Rita Schnarr made a dream board to help her through her fourth and last cycle of in vitro fertilization (IVF)-the one she desperately hoped would result in a child for herself and her husband, Mark. “I clipped a picture of a pregnant body out of a magazine,” explains the 37-year-old from the Vancouver area, “cut away the head and inserted my head, along with pictures of happy babies. Every time I did my injections, that board would remind me of why I was torturing myself.”
When that IVF cycle, like the three before it, didn’t result in a pregnancy, Schnarr went to bed for three days. “I was so depressed,” she says, sadness etching her voice. “I’m healthy, I’m active; and here I am facing the fact that I probably will not have my own children.”
The Schnarrs are not alone. One in eight couples faces fertility problems, according to Health Canada, and the past three years have registered Canada’s lowest fertility rates ever. While most worry more about avoiding pregnancy than maintaining fertility, couples who suffer from infertility say nothing hurts more than finding out that the child you long for isn’t to be.
Dr. Kimberly Elford, a specialist in reproductive medicine in Oakville, Ont., says, if you’re having trouble getting pregnant, you should first make sure that you and your husband are healthy and are checked thoroughly by a doctor. In 35 percent of cases, the primary fertility problem is with the woman; 30 percent of the time, it’s with the man. But, she says, “There’s a large degree of overlap, where both partners contribute to a state of subfertility.”
Various conditions can affect a woman’s fertility. If you have symptoms that include menstrual discomfort, pain during intercourse, backache, discomfort during bowel movements, diarrhea and constipation, see your doctor. You could have endometriosis, a condition that occurs when cells lining the uterus spread to other parts of the pelvic area, causing scarring, inflammation and sometimes infertility.
If untreated, sexually transmitted infections can also scar a woman’s fallopian tubes and leave her infertile. The two most common are gonorrhea and chlamydia. A simple cervical swab along with a pap test should enable a doctor to detect an infection, which is easily treated with antibiotics-and the earlier the treatment, the less likely there will be scarring.
Finally, doctors may check you for a hormonal condition called polycystic ovarian syndrome, which may make getting pregnant difficult. Symptoms include facial hair or acne well into your 20s, and irregular cycles.
What steps can you take to increase the odds that when you’re emotionally ready to have a baby, you’re still physically able? Here are some suggestions:
Maintain a healthy weight. One of the first group of studies to link body mass with female infertility came out of Harvard University’s School of Public Health in 1994. The findings: Women who were underweight had as much as a 60 percent higher chance of infertility than those at a normal weight, and obese women were three times more likely to be infertile. The results have since been replicated again and again. In both cases, hormonal effects may interfere with menstruation and ovulation, says Dr. Robert L. Barbieri, chairman of obstetrics and gynecology at Boston’s Brigham and Women’s Hospital.
For many thin women, just gaining five pounds is enough to prompt stronger, more regular ovulation and a higher pregnancy rate, says Barbieri. As for those with a high body mass, it’s not as clear what’s going on, he says, but the excess weight seems to provoke overproduction of certain hormones that inhibit ovulation. “There are many observational studies that demonstrate if you’re overweight and infertile, you often regain your fertility if you lose weight.”
Exercise appropriately. Lillian Anderson* spent eight to ten hours a day on her feet as a restaurant chef, then ran to keep fit. But despite the fact that the 33-year-old considered herself in great shape (at five-foot-eight and 120 pounds), she’d been trying to get pregnant for two years when she first went to a Boston fertility clinic. There she met Alice D. Domar, a Harvard researcher and author of Conquering Infertility. Domar told her that several studies pinpoint a link between strenuous exercise and infertility. She said that light or irregular periods can be a sign that ovulation has stopped. Anderson responded by giving up running, slowing down her pace at work and practising relaxation and meditation techniques to relieve stress. Within six weeks she was pregnant.
Barbieri recommends that if you’re a die-hard exerciser and are having trouble getting pregnant, you should at least reduce the number of hours you spend running, biking or working out. He also points out that overexercising can be detrimental for would-be fathers. “High levels of exercise and endurance training,” he says, “can lead to a decrease in testosterone levels, negatively affecting libido and sperm health.” And spending hours on end on a bicycle seat may cause impotence by cutting off blood flow to the penis.
Watch what you drink. Too much caffeine can interfere with fertility and cause increased rates of miscarriage, although it’s not clear just how much is too much. “One of the latest studies showed more than two cups of coffee a day can have harmful effects,” says Elford. She generally asks patients to cut back to one cup a day or to switch to noncaffeinated hot beverages.
As for alcohol, a Danish study found that the more women drank, the more trouble they were likely to have conceiving. While even five or fewer drinks a week reduced fertility in women (but not in men), the women who drank more than ten had about half the odds of getting pregnant as their more moderate counterparts. “This finding requires further corroboration,” the authors concluded, “but it seems reasonable to encourage women to reduce their intake of alcohol or not to drink at all when they are trying to become pregnant.”
