Reproductive Health

Both the male and female reproductive systems play a role in pregnancy. Problems with these systems can affect fertility and the ability to have children. There are many such problems in men and women.

Reproductive health problems can also be harmful to overall health and impair a person’s ability to enjoy a sexual relationship.

Your reproductive health is influenced by many factors. These include your age, lifestyle, habits, genetics, use of medicines and exposure to chemicals in the environment. Many problems of the reproductive system can be corrected.

What is reproductive health?

Reproductive health includes a variety of topics, such as:

• Menstruation and menopause
• Pregnancy and preconception care
• Fertility/Infertility
• Contraception

More information on some of these issues is provided below.

Menstrual Cycle

The menstrual cycle is the process by which a woman’s body gets ready for the chance of a pregnancy each month. The average menstrual cycle is 28 days from the start of one to the start of the next, but it can range from 21 days to 35 days.

Most menstrual periods last from three to five days. In the United States, most girls start menstruating at age 12, but girls can start menstruating between the ages of 8 and 16.

Menstruation and the menstrual cycle fact sheet

Menstruation is a woman’s monthly bleeding. When you menstruate, your body sheds the lining of the uterus (womb). Menstrual blood flows from the uterus through the small opening in the cervix and passes out of the body through the vagina (see how the menstrual cycle works below). Most menstrual periods last from 3 to 5 days.

What is the menstrual cycle?

When periods (menstruations) come regularly, this is called the menstrual cycle. Having regular menstrual cycles is a sign that important parts of your body are working normally. The menstrual cycle provides important body chemicals, called hormones, to keep you healthy. It also prepares your body for pregnancy each month. A cycle is counted from the first day of 1 period to the first day of the next period. The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens.

What happens during the menstrual cycle?

In the first half of the cycle, levels of estrogen (the female hormone) start to rise. Estrogen plays an important role in keeping you healthy, especially by helping you to build strong bones and to help keep them strong as you get older. Estrogen also makes the lining of the uterus (womb) grow and thicken. This lining of the womb is a place that will nourish the embryo if a pregnancy occurs. At the same time the lining of the womb is growing, an egg, or ovum, in one of the ovaries starts to mature. At about day 14 of an average 28-day cycle, the egg leaves the ovary. This is called ovulation.

After the egg has left the ovary, it travels through the fallopian tube to the uterus. Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is most likely to get pregnant during the 3 days before or on the day of ovulation. Keep in mind, women with cycles that are shorter or longer than average may ovulate before or after day 14.

A woman becomes pregnant if the egg is fertilized by a man’s sperm cell and attaches to the uterine wall. If the egg is not fertilized, it will break apart. Then, hormone levels drop, and the thickened lining of the uterus is shed during the menstrual period.

What is a typical menstrual period like?

During your period, you shed the thickened uterine lining and extra blood through the vagina. Your period may not be the same every month. It may also be different than other women’s periods. Periods can be light, moderate, or heavy in terms of how much blood comes out of the vagina. This is called menstrual flow. The length of the period also varies. Most periods last from 3 to 5 days. But, anywhere from 2 to 7 days is normal.

For the first few years after menstruation begins, longer cycles are common. A woman’s cycle tends to shorten and become more regular with age. Most of the time, periods will be in the range of 21 to 35 days apart.

What kinds of problems do women have with their periods?

Women can have a range of problems with their periods, including pain, heavy bleeding, and skipped periods.
Amenorrhea—the lack of a menstrual period. This term is used to describe the absence of a period in:

• Young women who haven’t started menstruating by age 15
• Women and girls who haven’t had a period for 90 days, even if they haven’t been menstruating for long

Causes can include:

• Pregnancy
• Breastfeeding
• Extreme weight loss
• Eating disorders
• Excessive exercising
• Stress
• Serious medical conditions in need of treatment

As above, when your menstrual cycles come regularly, this means that important parts of your body are working normally. In some cases, not having menstrual periods can mean that your ovaries have stopped producing normal amounts of estrogen. Missing these hormones can have important effects on your overall health. Hormonal problems, such as those caused by polycystic ovary syndrome (PCOS) or serious problems with the reproductive organs, may be involved. It’s important to talk to a doctor if you have this problem.

