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7 Early Signs You May Have Fertility Problems

Your body can reveal a lot about your fertility. These are common red flags and what to do about them.

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A woman in a blue shirt talking to her fertility specialist

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Hoping for a baby? Whether you want to get pregnant now or someday, you may wonder if your body will cooperate. It’s never too soon to start thinking about your fertility, says Nicole Noyes, MD, system chief for reproductive endocrinology and infertility at Northwell Health. “You want to be proactive about it,” she says. Many factors that mess with female fertility can be addressed, boosting your odds of having a successful pregnancy. 

Everything from structural issues like a blocked fallopian tube to constitutional problems like your age can work against you in the baby-making department. (Not to mention, if you have a male partner, the problem can be his.) That is why it’s key to identify and solve fertility issues well before you’re ready to get down to business. Here are some signs you may have fertility challenges, and how to navigate them.

Sign #1: You are well into your 30s

While our age isn’t something we can solve, it is a major factor that affects our chances of getting pregnant. The good news is that up until around age 33, we pretty much coast along without an age-related worry in the world. But then, fertility potential starts fading fast. “From 35 to 40, you can lose up to 15% of your fertility each year. This translates into many women being much less fertile at age 40 than they were at 35,” Dr. Noyes explains.

Then during the roughly 10-year period leading up to menopause, which most of us enter around age 50, women become sub- to completely infertile. “It’s a little different from person to person with age of natural menopause ranging from about 42 to 58, but almost every woman is infertile by 45,” Dr. Noyes says. Those who magically give birth at 50 have most often either had eggs or embryos frozen at a younger age, or they used eggs from a younger donor. “There’s no shame associated with any of these options, so misleading a 40-something-year-old woman into thinking she can wait until the fifth decade and simply turn up pregnant without help is a disservice. Egg age truly matters.”

While doctors used to counsel couples trying to conceive to give it a year of having unprotected sex before getting help for infertility, Dr. Noyes says that is a very outdated perspective.

“That approach was developed when the average woman gave birth in her early 20s. Now, more of us are waiting until our 30s to start a family—me included—so giving up a critical year when our eggs are best and youngest no longer makes sense. We often don’t have month after month to wait and see.”

So how long should you give it the “college try” before seeing the doctor? If you’re still in your early- to mid-30s, you can wait three to six months before checking in, Dr. Noyes says. “If you’re 38 or older, I would go to a fertility doctor within a month or two—fertility treatments can definitely decrease the time to pregnancy.”

Sign #2: You have irregular periods

Are your periods irregular, coming randomly, or not at all? That’s a red flag that you may not be ovulating regularly. You may also be in this camp if the reason you went on birth control pills was to make your random periods more regular. “The period you have on birth control pills is an artificial one,” explains Dr. Noyes. “Once these women go off birth control pills, their period can be irregular or disappear altogether. The Pill doesn’t correct the ovulation problem.”

Your best bet: See your OB/GYN or a fertility specialist as soon as you are contemplating motherhood. They will take a medical history and often get a snapshot of your ovarian function using blood tests such as the anti-Mullerian hormone (AMH) test and follicle stimulating hormone (FSH) test (to see how the ovaries are doing relative to age). An ultrasound may be done to assess for antral follicle count (AFC), another marker of ovarian reserve. Solutions for lack of ovulation range from medications to correcting the problem causing ovulation issues to fertility drugs such as clomiphene citrate, letrozole or FSH. As long as she is not yet in menopause, a fertility doctor can usually get a woman to ovulate.

Sign #3: You have pelvic pain

If you experience pelvic pain during sex or your periods leave you doubled over, you may have endometriosis, a condition that can impact fertility. With endometriosis, the tissue that normally lines your uterus grows outside of it, where it can lead to trouble. “Sometimes when we do a transvaginal ultrasound, we find that endometriosis is causing ovarian cysts or scar tissue where the ovary is enlarged or pushed over to the side,” Dr. Noyes says. “The inflammation from endometriosis can wreak havoc with fertilization and implantation.”

