Wednesday, July 29, 2009

What Really Affects My Pregnancy Chances?

I've decided that there's no such thing as reproductive justice. Many of my patients try desperately to prevent pregnancy in their fertile years...and an equal number are trying so hard to get pregnant when they're finally ready. I hear questions almost daily about what affects the chances of pregnancy (whether it's wanted right now...or not). So here is a run-down of what influences the pregnancy lottery.

These things CAN affect your fertility:
  • A history of STDs. Specifically, gonorrhea and chlamydia can scar your fallopian tubes and prevent sperm from fertilizing an egg.

  • Recent DepoProvera use. It takes the average woman 10 months after her last Depo injection to be able to conceive. (Of course, if you don't want to be pregnant, your fertility will return right away - call it Murphy's Law of Reproduction)

  • Irregular periods. Irregular menstrual cycles may be a sign of polycystic ovarian syndrome (PCOS), which is accompanied by irregular ovulation. Since you're not ovulating every month, it's harder to conceive.

  • Over- or under-weight. Weight that falls above or below the ideal for your height may also prevent you from ovulating regularly.

  • Medical problems. In addition to PCOS, there are other chronic medical conditions--over or underactive thyroid, endometriosis--that can impact ovulation or your tubes.

  • Age. It's incredibly unfair that just when many women are ready to have a baby, their fertility has started to decline. But "egg quality" begins to decrease after age 30, and this decrease picks up speed after age 35.

  • Not having sex enough. Don't laugh - I have seen several patients who can't understand why they're not pregnant, when they're having sex maybe once a month.

  • Having sex too much. Don't laugh - having daily sex at the start of your cycle may diminish the sperm count around the time it matters (generally, days 12 and 13 of a 28-day cycle).

  • A family history of infertility. Because there's still so much we don't know about infertility, there may be unknown factors that run in your family.

These things WILL NOT affect your fertility:

  • Wetness. No matter how lubricated or dry you are, there's no effect on the little swimmers heading towards your eggs.

  • Sexual position. No, standing up does not reduce your pregnancy risk. And no, positions with deep penetration don't increase your chances.
  • Uterine position. Having a retroverted uterus does not make it harder for the sperm to reach your egg.
  • Orgasm (yours). No justice here, either - your chances are the same whether or not you climax. Heavens, if women couldn't get pregnant without coming, there would be MANY fewer unplanned pregnancies!

  • Long-term contraception use. Prolonged pill, ring, or IUD use doesn't permanently reduce your pregnancy chances. Upon stopping the method, your fertility returns to what it would have been without the birth control.

  • Genital warts or herpes. Annoying to live with, but won't risk your fertility.

Somewhere in the middle:

  • High-risk HPV on your pap smear. IF the HPV causes moderate- to high-grade abnormalities on your cervix...and IF you have a LEEP or cone biopsy to remove the cells, there's a chance that you'll have complications with your cervix in a future pregnancy. But it won't affect at all your chances of conceiving.

Do you worry about something in particular affecting your chances at pregnancy?


Christine said...

I had an IUD for about 7 months and was miserable with it. My dr told me not to worry, that my body would take time to adjust. I had it removed because it didn't get better and I had a low-grade fever. They sent the IUD to the lab and found out it had Strep bacteria.

I've heard having an STD with an IUD can cause infertility, but nothing about a Strep infection like what I had. Could this make me unable to have children?

Dr. Kate said...

Christine, chances are the strep infection was Group B Strep, a fairly common bacteria in the vagina. It's not an STD, and you'll possibly need antibiotics if you're in labor with a baby. But this won't affect your fertility.