Dysmenorrhea (dis-men-uh-REE-uh)—painful periods, including severe cramps. Menstrual cramps in teens are caused by too much of a chemical called prostaglandin (pros-tuh-GLAN-duhn). Most teens with dysmenorrhea do not have a serious disease, even though the cramps can be severe. In older women, the pain is sometimes caused by a disease or condition such as uterine fibroids or endometriosis.

For some women, using a heating pad or taking a warm bath helps ease their cramps. Some over-the-counter pain medicines can also help with these symptoms. They include:

• Ibuprofen (for instance, Advil, Motrin, Midol Cramp>
• Ketoprofen (for instance, Orudis KT)
• Naproxen (for instance, Aleve)

If these medicines don’t relieve your pain or the pain interferes with work or school, you should see a doctor. Treatment depends on what’s causing the problem and how severe it is. Report vaginal bleeding that’s different from normal menstrual periods. It includes:

• Bleeding between periods
• Bleeding after sex
• Spotting anytime in the menstrual cycle
• Bleeding heavier or for more days than normal
• Bleeding after menopause

Abnormal bleeding can have many causes. Your doctor may start by checking for problems that are most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. Treatment for abnormal bleeding depends on the cause.

In both teens and women nearing menopause, hormonal changes can cause long periods along with irregular cycles. Even if the cause is hormonal changes, you may be able to get treatment. You should keep in mind that these changes can occur with other serious health problems, such as uterine fibroids, polyps, or even cancer. See your doctor if you have any abnormal bleeding.

When does a girl usually get her first period?

In the United States, the average age for a girl to get her first period is 12. This does not mean that all girls start at the same age. A girl can start her period anytime between the ages of 8 and 15. Most of the time, the first period starts about 2 years after breasts first start to develop. If a girl has not had her first period by age 15, or if it has been more than 2 to 3 years since breast growth started, she should see a doctor.

Menopause

Women usually have periods until menopause. Menopause occurs between the ages of 45 and 55, usually around age 50. Menopause means that a woman is no longer ovulating (producing eggs) or having periods and can no longer get pregnant. Like menstruation, menopause can vary from woman to woman and these changes may occur over several years.

The time when your body begins its move into menopause is called the menopausal transition. This can last anywhere from 2 to 8 years. Some women have early menopause because of surgery or other treatment, illness, or other reasons. If you don’t have a period for 90 days, you should see your doctor. He or she will check for pregnancy, early menopause, or other health problems that can cause periods to stop or become irregular.

When to Consult a Doctor about Your Period

See your doctor about your period if:

• You have not started menstruating by the age of 15.
• You have not started menstruating within 3 years after breast growth began, or if breasts haven’t started to grow by age 13.
• Your period suddenly stops for more than 90 days.
• Your periods become very irregular after having had regular, monthly cycles.
• Your period occurs more often than every 21 days or less often than every 35 days.
• You are bleeding for more than 7 days.
• You are bleeding more heavily than usual or using more than 1 pad or tampon every 1 to 2 hours.
• You bleed between periods.
• You have severe pain during your period.
• You suddenly get a fever and feel sick after using tampons.

You should change a pad before it becomes soaked with blood. Each woman decides for herself what works best. You should change a tampon at least every 4 to 8 hours. Make sure to use the lowest absorbency tampon needed for your flow. For example, use junior or regular tampons on the lightest day of your period. Using a super absorbency tampon on your lightest days increases your risk for toxic shock syndrome (TSS). TSS is a rare but sometimes deadly disease. TSS is caused by bacteria that can produce toxins. If your body can’t fight the toxins, your immune (body defense) system reacts and causes the symptoms of TSS (see below).

