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For couples who conceived easily and naturally and had a healthy birth for their first, or even second and third, children, secondary infertility (SI) can be a huge shock. But the truth is that secondary infertility occurs approximately as often as primary infertility.
Secondary infertility means that a couple was unable to conceive after 12 months of unprotected sex, after having previously had one or more healthy pregnancies and births. Some couples with secondary infertility are able to conceive, but experience miscarriages and/or stillbirth that prevents them from reaching a live birth.
Some couples have secondary infertility after multiple previous healthy births.
Note that it’s only called secondary infertility if your first birth occurred naturally. If you used fertility treatment like IVF to get pregnant the first time round, then any struggles to get pregnant a second time are considered part of your primary infertility.
It’s generally thought that secondary infertility affects about as many couples as primary infertility. One study from 2006 reported that 3.3 million women suffered from secondary infertility, and that secondary infertility now accounts for 60% of all cases of infertility.
Another study revealed that among women aged 20-44, 10.5% experienced secondary infertility, while a report from the CDC calculated that 39% of women with fertility issues were suffering from secondary infertility.
It’s clear from these figures that a significant number of couples experience secondary infertility, but it goes under the radar of society far more than primary infertility.
Secondary infertility can originate in either the woman or the man.. It’s estimated that SI cases are divided roughly equally between male-caused infertility, female-caused infertility, and secondary infertility due to unknown causes.
When secondary infertility originates in the woman, it can be caused by:
Secondary infertility that originates in men can be caused by:
The good news is that treatment for secondary infertility can have higher success rates than those for primary infertility. That’s because it’s usually possible to identify a specific cause for SI, and once the cause has been dealt with, fertility levels return.
In general, treatments for secondary infertility are similar to those for primary infertility.
When secondary infertility is caused by adhesions in the uterus or testicular varicocele, surgery to remove the scar tissue, fibroids, or other blockages, and to fix enlarged veins in men, can be very successful.
When secondary infertility originates in the woman, they are often given medications such as clomiphene and letrozole to increase and speed up ovulation and overcome ovulatory disorders.
When SI originates in men, they may be given antioxidants and anti-aging medication to improve sperm quality.
Depending on the cause of the SI, couples might be counselled about changing their diet to lose weight, reducing their caffeine and/or alcohol intake, and/or avoiding certain pollutants.
Timed intercourse together with ovulation monitoring can also help couples with secondary infertility to conceive.
Intrauterine insemination, or IUI, is when sperm is surgically placed within the fallopian tubes to increase the chances of fertilization. It’s been found to be very successful among couples with unexplained secondary infertility, with one study reporting IUI success rates of 47.4% among couples with SI, in contrast with 8.4% among those with primary infertility.
If other approaches don’t result in a healthy pregnancy, couples with secondary infertility are often advised to try IVF. IVF can be more successful among couples with SI than those with primary infertility.
Secondary infertility might be less talked about than primary infertility, but it can be just as upsetting for couples trying for another baby. If you’re struggling to conceive after one or more healthy births, take heart from knowing there are many successful treatment options which can help you build the family you dream of. Whatever path you take to adding to your family, we hope it’s as smooth as possible.
If it’s taking you a long time to conceive your first baby, or you had your first child using IVF, this child could be your one and only.
Perhaps you may not be able to give birth a second time; your local regulations won’t allow you to undergo IVF for a second child or the cost is too high; or you simply don’t have the emotional bandwidth to cope with the stress and challenges of trying to conceive all over again.
Whatever the reason, you might find yourself raising an only child when you had always expected to give your child a sibling. Perhaps you even dreamed of having a big family. As well as having to cope with the loss of a dream, you might also be worrying about how it will affect your child to be an “only.”
There’s a persistent belief in “only child syndrome,” which holds that only children are negatively impacted by growing up without siblings. But at a time when more and more people grow up as “onlies,” does that belief still hold water?
Since research into the topic began over 120 years ago, a lot has changed about society. Today, it’s widely believed that “only child syndrome” is a myth, and there’s no “perfect” size for a family.
The idea that there’s something negative about being an only child began in the 1890s. In 1898, child psychologists G. Stanley Hall and E. W. Bohannon carried out a survey researching only children. They reported that only children are spoiled, selfish, maladjusted, lonely, antisocial, and bossy, to list just a few of the bad traits.
That study led to decades of damning only children. Psychologists claimed that because only children got the full attention of their parents and grandparents, they didn’t learn how to share, acquired an inflated sense of their own importance, and believed that they were fragile beings in a dangerous world. Without other children around them, psychologists argued, they never had to learn interpersonal skills.
In 1928, psychologist Norman Fenton claimed “Being an only child is a disease in itself.”
There is research showing that it can be tough to be an only child. Only children tend to be less tolerant and less resilient than those who grew up with siblings, and more likely to experience stress later in life when caring for their parents.
One study of college students in China found that only children had higher rates of anxiety, depression, and/or a combination of the two than children with siblings. 33.4% of only children in the study had anxiety syndrome, compared with 17.4% of people with siblings; 30.7% had depression, vs. 12.9% of non-only children; and 24.8% experienced both anxiety and depression, compared with 11.3% of non-only children.
But another study just a year later examined the psychological impact of COVID-19 on adolescent mental health. It reported that teenagers with siblings showed higher rates of depression and anxiety than those who are only children, with 35.2% of only children and 38.8% of non-only children showing symptoms of depression, and 20.5% of only children and 24.7% of non-only children showing anxiety symptoms. So like many things, the evidence is mixed.
Most research over the last few decades pointed to the same conclusion: there is no serious handicap in being an only child. In fact, it even brings a lot of positives.
Study after study reported that only children manage as well as or better than most children with siblings. Psychologist Toni Falbo, who is an expert on only children, conducted a meta analysis of over 100 studies and concluded that when it comes to academic achievement and intelligence, only children out-perform everyone except for firstborns and children from 2-child families. They also have a more positive parent-child relationship and better character traits than people who grew up with siblings, and are develop mentally on a level with firstborns and people from 2-child families.
