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The World Health Organization reports that almost half of all pregnancies each year are unintended and that 61% of these pregnancies end in induced abortion. The decision to have an abortion is a very personal one, but statistics show it is very common and nothing to be ashamed of.
Even if women know they want to have children at some point in their lives, they may become pregnant without intending to before they are ready. Fearing that having an abortion will affect their future fertility may be a factor in whether or not they decide to go through with the procedure.
Women should be free to choose if and when they want to have children. Unfortunately, the negative stigma around abortion often prevents people from gaining accurate information, making it difficult for women to make informed decisions about their course of treatment.
Whether you have had an abortion in the past or are considering an abortion, worrying about how it might affect your future fertility is completely normal and we aim to address these concerns in this article.
There are two types of abortions available, the procedure a woman can have depends on how many weeks pregnant she is.
To start, data shows that an abortion carried out with no complications has virtually no chance of causing future fertility issues. The chance of experiencing any complications that could lead to infertility (assuming the abortion is safely carried out) are 0.23%.
Making a decision about having an abortion shouldn’t be rushed. However, the earlier in pregnancy the abortion takes place, the lower the likelihood of complications is. While major complications are rare, as with any medical procedure, there are potential risks.
It should be noted that according to multiple studies, legally performed abortions have a lower chance of negative outcomes than vaginal childbirth or C-section. In fact, the risk of death from childbirth is 14 times more likely than from abortion.
As previously stated, there is no evidence to support that having had a complication-less abortion in the past will lead to an increased risk of spontaneous abortion, ectopic pregnancy, preterm birth, or low birth weight in future pregnancies.
There is also no evidence to show decreased fertility or difficulty conceiving postabortion. However, in a small number of women who developed an infection and did not treat it right away, there is some risk.
Asherman’s Syndrome is a disorder in which scar tissue lines the walls of the uterus, and can sometimes occur after a surgical procedure such as C and D surgical abortion. One study found that out of 844 women only 0.7% were found to have Asherman’s Syndrome following sharp curettage and repeat curettage procedures.
Unfortunately, most women who have Asherman’s Syndrome do experience menstrual and fertility problems. In a study of 16 women with Asherman’s Syndrome who had not undergone treatment, only three patients achieved term deliveries.
The good news, however, is that hysteroscopic treatment of Asherman’s Syndrome has shown promising results, with a pregnancy rate of 62.5% in women under 35 years of age.
Thankfully, legal and safe abortions have a very low percentage of risk to women’s health and fertility. However, while women in parts of North America and Europe generally have access to abortions, there are many women around the world who do not.
The rate of serious abortion-related complications is much more likely in parts of the world in which the procedure is illegal or difficult to obtain. Many of these cases go unreported, but it is estimated that 8-11% of maternal death worldwide is the result of unsafe abortions.
Restricting the availability of the procedure is the most dangerous risk involved in abortions We must remove the stigma that surrounds abortion in order to give women the right to choose the course of care that is safest for them.
Celiac disease, an immune reaction to eating gluten, has been connected to a wide array of symptoms from gastronomical to mental. In some cases people with celiac disease have no obvious symptoms at all, making it difficult to diagnose at times.
While going gluten free might seem like just another diet trend, research shows that this is not entirely true. More and more people seem to be developing celiac disease over time and while the cause is not entirely clear, the consequences cannot be ignored.
Those suffering from undiagnosed celiac disorder may experience a number of health issues but could otherwise unexplained fertility loss be one of them?
While most of us have probably heard the terms celiac disease or gluten intolerance being thrown around in the last few years, we might not know what they mean. In short, celiac disease is an autoimmune disorder in which a person has a negative reaction to gluten, a protein that is found in barley, wheat, and rye.
When a person with celiac disease (CD) consumes gluten, their immune system becomes inflamed and overactive, which when left untreated over time can damage the body’s internal organs, such as the intestines. However, celiac disease can cause a number of symptoms that are not only stomach related.
Some of the main physical symptoms connected to celiac disease are:
Celiac disease has also been linked to some neurological symptoms, with as much as 36% of adult patients presenting with neurological changes such as depression, ADHD and even epilepsy.
People can develop CD at any age and the exact causes of the disease are still unknown. Studies show that while a susceptibility for the disease is inherited, the disease itself is not.
Numbers currently stand at about 1 in 133 people with gluten intolerance. However, it is believed that the numbers are actually higher with many people left undiagnosed.
People experiencing obvious symptoms are more likely to seek treatment. However, it is important to note that people with CD who do not present symptoms will still experience health complications over time.
Recent studies suggest that there is a connection between undiagnosed celiac disorder and reproductive changes in women. Some of these changes include fertility loss, miscarriages, low birth weights, preterm labor and early menopause. One study even found that babies of women with undiagnosed celiac disease who were delivered with a cesarean had a higher chance of developing the disease themselves.
Up to 50% of women with untreated CD have experienced either miscarriage or unfavorable pregnancy outcomes. Pregnancy complications are found to be four times more likely in women with undiagnosed CD than healthy women.