Young women may be more likely to get TSS. Using any kind of tampon puts you at greater risk for TSS than using pads. The Food and Drug Administration (FDA) recommends the following tips to help avoid tampon problems:

• Follow package directions for insertion.
• Choose the lowest absorbency for your flow.
• Change your tampon at least every 4 to 8 hours.
• Consider switching between pads and tampons.
• Know the warning signs of TSS (see below).
• Don’t use tampons between periods.

If you have any of these symptoms of TSS while using tampons, take the tampon out, and contact your doctor right away:

• Sudden high fever (over 102 degrees)
• Muscle aches
• Diarrhea
• Vomiting
• Dizziness and/or fainting
• Sunburn-like rash
• Sore throat
• Bloodshot eyes

Preconception Care

Why preconception health matters

Preconception health is a woman’s health before she becomes pregnant. It means knowing how health conditions and risk factors could affect a woman or her unborn baby if she becomes pregnant. For example, some foods, habits, and medicines can harm your baby—even before he or she is conceived. Some health problems, such as diabetes, also can affect pregnancy.

Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned. Unplanned pregnancies are at greater risk of preterm birth and low birth weight babies. Another reason is that, despite important advances in medicine and prenatal care, about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.

Five most important things to boost your preconception health

Women and men should prepare for pregnancy before becoming sexually active—or at least three months before getting pregnant. Some actions, such as quitting smoking, reaching a healthy weight, or adjusting medicines you are using, should start even earlier.

The five most important things a woman can do for preconception health are:

1. Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day if you are planning or capable of pregnancy to lower your risk of some birth defects of the brain and spine, including spina bifida. All women need folic acid every day. Talk to your doctor about your folic acid needs. Some doctors prescribe prenatal vitamins that contain higher amounts of folic acid.
2. Stop smoking and drinking alcohol.
3. If you have a medical condition, be sure it is under control. Some conditions that can affect pregnancy or be affected by it include asthma, diabetes, oral health, obesity, or epilepsy.
4. Talk to your doctor about any over-the-counter and prescription medicines you are using. These include dietary or herbal supplements. Be sure your vaccinations are up to date.
5. Avoid contact with toxic substances or materials that could cause infection at work and at home. Stay away from chemicals and cat or rodent feces.

Talk to your doctor before you become pregnant

Did you know?

It’s best to be at a healthy weight when you become pregnant. Being overweight or underweight puts you at increased risk for problems during pregnancy. Learn how healthy food choices and physical fitness, together, can help you reach or maintain a healthy weight.

Preconception care can improve your chances of getting pregnant, having a healthy pregnancy, and having a healthy baby. If you are sexually active, talk to your doctor about your preconception health now.

Preconception care should begin at least three months before you get pregnant. But some women need more time to get their bodies ready for pregnancy. Be sure to discuss your partner’s health too. Ask your doctor about:

• Family planning and birth control.
• Taking folic acid.
• Vaccines and screenings you may need, such as a Pap test and screenings for sexually transmitted infections (STIs), including HIV.
• Managing health problems, such as diabetes, high blood pressure, thyroid disease, obesity, depression, eating disorders, and asthma. Find out how pregnancy may affect, or be affected by, health problems you have.
• Medicines you use, including over-the-counter, herbal, and prescription drugs and supplements.
• Ways to improve your overall health, such as reaching a healthy weight, making healthy food choices, being physically active, caring for your teeth and gums, reducing stress, quitting smoking, and avoiding alcohol.
• How to avoid illness.
• Hazards in your workplace or home that could harm you or your baby.
• Health problems that run in your or your partner’s family.
• Problems you have had with prior pregnancies, including preterm birth.
• Family concerns that could affect your health, such as domestic violence or lack of support.

Bring a list of talking points to be sure you don’t forget anything. If you run out of time at your visit, schedule a follow-up visit to make sure everything is covered.