Recent original research concluded that only firstborns and people from 2-child families perform as well as only children in an academic context, and that onlies are on an equal footing with people who grew up with siblings when it comes to interpersonal relationships and character traits.
Much of the research that found that only children are selfish, spoiled, and/or antisocial came from studies in China in the wake of China’s One Child Policy (OCP), which created a generation of children referred to as “Little Emperors.” But deeper studies showed that this was not because they didn’t have any siblings, but because they grew up in a cultural context that lavished praise and admiration on the only child.
In the last few decades, psychologists have agreed that what matters isn’t whether or not you have brothers and sisters, but what your relationship is like with your parents. Falbo pointed out that the reason why only children, firstborns, and people from 2-child families all have high levels of academic attainment and intelligence is because of their parent-child relationships.
According to a recent report, “different developmental outcomes between only children and non-only children is because the former group have a special parent–child relationship characterized by increased parental anxiety and attention.”
That means that parents of only children are more inexperienced as parents, so they can be more anxious and overprotective. But they are also more careful and responsive, which raises children who feel safe and supported, produces positive parent-child relationships, and creates a more stimulating home environment.
Ultimately, being an only child has both positives and negatives, just like having brothers and sisters. It’s true that only children often say that they regret not having had a sibling when they were a child, but there are also children who get bullied by their siblings, or who grow up with low self esteem because they felt like the least-loved child.
Before worrying about your only child, it’s worth remembering that being an only child today is very different to being an only child in 1898, or even in 1928. 100 years ago, children without siblings didn’t have a lot of options for socializing outside of the family, especially since far fewer lived in urban areas. But between playdates, preschool, and playing in the park, things are very different for today’s children.
In 2021 it’s also far more normal to be an only child, so onlies don’t feel stigmatized for not having brothers or sisters. Research by the Pew Center found that in 2015, 22% of children didn’t have siblings by the time their mother reached the end of childbearing age, compared with 11% in 1967.
Finally, psychologists agree that many elements combine to create a child’s personality. It’s not just about being an only child or your birth order, it’s also about how much you’re exposed to challenges, how much you can rely on your early relationships, and more.
If you’re worried about your only child, make sure to give them plenty of opportunities to socialize, and think about the extent to which you “bubblewrap” them and prevent them from taking risks.
If you’re starting your family or hoping to enlarge it, whether through fertility treatments, IVF, or conceiving naturally, there’s no need to worry about how an only child might cope. We hope your parenthood experience is smooth and anxiety-free.
If you’re in a toxic relationship with a partner who’s physically, mentally, or emotionally abusive, or is hyper-controlling when it comes to money, sex, or daily life, it’s probably best to delay trying to start a family until your relationship reaches a more healthy place.
But a toxic relationship can spring up in almost any area of your life: at work, with your boss or a colleague; with your siblings or parents; or with someone you think of as a friend.
If you’re in a toxic relationship, you might find it hard to concentrate at work, difficult to enjoy yourself when you’re with your friends, and even struggle to sleep well at night. But have you considered that your bad relationship could also be affecting your ability to conceive?
Having a conversation with a toxic friend or relative can be incredibly stressful, and stress can impact fertility levels. Even seeing them or just thinking about them can raise your levels of alpha-amylase and cortisol, the primary stress hormones, and trigger your brain to release adrenaline which preps your body’s “fight or flight” response.
As well as leaving you feeling jumpy and exhausted, when these hormone levels are elevated, it throws your body’s hormone balance out of whack and that can affect production of vital reproductive hormones.
Gonadotropin releasing hormone (GnRH) is the substance your body produces to trigger the release of sex hormones like estrogen, which controls a woman’s menstrual cycle and ovulation, and testosterone, which governs men’s sperm quality and sperm count. Scientists have suggested that higher stress hormone levels could interfere with GnRH production, and thus affect both male and female fertility.
When men experience high levels of stress, it can also boost the release of glucocorticoids, which are steroid hormones that influence testosterone and thus affect sperm production.
Being in a toxic relationship means that you are frequently attacked, demeaned, undermined, and generally made to feel worthless and like a failure. No matter how much you tell yourself that “it’s them, not me,” or how many times your friends and partner reassure you, this kind of attack can drag down your self-esteem and trigger depression, anxiety, or both.
Both depression and anxiety can affect your fertility. As well as causing stress hormone levels to rise, anxiety disorders can be accompanied by an imbalance in your estrogen or testosterone levels.
Depression can interrupt the regular functioning of the hypothalamic-pituitary-adrenal axis, which is the central system controlling the menstrual cycle, or disrupt the body’s ability to regulate the luteinizing hormone that is responsible for ovulation.
It might not be the relationship itself which affects your fertility, but the way that you cope with its impact on your life.
If you’re in a toxic relationship, there’s a good chance that you’ll use alcohol, cigarettes and tobacco products, and “comfort foods” to help yourself calm down and recover from a painful interaction.
Although moderate drinking hasn’t been found to have much effect on either male or female fertility, drinking too much — defined as 4-6 drinks a week or more — can be harmful. One study found that women who drink more than 4 alcoholic drinks weekly are more than twice as likely to have a miscarriage as woman who don’t drink, and women who are heavy drinkers could experience menopause at an earlier age.
For men, heavy drinking is often associated with erectile and ejaculatory dysfunctions, which make it difficult to conceive, while long term, heavy alcohol use can lower testosterone, cause testicular atrophy which damages sperm production, and trigger liver dysfunction, which in turns leads to hormonal imbalances when the liver can’t metabolize estrogens effectively.
However, if you’re undergoing IVF, even one extra drink a day for women can significantly affect your chances of success. It’s also known that moderate to high alcohol consumption during early pregnancy can damage the unborn fetus and cause alcohol-related birth defects.
If you quit smoking, you’ll know how easy it is to restart when times get stressful, but any amount of cigarette smoke can make it harder to get pregnant. One study found that if one member of the couple smokes, it can take them around twice as long to conceive than for non-smoking couples.
For women, the chemicals in cigarettes can harm the ovaries and produce poor-quality eggs, as well as disrupting your brain’s endocrine function which is responsible for producing and releasing sex hormones.