Butt out. Tobacco smoke can impair fertility. The nicotine and other toxins in cigarette smoke interfere with the ability of ovarian cells to make estrogen, may cause a higher incidence of genetic abnormality in a woman’s eggs and sometimes prevent implantation of the embryo in the uterus, says Dr. Timothy Rowe, head of the division of reproductive endocrinology and infertility at the University of British Columbia. Smokers tend to go through menopause earlier, reducing the time available to get pregnant, and they’re more apt to suffer miscarriages.
In men, smoking may lead to atherosclerosis, diabetes or hypertension, all of which may impair blood flow and lead to impotence. Marijuana, cocaine and steroids may also affect the development of sperm or simply lower libido, although for most men, the impact disappears within 74 days (one full sperm cycle) after quitting.
De-stress. Research at Harvard Medical School has found that stress upsets hormonal balance, potentially causing missing or irregular menstruation and contraction of the fallopian tubes and uterus, which inhibits the movement of eggs. Also, says Elford, “if you take stress as a package, usually the person is not eating properly, they’re not sleeping properly and they’re not exercising. It’s a combination of things.”
Domar’s research indicates that support groups or coping skills can help mitigate the stress of infertility and improve pregnancy rates.
Not Now, You Say?
If now is not your time to have a baby, ward off pregnancy wisely.
Some forms of birth control may not be the best choice for women who haven’t yet had kids, says Dr. Timothy Rowe, of the University of British Columbia. Today’s IUDs (intrauterine devices) have come a long way from the older versions, but the risk of infection “is still not zero.” For that reason, Rowe doesn’t recommend them unless a woman has completed her family. “Any time there’s a risk of infection, you have to realize that it might lead to lasting tubal damage and infertility,” he says. As for Depo-Provera (an injectible contraceptive that protects against pregnancy for a minimum of three months), be warned that “it stays in the body for an unpredictable amount of time,” says Rowe. There can be a delay of nine months after you go off it before normal ovulation returns, and it is not recommended by doctors if you want to get pregnant within a year or two. In the end, suggests Rowe, the Pill may be your best choice. While it can mask some infertility problems, it certainly doesn’t create them.
A group of 184 women who’d been trying to get pregnant for one to two years without results were divided into three groups: one received group instruction in relaxation and coping skills; another involved membership in a support group; while the third received nothing but the regular fertility treatments. Within 12 months, 55 percent of those in the behavioural-cognitive group got pregnant; 54 percent of those in the support group got pregnant; and almost two thirds of the women in the control group bowed out because they were too depressed to continue. Twenty percent of the remaining women got pregnant.
For the support group nearest you, contact the Infertility Awareness Association of Canada (IAAC), 1-800-263-2929 or www.iaac.ca.
Have a drug check. Some prescription drugs, herbs and over-the-counter products can make it tougher to get pregnant, while others cause fetal abnormalities leading to miscarriage. Discuss any medication or remedies you take with your physician, pharmacist or fertility specialist, says Tom Brown, director of the University of Toronto’s doctor of pharmacy program.
Some trouble spots include nonsteroidal anti-inflammatories, which may prevent embryo implantation if taken during ovulation, as well as antidepressants and other psychoactive medications, which may affect libido or interfere with ovulation.
As a rule of thumb, you want to be on as few medications as possible when you’re trying to get pregnant, and you need to make sure that the medications you are taking won’t harm your baby. But don’t take yourself off medication without speaking to a doctor first. Brown also advises husbands to have a drug check, since a variety of prescription drugs, from antibiotics to blood pressure medications, can cause impotence or affect production of sperm or sperm development.
Younger is better. A woman’s biological clock ticks faster than was once thought. “Fertility is highest between the ages of 20 and 24,” says Rowe. And women are born with a finite number of eggs, says Dr. Seang Lin Tan, chairman of the department of obstetrics and gynecology at McGill University in Montreal; no new eggs are produced as they age. The best-quality eggs are ovulated early on, with the consequence that “fertility decreases and rates of miscarriage and abnormality in the fetus increase as a woman gets older,” says Tan.
That said, points out Elford, there’s no need to panic. Not until a woman hits her mid-30s is there a significant drop in fertility, and some women will bear children without difficulty even later. On average, though, by the time a woman hits 40, her chances of getting pregnant are 20 percent of what they were when she was 20.
Says IAAC executive director Beverly Hancks: “I guess what we like to tell couples is, if you’re part of a happy relationship and things are going your way, don’t decide to get your Ph.D. at 28-not if you absolutely want to have a family. If that is critical to your joy and happiness, you should make it a priority.”
* Name changed for reasons of privacy.