Your partner’s role in preparing for pregnancy

Your partner can do a lot to support and encourage you in every aspect of preparing for pregnancy. Here are some ways:

• Make the decision about pregnancy together. When both partners intend for pregnancy, a woman is more likely to get early prenatal care and avoid risky behaviors such as smoking and drinking alcohol.
• Screening for and treating sexually transmitted infections (STIs) can help make sure infections are not passed to female partners.
• Male partners can improve their own reproductive health and overall health by limiting alcohol, quitting smoking or illegal drug use, making healthy food choices, and reducing stress. Studies show that men who drink a lot, smoke, or use drugs can have problems with their sperm. These might cause you to have problems getting pregnant. If your partner won’t quit smoking, ask that he not smoke around you, to avoid harmful effects of secondhand smoke.
• Your partner should also talk to his doctor about his own health, his family health history, and any medicines he uses.
• People who work with chemicals or other toxins can be careful not to expose women to them. For example, people who work with fertilizers or pesticides should change out of dirty clothes before coming near women. They should handle and wash soiled clothes separately.

Genetic counseling

Did you know?

Some companies offer genetic tests that you can do yourself through the mail. These tests may not provide true or meaningful information. These tests might provide harmful information. Talk to your doctor before using this type of test.

The genes your baby is born with can affect your baby’s health in these ways:

• Single gene disorders are caused by a problem in a single gene. Genes contain the information your body’s cells need to function. Single gene disorders run in families. Examples of single gene disorders are cystic fibrosis and sickle cell anemia.
• Chromosome disorders occur when all or part of a chromosome is missing or extra, or if the structure of one or more chromosomes is not normal. Chromosomes are structures where genes are located. Most chromosome disorders that involve whole chromosomes do not run in families.

Talk to your doctor about your and your partner’s family health histories before becoming pregnant. This information can help your doctor find out any genetic risks you might have.

Depending on your genetic risk factors, your doctor might suggest you meet with a genetic professional. Some reasons a person or couple might seek genetic counseling are:

• A family history of a genetic condition, birth defect, chromosomal disorder, or cancer
• Two or more pregnancy losses, a stillbirth, or a baby who died
• A child with a known inherited disorder, birth defect, or intellectual disability
• A woman who is pregnant or plans to become pregnant at 35 years or older
• Test results that suggest a genetic condition is present
• Increased risk of getting or passing on a genetic disorder because of one’s ethnic background
• People related by blood who want to have children together

During a consultation, the genetics professional meets with a person or couple to discuss genetic risks or to diagnose, confirm, or rule out a genetic condition. Sometimes, a couple chooses to have genetic testing. Some tests can help couples to know the chances that a person will get or pass on a genetic disorder. The genetics professional can help couples decide if genetic testing is the right choice for them.

What is pregnancy?

Pregnancy is the term used to describe when a woman has a growing fetus inside of her. In most cases, the fetus grows in the uterus.

Human pregnancy lasts about 40 weeks, or just more than 9 months, from the start of the last menstrual period to childbirth.

What are prenatal and preconception care and why are they important?

Prenatal care is the care woman gets during a pregnancy. Getting early and regular prenatal care is important for the health of both mother and the developing baby.

In addition, health care providers are now recommending a woman see a health care provider for preconception care, even before she considers becoming pregnant or in between pregnancies.

Knowing if you are pregnant

A missed period is often the first clue that a woman might be pregnant. Sometimes, a woman might suspect she is pregnant even sooner. Symptoms such as headache, fatigue, and breast tenderness, can occur even before a missed period. The wait to know can be emotional. These days, many women first use home pregnancy tests (HPT) to find out. Your doctor also can test you.

All pregnancy tests work by detecting a special hormone in the urine or blood that is only there when a woman is pregnant. It is called human chorionic gonadotropin (kohr-ee-ON-ihk goh-NAD-uh-TROH-puhn), or hCG. hCG is made when a fertilized egg implants in the uterus. hCG rapidly builds up in your body with each passing day you are pregnant. Read on to learn when and how to test for pregnancy.

