If you’re having trouble getting pregnant, it’s natural to wonder about signs of infertility. But before freaking out, remember: It can take up to a year on average for a healthy individual under 35 to become pregnant if actively trying. The odds of getting pregnant begin to decrease exponentially, however, after turning 30 (more so after 35).
Knowing this, when exactly should one begin to suspect real fertility issues? Here are eight symptoms to watch out for in women—and men—that may indicate the need to be seen by a health care provider for possible infertility.
Signs of Infertility in Women
Many of the signs pointing to infertility in women generally revolve around periods, as well as general health and well-being. Fortunately, many of these can be treated if caught in time.
One of the first indicators that you may struggle with infertility is having a history of irregular periods, in part because irregular periods may indicate other issues that can inhibit fertility.
“A common cause of irregular periods is polycystic ovarian syndrome [PCOS],” says Lynn Marie Westphal, M.D., chief medical officer for Kindbody, which offers fertility and gynecology services. “It is the most common endocrine disorder in reproductive-age women and a common cause of infertility.”
Because of this, it’s important to keep track of periods, preferably for a lengthy amount of time to see whether there are any factors contributing to the irregularity. If you use an app like Clue or FitBit to input period information monthly, you can also take this information to your doctor in order to figure out what is causing the irregularity.
“There are medications that can be used to help improve ovulation and pregnancy,” says Westphal—but it’s important to discuss the best course of action with your health care provider.
Another major indicator of infertility is amenorrhea—i.e., a complete absence of periods. Amenorrhea is diagnosed when you’ve had three or more missing periods and can be brought on by a number of factors, including stress, low body weight, excessive exercise, taking certain medications, uterine scarring, and lacking certain reproductive organs, according to the Mayo Clinic.
The disappearance of your period can also indicate menopause. “About 1% of women will have menopause before the age 40,” Westphal says. “This can be due to genetic causes or from past chemotherapy—although a cause may not always be found.” In these instances, Westphal says, women may consider obtaining eggs from a donor.
Many women experience some degree of minor cramping while menstruating, but according to Westphal, it should only minimally impact normal activity. In other words, if it doesn’t get better after taking some ibuprofen, it’s worth getting evaluated, she says.
That’s because painful periods are often caused by other issues which may lead to infertility. One is pelvic inflammatory disease (PID), which is frequently linked to STDs. PID is treatable but, if left untreated, can cause scar tissue to form in and around the fallopian tubes, which can lead to infertility.
Another cause of painful periods is endometriosis—a condition in which uterine lining grows outside the uterus. “There are a lot of varying statistics on endometriosis,” Westphal says. Endometriosis occurs in about 6% to 10% of women, according to the American College of Obstetricians and Gynecologists, “but may be as high as 30% to 50% in infertile women and even higher than that in women with chronic pelvic pain,” Westphal says. “It can cause infertility a number of ways, such as forming cysts in the ovaries and scarring of the fallopian tubes.”
While surgery can be performed to remove the endometriosis, Westphal warns that fertility may not be completely normal afterward, adding that in vitro fertilization (IVF( is generally the most effective treatment in those cases.
Battling cancer and undergoing cancer treatments can be especially harsh on fertility.
“Chemotherapy or pelvic radiation can cause rapid loss of eggs, and some women may have an earlier menopause,” says Westphal. She recommends speaking with a fertility specialist prior to cancer treatment in order to discuss your fertility preservation options. (Some of these options include in vitro maturation, ovarian transposition, and ovarian tissue cryopreservation.)
Signs of Infertility in Men
Infertility in men can be more difficult to pinpoint due to a lack of obvious symptoms. However, according to Westphal, infertility in men accounts for roughly a third of all cases (another third are related to the female partner, with the final third pointing to both), and is just as important to diagnose and potentially treat.
Swelling or pain in the testicular area
One of the easiest symptoms of infertility to diagnose is swelling or pain in the testicular area. There are a number of reasons for this (including infections, fluid buildup, trauma, and cancer), but not all necessarily indicate infertility.
Another cause, however, is varicoceles—an enlargement of the veins in the scrotum. “This can cause overheating of the testicles and lead to lower sperm production,” says Westphal. “About 15% of men have varicoceles, but most will have not had fertility problems.” If it is associated with infertility, surgery can likely correct it, she says.
Men who experience ejaculatory dysfunction of any kind (such as premature ejaculation, delayed ejaculation, retrograde ejaculation, and anejaculation) may struggle with infertility.
Take retrograde ejaculation, which is when the sperm can stream into the bladder instead of out the penis. “Health problems like diabetes or a spinal cord injury can cause this, or previous surgery on the bladder, prostate, or urethra,” Westphal says. Medications can sometimes help, she says, as well as finding other ways to retrieve the sperm in order to use them for IVF.
As far as premature ejaculation, a study in Reproductive Medicine and Biology found it usually doesn’t affect fertility but often co-occurs with fertility struggles. (Retrograde ejaculation and anejaculation are more likely to actually cause infertility.)
Low sperm count
Issues with semen and sperm count are sometimes related to ejaculatory dysfunction issues. Other times, low sperm counts are due to infections (like epididymitis, orchitis, and certain STDs). “Some infections can affect sperm production or cause scarring that could block the passage of sperm,” says Westphal. She also mentions that certain medications, like ones to treat high blood pressure, depression, arthritis, and cancer, can affect both sperm production and/or delivery. “Testosterone replacement or medication to treat prostate enlargement (BPH) can reduce sperm too. When possible, stopping or switching to another medication may help improve sperm,” she says. Always talk to your doctor before making any changes in medication.
Additional causes include anti-sperm antibodies, hormone imbalances, chromosome defects, tumors, celiac disease, certain medications, and previous surgeries.
Fortunately, many of these causes of low sperm count and infertility are treatable. Infections (like gonorrhea) can be treated with antibiotics. Hormone treatments can be offered, surgeries can be performed to correct certain issues, and medications can be prescribed for others. Additionally, assisted reproductive technology can be used to obtain or extract sperm for IVF.
Just as in women, certain lifestyle choices that negatively affect personal health can cause issues that affect fertility in men. “Tobacco smoking, marijuana use, and alcohol use can decrease sperm production,” says Westphal.
Tobacco is well-known to negatively impact fertility, sometimes causing abnormal sperm morphology, among other things. Alcohol also has deleterious effects on male fertility, including reducing testosterone levels and affecting other hormones. And studies have also shown that cannabis use can reduce sperm count and concentration, as well as other problems. Additionally, obesity has been linked to hormone issues that can cause infertility, though these seem to be reversible. Overall, it’s advised to reduce or eliminate use of these substances and to actively make health-conscious lifestyle choices (such as exercising and reducing stress) in order to improve fertility.
Experiences of infertility always have one thing in common: uncertainty. The countless visits to doctors, the months (or years) of planning, the tens of thousands of dollars, never add up to a guarantee. Even under the best of circumstances, there’s only so much about pregnancy you can plan, and in the midst of a pandemic, the idea of planning anything seems foolish. For National Infertility Awareness Week, we’re exploring the uncertainty—and the hope.