Men who smoke are affected too. Cigarette toxins can damage the DNA in sperm and reduce sperm quality, affecting their ability to fertilize the egg and increasing miscarriage rate when conception does occur. 120,000 men in the UK aged 20-39 are infertile because of smoking.
When men and women turn to food to soothe their feelings, they are very likely to eat foods that are high in fat, sugar, and chemicals, speeding up weight gain and obesity which in turn affect fertility.
One study found that your chances of getting pregnant naturally within 1 year (the definition of normal fertility) drop by about 5% for every extra BMI point a woman has above 29. Men who have a BMI of over 25 could see sperm counts fall 22% and sperm concentration drop 24%.
Women who become obese, or eat far too little, could experience anovulation, where the ovaries stop producing eggs on a regular basis or quit altogether.
It’s not surprising that people in toxic relationships have trouble sleeping, because their anxiety and stress levels are so high and they struggle to wind down enough to sleep. But the body uses sleep to regulate hormone production, so if you’re not sleeping well, it can throw your sex hormones out of sync.
Finally, toxic relationships have a way of taking over your life. Everything you do revolves around your reaction to the last incident, or your attempts to avoid having another bad interaction, to the extent that you can’t even enjoy sex. Less sex is practically guaranteed to lower your chances of conceiving.
A toxic relationship can even end up poisoning the other, healthy, relationships in your life, causing your stable marriage or partnership to fall apart.
There’s any number of reasons for leaving a toxic relationship, but it seems like you can add fertility to the list. If you’re hoping to start a family, whether through IVF or by conceiving naturally, removing toxic relationships from your life can only be a good move. We hope your path to parenthood will be smooth and stress-free.
It’s common knowledge that smoking cigarettes can reduce a woman’s ability to conceive. But as the e-cigarette craze continues sweeping the globe, the trend raises questions about the impact of consuming tobacco and nicotine in other forms, such as vaping, for women trying to conceive.
So, how does vaping really affect fertility?
The negative impact of smoking on fertility can’t be overstated. Multiple studies and meta-analyses have found that:
With cigarette smoking linked to both troubles in conceiving and negative outcomes for pregnancy, doctors recommend that women who are trying to get pregnant stop smoking. Even a few cigarettes a week can put a roadblock between a woman and a healthy pregnancy.
It’s clear that smoking reduces the chances of becoming pregnant naturally. Can the same be said for women who are trying to conceive via assisted reproduction?
An American study of women undergoing IVF treatments found that smokers experienced lower rates of success. They had a 50% reduction in implantation and ongoing pregnancy rate, compared to women who did not smoke during their treatment cycle.
Strikingly, the study found that women who had stopped smoking shortly before their treatment cycle had the same rates of implantation and full-term pregnancy as non-smokers, illustrating just how damaging smoking is for fertility.
That conclusion was confirmed by a Danish study, which found a direct link between smoking and unsuccessful fertility treatments. Tobacco use before and during pregnancy lead to higher rates of maternal, fetal, and infant morbidity and mortality, the researchers wrote, along with lower rates of pregnancy.
Often touted as a healthier alternative to smoking cigarettes, vaping refers to consuming tobacco via an electronic device. There are a number of vaping devices on the market. Some are visually similar to traditional cigarettes, while others are sleek, futuristic-looking devices.
Unlike cigarettes, these battery-powered devices heat up cartridges filled with liquid, turning them into vapor which is then inhaled by the user.
Because the most damaging chemicals in cigarette smoke -- carbon monoxide and tar -- are not present in vape smoke, the UK’s National Health Service has recommended that smokers try vaping as a tool to wean themselves off cigarettes.
However, vaping is not harmless. Vape liquid contains large amounts of highly addictive nicotine, and initial studies have linked the practice to lung irritation. And because vaping is so new, the long-term effects are still unknown.
While research is ongoing, it appears that yes, vaping can lead to fertility difficulties.
A recent study published in the Journal of the Endocrine Society found a correlation between e-cigarette use and embryo implantation. Researchers found that mice exposed to e-cigarette vapor had major delays in the onset of their first litters, along with difficulties in embryo implantation. In pregnant mice, vaping “caused changes in metabolic, inflammatory, neurological, and pulmonary factors within exposed offspring.”
In other words, there was a strong connection between delayed pregnancy, impaired implantation of embryos, birth defects, and vaping. The negative impact on both fertility and fetal health should serve as a caution for women who vape that are considering becoming pregnant.
Researchers from Oregon State University found in a meta-analysis that “e-cigarette usage during pregnancy will be as harmful to fetal lung development as is conventional cigarette usage.”
But it’s not just women’s fertility that’s impacted by vaping. Men who use e-cigarettes daily were found to have poorer quality sperm and lower sperm counts than non-smokers.
A Polish study noted that vaping liquid contains a range of harmful substances that have the potential to affect fertility, including “endocrine disruptors, which disturb hormonal balance and morphology and the function of the reproductive organs.”
Although e-cigarettes may be safer than traditional cigarettes, nicotine is definitively linked to health risks for both pregnant women and their fetuses.
Some of the dangers for babies exposed to nicotine in utero include:
For women who are trying to conceive, there’s a clear link between smoking and a higher chance of ectopic pregnancy. Nicotine has been found to cause a spike in abnormal sperm morphology among male mice, and it’s likely that also applies to humans.
E-cigarette liquid is largely unregulated, which means that it’s hard to know just how much nicotine one cartridge contains. This lack of standardization adds another risk factor for women who are trying to conceive or who are pregnant.
Absolutely!
If you’re thinking about becoming pregnant, this is an excellent time to put the vape down and embrace a nicotine-free life. While it’s tempting to think that e-cigarettes are a safe alternative to smoking, the truth is that vaping can also seriously hurt your health - not to mention that of your future baby.
There are many resources available to help you kick your tobacco habit before you become pregnant. Nicotine Replacement Therapy (NRT) is one option, but you should consult with your doctor about the best plan of action for you.