Home pregnancy tests

Reading a home pregnancy test

HPTs are inexpensive, private, and easy to use. Most drugstores sell HPTs over the counter. The cost depends on the brand and how many tests come in the box. They work by detecting hCG in your urine. HPTs are highly accurate. But their accuracy depends on many things. These include:

• When you use them—The amount of hCG in your urine increases with time. So, the earlier after a missed period you take the test the harder it is to spot the hCG. Some HPTs claim that they can tell if you are pregnant one day after a missed period or even earlier. But a recent study shows that most HPTs don’t give accurate results this early in pregnancy. Positive results are more likely to be true than negative results. Waiting one week after a missed period will usually give a more accurate result. You can take the test sooner. But just know that a lot of pregnant women will get negative test results during the first few days after the missed period. It’s a good idea to repeat the test again after a week has passed. If you get two negative results but still think you’re pregnant, call your doctor.
• How you use them—Be sure to check the expiration date and follow the directions. Many involve holding a test stick in the urine stream. For some, you collect urine in a cup and then dip the test stick into it. Then, depending on the brand, you will wait a few minutes to get the results. Research suggests waiting 10 minutes will give the most accurate result. Also, testing your urine first thing in the morning may boost the accuracy. You will be looking for a plus sign, a change in color, or a line. A change, whether bold or faint, means the result is positive. New digital tests show the words “pregnant” or “not pregnant.” Most tests also have a “control indicator” in the results window. This line or symbol shows whether or not the test is working. If the control indicator does not appear, the test is not working properly. You should not rely on any results from a HPT that may be faulty.
• Who uses them—The amount of hCG in the urine is different for every pregnant woman. So, some women will have accurate results on the day of the missed period while others will need to wait longer. Also, some medicines affect HPTs. Discuss the medicines you use with your doctor before trying to become pregnant.
• The brand of test—Some HPT tests are better than others at spotting hCG early on.

The most important part of using any HPT is to follow the directions exactly as written. Most tests also have toll-free phone numbers to call in case of questions about use or results.

If a HPT says you are pregnant, you should call your doctor right away. Your doctor can use a more sensitive test along with a pelvic exam to tell for sure if you’re pregnant. Seeing your doctor early on in your pregnancy can help you and your baby stay healthy.

Unplanned Pregnancy

Unplanned pregnancy is common. About 1 in 2 pregnancies in America are unplanned. Ideally, a woman who is surprised by an unplanned pregnancy is in good preconception health and is ready and able to care for a new child. But this sometimes isn’t the case.

If you have an unplanned pregnancy, you might not know what to do next. You might worry that the father won’t welcome the news. You might not be sure you can afford to care for a baby. You might worry if past choices you have made, such as drinking or drug use, will affect your unborn baby’s health. You might be concerned that having a baby will keep you from finishing school or pursuing a career.

If you are pregnant after being raped, you might feel ashamed, numb, or afraid. Unplanned pregnancy is common among abused women. Research has found that some abusers force their partners to have sex without birth control and/or sabotage the birth control their partners are using, leading to unplanned pregnancy.

You might wonder what options you have. Here are some next steps to help you move forward:

• Start taking care of yourself right away. Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) folic acid every. Stop alcohol, tobacco, and drug use.
• Make a doctor’s visit to confirm your pregnancy. Discuss your health and issues that could affect your pregnancy. Ask for help quitting smoking. Find out what you can do to take care of yourself and your unborn baby.
• Ask your doctor to recommend a counselor who you can talk to about your situation.
• Seek support in someone you trust and respect.

Trying to Get Pregnant

How do you figure out when you’re fertile and when you’re not? Wondering if you or your partner is infertile? Read on to boost your chances of conception and get help for fertility problems.

Fertility awareness

The menstrual cycle

Being aware of your menstrual cycle and the changes in your body that happen during this time can help you know when you are most likely to get pregnant.

