reasons for conception difficulties for women include endometriosis and cervical factors.
Dr. Patel adds that for a surprising number of couples coming in for help, the underlying problem turns out not to be medical at all. "Many times, it's a scheduling problem. With career couples managing hectic schedules and traveling for their respective jobs," she explains, "coming together during the two or three peak ovulation days can be very difficult."
So, when is it time to seek out a fertility specialist? "We do know that the age of both the woman and the man can impact fertility, so the key is to see a doctor sooner rather than later: after a year [of trying to conceive without success] if the woman is under 35, after six months if she is over 35, and after three months if she is over 40," says Dr. Domar.
Seeking treatment early on also seems to be a wise move if either partner has a known medical issue. "If there are any known fertility risk factors, such as for women, a history of irregular menstrual cycles, pelvic infection, a ruptured appendix, known or suspected endometriosis... and for the man, a history of an undescended testicle or having had mumps as an adult, it is recommended that you see an infertility doctor after only a few months of trying on your own," says Domar. "Getting a check-up is always a good idea, in case there is something which should be treated prior to pregnancy."
Maximizing your fertility, say experts, may come down to some simple health decisions. "Don't smoke, limit alcohol and caffeine, and keep your weight in check—in both directions," says Dr. Patel. "Women who are underweight [a body mass index of 19 or less] causes a four-fold increase in the time to conception. Smoking, consuming more than two alcoholic drinks per day, and consuming more than four cups of coffee per day increases the chances of infertility by 60 percent, for both men and women."
But even for couples who run into difficulties getting pregnant, despite their best efforts, fertility specialists offer a surprisingly upbeat message.
As Dr. Domar sums up, "The good news is that most cases of infertility can be successfully treated, often with very low-tech treatments."