Cutting out nicotine doesn’t just raise your chances of becoming pregnant - whether you’re conceiving naturally or using reproductive assistance - it can also increase the likelihood of carrying a baby to term. Not to mention that your baby will have a smaller risk of potential issues upon birth.
Although research is still ongoing into whether or not e-cigarettes are safer than traditional smoking during pregnancy, there’s plenty of evidence that shows any nicotine consumption can negatively affect the health of both mother and baby.
It’s widely known that the toxins and chemicals in cigarette smoke can affect your fertility, and that if you want to become pregnant, it’s best to stop smoking.
But cigarette smoke isn’t the only source of harmful chemicals that can make it hard for couples to conceive and give birth to a healthy baby. As science advances, scientists learn more about the ways that regular products that you use at home every day can interact with your reproductive health.
There are 3 main ways that environmental toxins can harm your fertility, but bear in mind that some products can affect you in more ways than one:
Each one of us is exposed to millions of chemicals every day, and no one is certain just how many of them could impact on fertility. It’s estimated that each pregnant woman in the US is exposed to over 43 different chemicals on a regular basis.
Here are some of the most common products that you’re likely to have at home and could contain chemicals that can make it harder for you to conceive.
Old pipe networks and paint compounds used to contain high levels of lead, which can damage the reproductive system. For example, the headline-grabbing health crisis in Flint, MI, in 2015 was caused by lead leaching out of old pipes and into the water supply.
If you live in an old house which hasn’t had the paint replaced since the 1970s, the chances are high that it’s lead-based. Oil-based paints, paint thinner, and painting supplies can contain lead and mercury, but newer paints aren’t 100% safe, either. Latex-based paints can be made with ethylene glycol ethers and biocides, which can disrupt the menstrual cycle, decrease sperm quality, and increase the risk of miscarriage.
The chemicals in paint don’t have much impact on your health if they are already on the walls, but they can affect you if you start scraping them off or putting on a fresh coat of paint. That’s when you’ll either create fine particles of dried paint or release paint fumes into the air, which can be easily breathed in.
Many household cleaning products and detergents contain:
Heavy metals have been linked to increased incidence of miscarriage, uterine fibroids, and hormonal disorders which affect fertility.
Triclosan is an endocrine disruptor which raises thyroid hormone levels, affecting fertility in men and women, and can also increase breast cancer. It’s found in many antibacterial soaps as well as household cleaners.
Chlorinated hydrocarbons are used in cleaning agents, pesticides, and the manufacture of PVC items. Women with the highest levels of PCBs have a 50% decrease in their ability to get pregnant, and are far more likely to miscarry when they do become pregnant.
If you live in a busy city or close to a main road, you’re likely to be breathing in a lot of traffic fumes which contain heavy metals, particulate matter, and other harmful chemicals. There’s a slight but definite link between the distance a woman lives from a highway, and her fertility levels.
Traffic fumes affect male fertility too, with motor vehicle exhaust emissions found to affect sperm count, motility, and vitality. .
Organic solvents like polybrominated diphenyl ethers (PBDEs) and organophosphate flame retardants (PFRs) are used as fire retardants. They can affect thyroid balance and sex hormone production, which in turn damages the menstrual cycle and ovulation in women.
One study of PFRs among 211 women undergoing IVF found that women with the highest concentrations saw their chances of successful fertilization drop by 10%, of embryo implantation falling by 31%, and a 38% drop in live births.
PFRs and PBDEs are used in:
They are very prevalent in the US and are already in most people’s bloodstreams.
Phthalates and parabens, which are serious endocrine disruptors, are used in a massive number of different household and personal products.
You’ll find them in:
Phthalates and parabens are among the most harmful chemicals for reproductive health, and what’s worse is that they are truly everywhere. Over 97% of Americans have a detectable level of phthalates in their bloodstream, even though phthalates are quickly excreted from the body, because they are so prevalent that blood-chemical levels are replenished just as swiftly.
Many studies over the past several years have linked higher phthalate levels to lower chances of successful IVF outcomes, and increased miscarriage risk both for natural pregnancies and those enabled by IVF. In April 2020, researchers warned that pre-conception phthalate exposure could be a risk factor for adverse pregnancy outcomes. Men with high phthalate levels show damage to sperm.
It’s important to read the labels on cosmetics and look for items that are paraben-free and fragrance-free. It's also a good idea to regularly air your house to get rid of any build-up of fumes, and choose nail polish brands that don’t contain acetone. Although nail polish choices will only prove problematic if you paint your nails weekly or more often.
An astonishing number of plastic products contain BPA (Bisphenol A) or the almost equally harmful Bisphenol S (BPS). Like phthalates and parabens, these are endocrine distributors that affect male and female reproductive fertility.
In men, high BPA levels can drag down sperm count, sperm vitality and motility, and sperm concentration, while in women it can damage tissue in the uterus, ovaries, and the hypothalamus and pituitary gland which govern sex hormone production.
BPA is used in many different types of plastics, including:
BPA is also used to coat sales receipts, so it’s best not to handle them with wet hands and to throw them out ASAP. You should avoid heating up food in soft plastic containers or covering it with cling wrap, because BPA chemicals and phthalates too transfer when they are heated. Use glass or ceramic dishes to reheat food, and cover it with a paper towel instead of plastic.
Unless you buy organic food, all your produce, meat, and dairy is likely to contain some pesticides. If an all-organic diet is impossible, it’s still worthwhile to do what you can to cut your exposure to pesticides as much as possible.
Pesticides can damage sperm quality and quantity, act as endocrine disruptors, and affect fetal development leading to miscarriage. A study of women in Ontario, Canada, found that when pesticides use rose, fertility fell. Washing produce before eating it can help, and if you’re involved in gardening or farming you should also stay away from pesticide usage.
You can also help cut the level of phthalates in your food by avoiding processed foods and takeout food that are sold in soft plastic packaging.
You can’t always remove all the multiple factors that have an impact on your fertility, but the more that you can reduce them, the better.