Fibroids are benign tumors of the uterus that sometimes get in the way of fertility (for instance, one might be growing in the area of the womb where implantation occurs). They often don’t cause pain, though, so you might not know you have them, says Dr. Noyes.

The fix with fibroids can be surgery, but the exact procedure depends on their size and location within the uterus. Many don’t cause a problem at all while others are a big problem. If surgery is recommended, after the procedure, you may have to give it months for healing before you try to conceive.

If you have endometriosis and want to conceive, in vitro fertilization—which is when your egg and his sperm are combined in a lab and the fertilized embryo is implanted into the uterus—may be a good option. Surgery is another possible fix, but because endometriosis is an inflammatory condition, it tends to return, so if you go the surgical route you’ll be encouraged to try to get pregnant within six months of surgery.

Sign #4: You had an STI or abdominal surgery

Did you have your appendix out when you were 10? Did you have a sexually transmitted infection like chlamydia back in college? Did you develop a postpartum infection with your first child? Inflammation, fluid, and adhesions of scar tissue from previous infections and surgeries may make it harder to conceive by blocking or impairing the function of the fallopian tubes.

Surgery can sometimes take care of these problems. If you have blocked or impaired fallopian tubes, your doctor will likely recommend in vitro fertilization. With this option, since egg and sperm are fertilized outside the body and implanted directly into the uterus, you can bypass the fallopian tubes and still get pregnant.

Sign #5: Your thyroid levels are off

Both hypothyroid (underactive thyroid gland) and hyperthyroid (overactive thyroid gland) contribute to fertility issues. If your problem is a sluggish thyroid, you will need to go on thyroid hormone medication and get your thyroid hormone levels to the normal range (which usually happens within three to six weeks) to be fertile again. “The problem is a lot of women don’t realize they have what we call subclinical low thyroid disease,” says Dr. Noyes. A complete panel of blood tests including TSH, free T3, free T4, and a thyroid antibody test will tell you if you’re borderline low and could benefit from treatment.

“Hyperthyroid is a more serious situation and harder to treat,” Dr. Noyes adds. In the short term, medication that tells your thyroid to not produce as much hormone helps, but if the disease progresses, you may need removal of the thyroid gland and/or radioactive iodine therapy. If radioactive iodine is used, you have to wait six to 12 months after treatment to try to get pregnant because it isn’t safe for the fetus, she explains.

Sign #6: You are on antidepressants

The SSRI class of antidepressants (such as Prozac and Zoloft) can cause high levels of prolactin—a hormone made by the pituitary glands. High prolactin levels can make your period irregular and interfere with the uterus lining’s preparation for the implantation process by disrupting production of estrogen and progesterone hormones. If you’re taking antidepressants and want to conceive, you’ll need to carefully weigh with your doctor the risks and benefits of taking versus not taking the drugs. “A general rule of thumb is to be on the least amount of medication possible when attempting pregnancy, particularly in the first trimester when the fetus is undergoing important organ development,” says Dr. Noyes.

Sign #7: You have polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) can also stand in your way of a quick-and-easy conception. Women with this condition have higher levels of male hormones called androgens, as well as enlarged ovaries that produce cysts and problems with ovulation. “Many women are diagnosed in their teens and 20s because of issues other than infertility—maybe they had a lot of acne, excessive hair, problems with their period, weight gain, or even diabetes,” says Dr. Noyes.

It’s essential to see a fertility specialist to formulate a game plan. “With PCOS there are often subtle things that go awry,” says Dr. Noyes. “I monitor the cycle to see if the egg is maturing the way it's supposed to, for instance, by tracking the egg’s development by ultrasound or monitoring if the estrogen level is rising appropriately. It requires a more in-depth evaluation of ovulation because some women ‘kind of’ ovulate—they almost get there and then it fades.” Medications to regulate ovulation or trick the body into ovulating can help.

Dropping some pounds can help, too, because extra weight makes PCOS worse, says Dr. Noyes: “Weight loss can sometimes restart the ovulatory process and allow for spontaneous pregnancy.”

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Published May 21st, 2019
A woman in a blue shirt talking to her fertility specialist

Make an appointment - fertility