What increases my risk for infertility?

You hear stories all the time. As soon as a seemingly infertile couple decides to stop trying and go the adoption route, bam, the woman becomes pregnant. There's a reason for this: The stress of trying so hard has stopped. In fact, research shows that women who are emotionally expressive about fertility treatments had a harder time getting pregnant than those who were better able to deal with the stress of infertility internally.

This applies to men, too. Stress seems to affect both sperm quality and quantity, making it more difficult to conceive. Historically, when we faced stress in our environment (like a famine), our ancestors were in no position to make babies. In the male, increased levels of the stress hormone cortisol seem to inhibit production of normal semen. In women, increased cortisol influences the other stress hormones coming from the ovaries and adds a supersonic drum roll to a very delicate symphony. The resulting cacophony makes pregnancy very difficult. And contrary to popular wisdom, you can be too thin (to your body, that's also a form of stress). If you have a BMI of less than 20, you may increase your chances of getting pregnant by gaining 5 to 10 pounds.

Smoking appears to accelerate the loss of a woman’s eggs as she ages and may cause an early menopause. It is also strongly associated with an increased risk for miscarriage. Women who smoke during pregnancy are known to have low-birth-weight babies and preterm labor and delivery. There is also an increase in sudden infant death syndrome in homes where a smoker lives.

Physical and emotional stress have long been considered factors that affect a couple's ability to conceive, but doctors now have more solid evidence for their role. Stress raises levels of cortisol, one of the major metabolic hormones from the adrenal glands that can influence the way other hormones are produced and metabolized. Ovarian hormones, such as estradiol and progesterone, seem to be particularly vulnerable to the direct and indirect effects of cortisol.

It's hard to define how much stress is too much for you. Many couples with stressful lifestyles have no difficulty conceiving, hinting that other factors may override the stress effects.

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Up to 13 percent of fertility problems and pregnancy loss are attributable to tobacco. In addition, smokers are destined to go through menopause two to four years early. Kick the habit today.

Causes of infertility, both male and female, are numerous. For many couples having difficulty conceiving, the infertility may, in fact, be related to both the male and female. More common causes for infertility include ovulatory disorders, fallopian tube damage/blockage, uterine abnormalities, peritoneal factors, cervical factors and abnormal semen parameters.

Infertility can cause a great deal of stress and anxiety, both individually and as a couple. Receiving support of friends, families and professionals can help get couples through the process. There are effective coping strategies that have been found to help both the patient and partner. While there is clear evidence that infertility causes stress, it is not clear that stress impacts fertility. The human body is rather resilient when it comes to emotional stress, to the point where if a normal egg is released, it will fertilize and implant regardless whether the women is “relaxed” or “stressed.”

There are many reasons why couples experience infertility. Age may be a factor, a low sperm count, blocked fallopian tubes, endometriosis, defects in ovulation, etc.

Research shows that not getting pregnant is very stressful but probably does not cause infertility. If stress is keeping you from having intercourse, it may be playing a role. Often an occasional delay in ovulation leading to a delayed period can be due to stress or another life event. However, there are also many other causes, and seeing a doctor is a good idea.

Your doctor will investigate the potential causes of your infertility. It is recommended that women under age 35 see a fertility specialist after a year of trying to conceive. Women age 35 and above should see a fertility specialist after trying to conceive for six months.

There are a number of factors that can increase your risk of infertility, including age for both partners. In addition, diet and lifestyle habits play a role. You should both limit alcohol and caffeine consumption, eliminate any exposure to nicotine (smoking or exposure to second hand smoke), and try to maintain a healthy weight.

There is a complex relationship between stress and fertility. Infertility causes a lot of stress because it can impact every area of one's life—your relationship with your partner, your sex life, your job, your relationship with your family and friends, and your financial stability. Many women experiencing infertility report feeling anxious and depressed, and their stress levels are equivalent to the stress levels of women with cancer, HIV+ or heart disease. But the good news is that various relaxation and stress management strategies can help, both to make you better able to cope and to increase your chance of conceiving.