Checking the products you bring into your home to make sure that none of them contain dangerous parabens, phthalates, BPA, or other harmful chemicals, and trying to stay away from thing that would adversely affect you, can help remove obstacles in your path to starting a family, whether you’re using IVF or hoping to get pregnant.
If you’re over age 35 and you don’t yet have children, you’ve probably had at least one interfering person remind you that you’d better hurry up because your fertility will decline. No one ever says that to men, of course. Menopause is like a ticking time bomb for women who want to start a family, but men don’t have the same finish line for their fertility.
Or do they?
Men can produce sperm throughout their lives, so there is no “male menopause” when men can’t have children any longer. But that said, studies have shown that male fertility does decline with age.
If a man is over age 45, it can take five times longer for he and his partner to conceive than if he was aged 25 or under. When the man is over 40, he and his partner are 30% less likely to conceive during a 12-month period than if the man is under 30.
Male age affects IVF success rates too. One study found that when both the man and the woman are aged 35-39, they have a conception rate of 29%, but that drops to 18% if the woman is aged 35-39 but her partner is five or more years older.
Women tend to see their fertility drop off steeply in their late 30s and 40s, but for men, fertility lessens much more gradually, and from a later age. Male fertility generally starts to fall in their 40s and through their 50s.
A French study found that women’s reproductive capability drops from age 35, but for men it’s only from about age 40. Other research concluded that before age 34, there was no noticeable change in sperm concentration, sperm motility, sperm morphology, or sperm volume, but that after 40, sperm concentration and sperm morphology had both declined.
There are two main ways that male fertility can decline over time:
Scientists have also found that as men age, sperm shows increasing DNA fragmentation, which in turn increase the chromosomal defects that trigger miscarriage.
When men struggle to achieve erection, it’s referred to erectile dysfunction. Without an erection, a man can’t naturally ejaculate the sperm which fertilize the egg and achieve conception. ED can have a number of causes, including insufficient testosterone and poor blood circulation. The risks of severe ED rise 300% between the ages of 40 and 70, and those of moderate ED by 200%.
As men get older, their hormonal balance changes and testosterone levels drop. The decline begins at around the age of 40, which is much later than the age when female fertility begins to decline, but it’s still significant.
Testosterone is the hormone that controls men’s libido, ability to ejaculate, and the ability to achieve and hold an erection. Total testosterone declines at around 0.8% per year, and sex hormone-binding globulin (SHBG) increases at 1.6% per year, which scientists speculate further reduces testosterone levels.
By now, scientists agree that sperm quality decreases with age, but there’s less agreement about exactly why and how that takes place. The drop in testosterone certainly plays a role. Leydig cells in the testes generate very high levels of testosterone which produce sperm, but those Leydig cells drop in number with age.
There are a number of factors which affect sperm and semen health. (Sperm is what fertilizes the egg, and semen is the liquid which holds the sperm.) The main issues are:
It’s still unclear whether sperm concentration falls significantly. Some scientists even think that sperm concentration may increase slightly with age.
There are studies that show that sperm morphology can decline by anything up to 0.9% per year, with a total change of up to 18% over 20 years. Sperm shape affects the sperm’s ability to fertilize the egg. The more that it varies from the normal, the harder it will be for conception to take place. However, sperm morphology is difficult to research with confidence, because the data can vary a lot between studies.
Scientists are far more concerned about the way that changes to sperm motility affects male fertility. According to the most recent research, sperm motility could drop by 0.8%/year of age for every year of age. In fact, 40% of men aged 40-60 have low motile sperm, in contrast with just 20% of 20-30 year olds and 17% of 30-40 year olds.
Other issues that cause sperm health to decline are a drop in semen volume, and a loss of strength in vesicular function, which means that the semen is ejaculated much more weakly and doesn’t travel as far.
Women are born with a finite number of eggs, but men keep on producing sperm throughout their lives. Every time that sperm is made, it reproduces the male DNA, and with every replication there’s a risk of mutations, or DNA fragmentation. As men get older, DNA fragmentation increases.
A rise in DNA fragmentation also means a rise in chromosomal abnormalities, which can cause health defects, low birth weight, and miscarriage or stillbirth. The risk of miscarriage in the first trimester is 25% higher when the father is over 35, even if the mother is under 30. Another study found that babies born to fathers aged 45 or over were more likely to be born premature and more likely to have a low birth weight and Apgar score than those born to younger fathers. Additionally, babies with fathers aged over 55 were more likely to need assisted ventilation and to be admitted to a NICU.
Bear in mind that the older you are, the more time you’ve had to be exposed to toxins, germs, and to develop conditions that can affect fertility. The authors of one study observe that “the risk of developing a medical condition or of being exposed to environmental toxins increases with age.”
Some of the environmental issues that can affect male fertility include:
Endocrine disruptors are found in many common items both at home and at work. These are materials that disrupt the release of the sex hormones which control sperm production and erectile function. Some serious endocrine disruptors include:
Other chemicals that affect the hormonal balance include pesticides, DDE, diesel fumes, lead, and paint thinners. Traffic fumes can also affect sperm count, motility, and vitality.
Sperm production works best when the testes are a couple of degrees cooler than typical body temperature, but a lot of men work in hot environments like factories, garages, etc. which raise testicular temperature. When the testes are too hot, they are more likely to produce sperm that’s the wrong shape, affecting sperm motility.
Male fertility problems are often linked to other health conditions, like obesity, cancer, hypertension, heart disease, and kidney disease. Heart disease and hypertension, for example, affect vascular health and increase the risks of ED. Obesity can affect the hormonal balance. All of these conditions are more likely to affect older men rather than younger men.
Common medications like spironolactone and calcium channel blockers prescribed for hypertension, H2 blockers prescribed for stomach ulcers, and antiandrogen treatments (flutamide) for the prostate can all have side effects that affect sperm production.
Like with other health issues, maintaining a healthy weight and avoiding known toxins can make a difference to male reproductive health. If you’re having trouble conceiving, it’s also worth considering if there’s something in your workplace or home environment that could be affecting your fertility.