Undiagnosed women also experience a shorter fertility period and have been shown to begin menstruation later and begin menopause two to three years before women who treated the disease.
The numbers speak for themselves, but you may still be wondering how celiac disease causes these reproductive changes.
Celiac disease affects women in two main ways:
While these potential outcomes may be overwhelming, it is important to note that the women who experienced these issues were only diagnosed with CD after their pregnancies. Women with CD who stopped consuming gluten before and during their pregnancies eliminated many of the risks highlighted above.
Experiencing infertility can be extremely stressful, especially when the cause is unknown. Symptoms of celiac disease have also been known to worsen when a person is under an intensified amount of stress. Which when left undiagnosed can increase chances of infertility further.
This information can actually be good news for many women experiencing unexplained infertility. Around 10-15% of women experience unexplained infertility and studies have found that many of these women have dramatic therapeutic effects after cutting gluten from their diets.
Many doctors are becoming more aware that CD may be a cause of unexplained infertility, but if you are trying to get pregnant or are considering it, it may be a good idea to go ahead and get tested for CD even if you do not have any other obvious symptoms.
If you were diagnosed with celiac disease and you still cannot get pregnant, don’t panic. Your body may need some time to recover and adjust to a gluten free lifestyle. One Swedish study of 11,000 women found that fertility was reduced in women for two years after a CD diagnosis, but returned to normal afterwards.
Women with untreated CD are not the one ones who experience fertility loss. Men with undiagnosed celiac disorder may also experience fertility loss, with one study showing up to 19% of undiagnosed celiac men with abnormal hormone and sperm levels.
While there is a lack of information on the subject, there is some evidence that celiac men, like women, who refrain from eating gluten have also been shown to regain normal sperm and hormone levels over time.
Therefore, men who are experiencing unexplained infertility should also be tested for celiac disease even if there are no other clear symptoms pointing to gluten intolerance.
The course of treatment for celiac disease may seem obvious, stop eating gluten.
Thankfully, today, celiac disease is much more widely recognized than it once was and there are many gluten free alternatives available on the market. That being said, a gluten free diet can still be a serious lifestyle change, even for people who don’t necessarily care for bread and pasta. There is gluten hidden in all kinds of less obvious foods that people with CD will need to look out for.
People with celiac disease will need to stick to a gluten free diet for their entire lives if they want to remain healthy. Consuming gluten even in small amounts can cause autoimmune flare ups. Consulting a doctor or dietitian, especially in the beginning of the transition, is highly recommended.
Women with CD planning to get pregnant should also ensure that once they have cut gluten out of their diets, they are not losing nutrients found in glutenous foods such as fiber, folic acid, and vitamin D. There are many options for gluten supplements such as vitamins and other food sources. Again, consulting a doctor is important for determining the right diet for you.
Getting a celiac disease diagnosis may seem discouraging at first. However, the positive results of a gluten free lifestyle for people with CD are extremely encouraging. The long term negative effects of CD decrease to almost zero the earlier treatment begins.
People with celiac disease can expect to live happy, healthy lives as long as they make the necessary changes to their diet. For celiacs, gluten-free means worry free.
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.
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.
If you’re trying to start a family, you are probably vaguely aware of the onset of menopause as you consider your timing. It’s like a huge “end” sign in the race to have children. For most women, menopause occurs between 45 and 55 (on average at 51), but some women find that it appears much earlier than expected, which could potentially throw a wrench into your family planning preferences.
Doctors distinguish between early menopause, which happens between the ages of 40 and 45, and premature menopause, also called premature ovarian failure (POF) or premature ovarian insufficiency (POI), which occurs before the age of forty.
Studies have found that around 5% of women experience early menopause, and another 1% experience premature menopause.
For many women, early or premature menopause is idiopathic, which means that there’s no known medical cause. That said, there are a number of issues that can lead to early menopause or POI:
Chemotherapy and radiotherapy often bring on menopause because the treatment can damage your ovaries and stop them from ovulating. In these situations, it’s possible for your body to recover and begin ovulating again, although you might still struggle to get pregnant because of other ways that the treatment impacted your reproductive organs.
Genetic and chromosomal disorders, like Turner’s syndrome, can affect the ovaries from birth and bring on early or premature menopause.
Autoimmune diseases like diabetes, rheumatoid arthritis, and thyroid diseases are signs that your immune system has malfunctioned in some way and is attacking your body instead of the disease. In these cases, your immune system could also attack your ovaries and prevent them from working properly.
Infections, like mumps, malaria, and tuberculosis, can damage the ovaries, but this is very rare. HIV and AIDS that are not controlled properly with medication can also bring on menopause.
Surgery to remove the ovaries inevitably causes menopause.
Smoking can speed up the degeneration of follicles (premature eggs). A woman is born with one million follicles on average, and these slowly dwindle over time. Follicles aren’t just used up through ovulation and menstruation; they go through a process called atresia, which means that the egg follicles simply degenerate and die. If you smoke, you speed up this process.