However, no one can (or should try to) avoid getting older, and it’s inevitable that male fertility will decrease somewhat with age. If you’re a man aged over 40 and you and your partner are struggling to conceive, it’s worth it to check if there’s anything that could be affecting your fertility levels as well as investigating female fertility.
Whether you use IVF, donor sperm, or natural conception to build your family, we hope your experience is as smooth as possible.
Most couples discuss when might be the ideal time to start a family. Although everyone would love to be told exactly when is the best time to have a child, the truth is that there’s no single perfect moment when you should try to conceive.
There are always a lot of variables to consider, including:
It’s important to explore these issues. Although there’s no perfect time, there are indeed periods in your life which would be more suitable to raising a child, and times when it would be better to wait. Here are some of the issues to consider before you plan to start a family.
Ideally, it would be best to wait to start a family until your lifestyle is established and there are no major changes expected in the next year or two.
This isn’t just because you want to raise your child in a stable environment, but also because big changes to your life always increase stress and anxiety. That’s true even for positive changes, like moving to the region where you always wished to live or switching careers to pursue your dream job.
It’s still unclear whether stress has a significant effect on your fertility, but scientists do think that increased levels of the stress hormones alpha-amylase and cortisol could interfere with the production of GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones. A US-based study found that women who have the highest levels of alpha-amylase took 29% longer to get pregnant than those with the lowest levels, and different research concluded that for men, stress affects sperm shape and speed.
You should also never decide to try for a child as a way of fixing a problematic relationship. Again, not just because you might not have resolved your issues by the time your baby is born, but also because the added stress can affect fertility.
Many people struggle with mental health disorders like anxiety and depression, and worry that these could stop them from starting a family. The good news is that there is no reason why you can’t have a healthy baby and a happy family even while struggling with anxiety or depression.
However, both anxiety and depression can make it take longer for you to conceive naturally.
Anxiety could raise your stress hormone levels, and may be caused by an imbalance in the sex hormones estrogen and testosterone. Depression can disrupt the hypothalamic-pituitary-adrenal axis, which controls the menstrual cycle, or disrupt the luteinizing hormone which regulates ovulation.
If you’re suffering from depression or anxiety, and it’s not yet under control with medication or lifestyle changes, it is better to wait until you have received medical help and balanced your mental health.
In general, if you or your partner are scared about having a baby, wrestle with anger management problems or psychosis, or a mental or emotional health disorder that affects your daily life, it’s not a good time to start a family. Simply trying for a baby can be stressful on its own and could adversely affect your state of mind, while caring for a new baby, and then a toddler, can be the last straw if you’re already depressed, anxious, or experiencing mood swings.
It’s best to consult with your healthcare provider to improve and stabilize your mental and emotional health, before you begin or expand your family.
Most temporary illnesses don’t affect female fertility, so a cold, cough, or flu isn’t a reason to wait to start a family, although you might not feel much like having sex when you’re feeling ill. However, male fertility can be affected by a high fever (38.8°C and up) that continues for three days or more. The high body temperature can depress sperm production for up to six months, but it does recover with time.
Some chronic illnesses can reduce male and/or female fertility, including:
Other conditions don’t affect your fertility but can increase your risk of miscarriage or stillbirth. Women who have heart or kidney conditions, rheumatoid arthritis, high blood pressure and other auto-immune disorders, are generally considered to be high-risk, and are therefore kept under careful observation during their pregnancy. If you fall into any of these categories, it’s wise to consult with your doctor before you start trying to conceive.
If you have lupus, you should plan your pregnancy carefully. The CDC advises that you make sure that your disease is under control or in remission for at least six months before you conceive. Getting pregnant while you have active lupus can cause serious health problems for you and/or your baby or lead to miscarriage or stillbirth.
If you’re taking certain medications, they could make it harder for you to conceive. These include:
Most of these effects are reversed once you stop taking the medication. If you’re on any of these medications, you may prefer to wait to try for a baby until after you finish taking them.
Your age is definitely going to affect your timing. Although you can still get pregnant when you are aged 40+, your fertility declines faster once you reach the age of 32, and drops faster still from age 37.
Additionally, when you’re over 35 your risk of having a miscarriage or stillbirth increases significantly. One study found that for women in their early 20s, 10% of pregnancies end in miscarriage, but that rises to 18% when you’re over 35 and 34% if you’re in your early 40s.
That means that if you’re approaching 35, you might want to consider your options including both trying for a baby soon, or potentially freezing eggs for a later date. The American Society of Reproductive Medicine (ASRM) recommends that if you are aged over 35 and you haven’t become pregnant within six months of unprotected sex, you should begin evaluation for infertility treatment, rather than waiting the standard 12 months.
If you received radiation therapy for cancer or other illness, you have PCOS, fibroids, or endometriosis, or you’ve had an STI in the past, the American College of Gynaecologists suggests seeing a fertility advisor straight away. They can help you plan the best times to get pregnant and give you advice about IVF and egg freezing.
Many doctors advise freezing your eggs before undergoing any kind of treatment which could affect your ability to get pregnant in the future. Egg freezing means that your eggs are collected, frozen and stored securely until you are ready to start a family, when fertility doctors will help you through the IVF process. If you freeze your eggs when you are young and healthy, it greatly increases your chances of success later on when you’re ready to undergo treatment, even if you have conditions like those mentioned above which make it difficult to get pregnant naturally.
Although there’s no perfect time to start a family, there are many good options. What matters most is that you both feel that the time is right. Whenever that may be, we hope that your path to parenthood goes smoothly.
Anyone who’s struggling to conceive knows that the entire experience can be extremely stressful. It’s not surprising that anyone finding it difficult to start a family feels a lack of control that fosters anxiety and potential depression.
One study found that women who are grappling with infertility show similar levels of depression to women who are fighting cancer. Another study found that women who were undergoing IVF treatments and had higher signs of stress (both self-reported and clinical) were less likely to get pregnant after their first IVF cycle.
It doesn’t help that some of the medications that are used to increase fertility, like clomiphene, leuprolide, and gonadotropins, have side effects that include increasing anxiety, depression, and irritability.