A Danish study found that there’s a link between your mother’s age at menopause, and your own ovarian reserve, which means the number of eggs that remain in your body. If you have a family history of early menopause, you’re likely to have a lower ovarian reserve than average, have trouble conceiving at a younger age than average, and experience menopause yourself at an earlier age than average.
It’s rare for menopause to occur completely overnight (in fact, that would only happen if your ovaries were surgically removed). Women go through a period called perimenopause, which is when you’re still ovulating, but far less frequently. During this time, your periods become irregular and spaced further apart.
Perimenopause can last as long as six years or more, and during this time it is still possible to get pregnant, but it’s far more difficult.. One study found that between 2.2% and 14.2% of the women involved conceived naturally and gave birth to a healthy baby.
If your periods become noticeably longer or shorter than usual, or stop entirely for three cycles, you could be entering perimenopause. You might also see some of the symptoms of menopause, such as hot flashes, vaginal dryness, insomnia, headaches, anxiety, and joint pains.
Once you’ve gone through menopause, you won’t be able to conceive naturally, but you can still successfully start a family by using IVF with either donor eggs, or your own eggs that you froze at an earlier point in life.
You might have heard about hormone replacement therapy, or HRT, which is often recommended for women who experience early menopause. However, HRT is only prescribed to address various other health issues associated with menopause, like osteoporosis and an increased risk of cancer, in addition to managing its symptoms. It doesn’t improve your fertility.
If you:
it’s wise to consider freezing your eggs as soon as possible.
When you freeze your eggs in your 20s or 30s, egg quality is higher, which improves your chances of success when you use them later to get pregnant via IVF. Egg quality can drop well before menopause, which means that even if you do get pregnant during perimenopause, you’ll have a higher risk of miscarriage and of the egg failing to divide properly, resulting in the wrong number of chromosomes in each cell in the embryo.
The chances of going through early or premature menopause is something that you should bear in mind when you think about your path to growing a family. We hope that whatever you choose, your journey to parenthood is smooth and successful.
You’ve probably heard the phrase “The clock is ticking…” so often that it’s nauseating - or at best ultra-cliché. But for women who have bearing children on their radar, the ‘ticking’ feeling can’t be just brushed off as a nothing. The complexities of fitting in career advancement, the search for an ideal partner and other life complications all before having a child means that that “ticking clock” isn’t just an annoying joke; it’s a legitimate concern. While fertility doesn’t suddenly disappear in a poof of smoke, neither does it last forever - and the process of fertility decline starts in one’s 30s. Here’s why - and here’s what you can (and can’t) do about it.
A woman’s supply of fertile eggs is not constant over her lifetime. While an adolescent girl has approximately 400,000 eggs available, these numbers taper quickly. Dr. Sherman Schreiber, author of “Beating Your Biological Clock,” explains that once a teen starts her menstrual cycle, she loses 1,000 immature eggs every month, and that this loss is simply a biological process, not something that can be changed by factors over which we have control. The average woman has around 25,000 eggs available at age 37 and only 1,000 at age 51. One might still think - hey! In order to conceive a child, only ONE healthy egg is necessary. So those numbers still sound pretty high. But successful conception is not only a numbers game.
Not all eggs are created equal. In order for an egg cell to be ready to be fertilized, it must undergo several cell divisions first. In the complex, amazing process that is cell division, the chromosomes must replicate themselves, then be split perfectly as the cell divides into two. As egg cells get older, they have more difficulty with the division process. One issue can occur with the chromosomes themselves. They separate too early in the process of cell division, giving the resulting egg the wrong number of chromosomes - called aneuploidy. Another issue can occur with the parts of the cell that surround the chromosomes and make them line up correctly during cell division. In aging egg cells, these parts - called the microtubules - often have less control over the process, and end up - again - giving the resulting egg the wrong number of chromosomes.
What happens to an egg cell with the wrong number of chromosomes? It may either:
Bottom line? While plenty of older women do bear healthy children naturally, the older an egg cell gets, its chances of abnormal development increase, and its chances of resulting in a healthy birth decrease.
Professor Greg Fitzharris suggests that in the future, we might be able to take the chromosomes from an older woman’s cell and put them into the cell of a younger woman. That way, the genetic material would remain entirely yours (NOT like getting a “donor egg cell” today), but the younger cell microtubules would make the chromosome division more successful. Exciting as that sounds, it’s still far off. But women who are thinking in advance about fertility can effectively preserve their egg cells’ youth - even today. Women who freeze some of their eggs when they’re in their early 30s, for example, can use them in their 40s when they decide it’s the right time for parenthood. This freezing process is called mature oocyte cryopreservation and it is done in fertility clinics around the world. Freezing eggs effectively stops the clock, retaining the quality in both the chromosomes and the surrounding cell matter. It’s one of the best solutions we have today for preserving fertility. While there are never any guarantees, being aware of the options, anticipating and planning ahead are the best steps you can take to make your motherhood dreams can come true.