So it’s not surprising that stress and infertility go hand in hand. The big question is: does infertility cause stress, or does stress reduce fertility?
It’s not an easy question to answer.
The easiest way to measure stress is to ask the people involved to rate how stressed they feel (self-reported stress levels). The trouble is, this measure is not objective and could therefore be under- or over-reported.
It’s more scientific to measure levels of stress hormones. Stress triggers the release of two hormones:
The challenge here is that cortisol is released in pulses throughout the day, so levels can fluctuate significantly from hour to hour, making it tough to be sure of an individual’s long-term cortisol levels.
Alpha-amylase is more constant, but scientists still aren’t confident about its reliability in representing stress levels.
Most studies try to measure both self-reported stress levels, and at least one stress hormone level.
So far, studies haven’t been conclusive. 2010 saw the first study to find a link between stress levels and fertility outcomes. It tracked both cortisol and alpha-amylase levels and concluded that women with higher levels of alpha-amylase saw a 12% drop in their chances of becoming pregnant. However, this isn’t a statistically significant difference.
A later study in the US found that women with the highest levels of alpha-amylase took 29% longer to get pregnant than those with the lowest levels, but it didn’t take sufficient measurements to be confident of the results. Another one in China found that couples with higher levels of the enzyme had more difficulty conceiving than those with lower levels, but it didn’t rule out the impact of other factors on the delay in conception.
In case you might think that stress only affects women’s fertility, some studies have shown that stress could affect sperm production. The amount of sperm produced, their shape, and how fast they can swim all affect chances of conception. Unfortunately, however, the evidence isn’t clear cut for male fertility, either. A study from 2014 found that life stress affected the speed and shape of sperm, but not sperm concentration, while an earlier study found that men with 2 or more recent stressful life events showed lower sperm concentration and lower sperm motility (speed), but that sperm shape wasn’t affected.
An analysis of scientific studies from 1978-2014 discovered that couples undergoing fertility treatment who also received mindfulness training or Cognitive Behavioral Therapy were more than twice as likely to get pregnant than those receiving no such therapy. The study concluded that the more anxiety was reduced, the greater the improvement in pregnancy rates.
Although the jury is still out about whether stress really does affect fertility, it is thought that alpha-amylase and cortisol could interfere with the production of GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones.
In this way, it could affect the menstrual cycle and ovulation in women, and the quality and count of sperm in men. Stress may also increase amounts of steroid hormones called glucocorticoids, which control the secretion of testosterone and thus affect sperm production.
Many doctors agree that stress on its own isn’t likely to affect fertility levels. What matters is the ways that you respond to feeling stressed.
For a lot of people, high stress levels lead them to:
all of which can lower your chances of getting pregnant.
If you’re trying to get pregnant, whether you’re hoping to conceive naturally or starting IVF, it seems safe to say that the less stressed you are, the better your chances of conception. It’s never easy to relax, but take the time to do activities that calm you down. We hope your path to parenthood will be smooth and stress-free.
We’ve all been bombarded with messages about the dangers of smoking for several decades, but there’s one issue that tends to fly under the radar: the impact that smoking has on your fertility.
It’s estimated that over 1 billion people worldwide regularly smoke tobacco every year, but many people aren’t aware that it can harm their chances of conceiving and giving birth to a healthy baby.
Most couples who have regular, unprotected sex will succeed in getting pregnant within one year. But for people who smoke, it can take approximately twice as long to get pregnant. Another study found that women who smoke are less fertile than non-smokers.
Contrary to popular myth, low-tar and low-nicotine cigarettes pose the same danger to fertility as traditional cigarettes.
There’s no amount of cigarette smoke that is safe for women who want to start a family.
Even if you smoke only one to five cigarettes a day, you’re still at risk of ectopic pregnancies or premature birth. Secondhand smoke also harms your fertility, such as if your partner smokes, or if you work in smoke-filled conditions.
When you smoke, the toxins in the cigarettes enter your body and pervade every part of your system. As a result, smoking affects your fertility in a number of different ways.
Poor quality eggs
The nicotine, cyanide, carbon monoxide, and other chemicals in cigarette smoke can harm the ovaries, producing poor quality eggs that are less likely to be fertilized and develop into a healthy fetus.
Early menopause
Every woman is born with a finite number of follicles, which develop into eggs. These are your ovarian reserve. Eggs die naturally throughout your life, and once they have been used up, you enter menopause. Women who have completed menopause can no longer become pregnant.
A number of studies have found that women who smoke have a significantly lower ovarian reserve than non-smokers, because the toxins in cigarette smoke cause the eggs to age and die off faster than normal. On average, smokers enter menopause more than 1 year earlier than non-smokers.
Disruption of the hormonal balance
The chemicals present in cigarette smoke also interfere with your endocrine function, which is the part of your brain which is responsible for producing and releasing sex hormones. Oestrogen, progesterone, testosterone, and follicle stimulating hormone (FSH) govern your menstrual cycle, ovulation times, and uterine development in order for you to become pregnant.
Damage to the fallopian tubes
There is also evidence that smoking affects the fallopian tubes, increasing the risk of lesions. It’s thought that this is why smoking raises the incidence of ectopic pregnancy, which is when an embryo implants in the tubes rather than the womb.
Ectopic pregnancy can be life-threatening, or permanently damage the fallopian tubes to the extent that future conception is impossible.
Lower embryo implantation rate
Cigarette smoke and the toxins that it contains can affect the behavior of the cilia, which are tiny “hairs” that line the fallopian tubes and transport the egg and embryo to the uterus. When the embryo settles in the uterus, it’s “implanted,” and can continue to grow and develop into a healthy baby. In women who smoke, implantation rate drops by over 20%.
For women who smoke or who spend a lot of time in a smoke-filled environment, cigarettes can continue to cause harm even after conception.
It’s not just women who need to stop smoking before starting a family. Male fertility is also affected by cigarette smoke. Out of the 8.75 million men in the UK aged 20-39, 120,000 of them are infertile because of smoking.
Cigarette toxins like cadmium and cotinine damage sperm DNA, which can then cause problems with fertilization, embryo development, and embryo implantation, hampering attempts to become pregnant and increasing miscarriage rates.
Cigarette smoke negatively affects semen and sperm quality, causing:
Surprisingly, all these effects have been spotted in men whose mothers smoked half a pack of cigarettes or more every day while pregnant and/or breastfeeding, even if the men themselves didn’t smoke, which shows just how far the effects of smoke can reach.
As well as reducing your ability to conceive naturally, smoking also harms your chances of getting pregnant through IVF.
It’s been found that smokers need twice as many cycles as non-smokers before they can conceive. Women who smoke need more ovary-stimulating medication, and still see 30% lower pregnancy rates.
Even when women stopped smoking many years before receiving IVF, there’s some evidence that the difference may still be noticeable. There’s also a recent study that found that smoking at any point in your life can harm your placenta, which can affect your ability to carry a baby to term as well as harming the health of the fetus.
Men who smoke see much lower success rates in assisted reproductive technologies like IVF or intracytoplasmic sperm injection.
As a result, in the UK couples who smoke, or where one partner smokes, aren’t entitled to any free IVF cycles.
The good news is that when you stop smoking, your fertility can recover very quickly, although you can’t undo all the damage. Sperm and egg DNA improve, sperm quality rises, and female hormonal balance returns, although some aspects of harm, like your reduced egg supply, can’t be fixed.
If you’re thinking of starting a family, it’s best to stop smoking as soon as possible. Women who have stopped smoking don’t see any significant drop in their fertility compared with women who have never smoked.
Whether you’re hoping to conceive naturally or thinking or starting IVF, quitting smoking will give you the best shot at growing a healthy family. We hope that your path to parenthood will be easy and worry-free.
You’ve probably heard a lot about the risks of delaying starting a family until after you’ve become stable within your career, since trying for a baby later in life can potentially limit your chances of a successful pregnancy and birth. But you might not realize that the work you do or your workplace conditions themselves could also be affecting your chances of conceiving and giving birth to healthy children.
There are at least six ways that your work could affect your fertility:
It’s hard to say exactly how many chemicals women are exposed to daily, because they are all around us - in our makeup, our sanitary products, and in both our water and our food. One study found that every pregnant American woman is exposed to at least 43 different chemicals during her pregnancy.
But the workplace can be particularly hazardous. More than 1,000 common workplace chemicals have been shown to affect reproduction in animals, but millions more have never even been studied. The European Chemicals Agency (ECHA) registered over 21,000 substances since 2008, and that’s just for substance manufactured in amounts of more than 1 ton. It’s impossible to know which ones might affect fertility.
That said, there are some chemicals that scientists already know can make it hard to get pregnant, and it’s so easy to be exposed to them. Some of the main hazardous chemicals affecting fertility include:
As you can see, this includes a large number of workplaces and job types, including working in nail salons, factories, healthcare, farming, art, and garages.
These chemicals can disrupt the balance between your pituitary gland in your brain, (which controls your hormones) and your ovaries.
Estrogen and progesterone are the hormones that govern your menstrual cycle and prepare the uterus for a fertilized egg. If your pituitary gland doesn’t produce them at the right time and in the right amounts, it can alter your ovulation timing, damage egg production, and lower egg quality. It’s more likely that you’ll struggle to conceive with damaged eggs. Further, when egg quality is lower, the risk that it won’t divide correctly is higher, leading to a greater chance of chromosomal defects.
Chemotherapy drugs, X-rays, and fluoroscopy procedures all produce ionizing radiation, which we usually just call radiation. They affect the fertility of patients who have to undergo the treatments, but they can also affect medical staff who carry out the procedures or care for people after they receive treatment.
Direct radiation can damage the ovaries, and leaked radiation can harm the DNA in cells. Today’s workplace safety practices usually keep the amount of leaked radiation well below harmful levels, but it’s important to follow the rules and make sure your employers keep to them as well. Even a low dose of radiation can bring on early menopause.
Any profession that causes a lot of stress can impact your fertility.
We’re talking high-powered executive roles, jobs that include a lot of last-minute deadlines, and exposure to a toxic boss or stressful work environment.
That’s because stress produces a hormonal response (the “fight or flight” response) which affects the hormonal balance in the body, which can affect the production of reproductive hormones.
When you travel regularly or work night shifts, early morning, or late evening shifts, it can disturb your biological clock and cause jet lag. When your internal clock isn’t functioning properly, it can have an effect on hormone production, disrupting your menstrual cycle and ovulation window.
That includes:
Only around 24% of Europeans work a regular 8-hour day, five days a week, during daylight hours. 17% work shifts, and 14% work for 10 hours or more on a regular basis.
A large number of women work at jobs that involve too much bending at the waist or lifting, and it’s been found that these activities can affect your egg quality and egg production. The CDC defines “too much” bending and lifting as bending at the waist more than 20 times per day, or lifting heavy objects more than once every five minutes.
A study published in the Journal of Occupational & Environmental Medicine found that women engaged in physically demanding jobs had a 9% lower reserve of eggs, and 14.5% fewer mature eggs, than those whose jobs don’t include heavy lifting.
Women working in restaurants or bars, as childcare providers, in factories and distribution warehouses, in retail environments, and in a number of other industries could all have to carry out “too much” physical activity, according to the study.
Workplace environments can also affect male fertility, so it’s something to think about if you’re struggling to conceive.
Heat is a significant risk factor for male infertility.
The ideal temperature for sperm production is a couple of degrees below body temperature, but many men work in hot environments that raise the temperature inside the testicles. When that happens, it changes the shape of the sperm, so they can’t swim well enough to reach the egg and fertilize it.
Heat can be an issue for:
Exposure to chemicals like pesticides, DDE, diesel fumes, lead, and paint thinners can impact:
Before you panic, consider that not every chemical is going to affect your reproductive health.
Issues that make a difference include:
Scientists still don’t know all the ways that your work could affect your fertility, so it’s important to do all you can to create a healthy workplace environment.
That includes:
Whatever path you take to building a family, we hope that your experience is as smooth as possible.