The average menstrual cycle lasts 28 days. But normal cycles can vary from 21 to 35 days. The amount of time before ovulation occurs is different in every woman and even can be different from month to month in the same woman, varying from 13 to 20 days long. Learning about this part of the cycle is important because it is when ovulation and pregnancy can occur. After ovulation, every woman (unless she has a health problem that affects her periods or becomes pregnant) will have a period within 14 to 16 days.

Charting your fertility pattern

Knowing when you’re most fertile will help you plan pregnancy. There are three ways you can keep track of your fertile times. They are:

1. Basal body temperature method—Basal body temperature is your temperature at rest as soon as you awake in the morning. A woman’s basal body temperature rises slightly with ovulation. So by recording this temperature daily for several months, you’ll be able to predict your most fertile days.

Basal body temperature differs slightly from woman to woman. Anywhere from 96 to 98 degrees Fahrenheit orally is average before ovulation. After ovulation most women have an oral temperature between 97 and 99 degrees Fahrenheit. The rise in temperature can be a sudden jump or a gradual climb over a few days.

Usually a woman’s basal body temperature rises by only 0.4 to 0.8 degrees Fahrenheit. To detect this tiny change, women must use a basal body thermometer. These thermometers are very sensitive. Most pharmacies sell them for about $10. You can then record your temperature on our special Basal Body Temperature Chart.

The rise in temperature doesn’t show exactly when the egg is released. But almost all women have ovulated within three days after their temperatures spike. Body temperature stays at the higher level until the woman’s period starts.

A woman is most fertile and most likely to get pregnant:

• Two to three days before your temperature hits the highest point (ovulation)
• 12 to 24 hours after ovulation

A man’s sperm can live for up to three days in a woman’s body. The sperm can fertilize an egg at any point during that time. So if you have unprotected sex a few days before ovulation, you could get pregnant.

Many things can affect basal body temperature. For your chart to be useful, make sure to take your temperature every morning at about the same time. Things that can alter your temperature include:

• Drinking alcohol the night before
• Smoking cigarettes the night before
• Getting a poor night’s sleep
• Having a fever
• Doing anything in the morning before you take your temperature—including going to the bathroom and talking on the phone

2. Calendar method—This involves recording your menstrual cycle on a calendar for eight to 12 months. The first day of your period is Day 1. Circle Day 1 on the calendar. The length of your cycle may vary from month to month. So write down the total number of days it lasts each time. Using this record, you can find the days you are most fertile in the months ahead:
   • To find out the first day when you are most fertile, subtract 18 from the total number of days in your shortest cycle. Take this new number and count ahead that many days from the first day of your next period. Draw an X through this date on your calendar. The X marks the first day you’re likely to be fertile.
   • To find out the last day when you are most fertile, subtract 11 from the total number of days in your longest cycle. Take this new number and count ahead that many days from the first day of your next period. Draw an X through this date on your calendar. The time between the two Xs is your most fertile window.

   This method always should be used along with other fertility awareness methods, especially if your cycles are not always the same length.

Did you know?

The cervical mucus method is less reliable for some women. Women who are breastfeeding, taking hormonal birth control (like the pill), using feminine hygiene products, have vaginitis or sexually transmitted infections (STIs), or have had surgery on the cervix should not rely on this method.

3. Cervical mucus method (also known as the ovulation method)—This involves being aware of the changes in your cervical mucus throughout the month. The hormones that control the menstrual cycle also change the kind and amount of mucus you have before and during ovulation. Right after your period, there are usually a few days when there is no mucus present or “dry days.” As the egg starts to mature, mucus increases in the vagina, appears at the vaginal opening, and is white or yellow and cloudy and sticky. The greatest amount of mucus appears just before ovulation. During these “wet days” it becomes clear and slippery, like raw egg whites. Sometimes it can be stretched apart. This is when you are most fertile. About four days after the wet days begin the mucus changes again. There will be much less and it becomes sticky and cloudy. You might have a few more dry days before your period returns. Describe changes in your mucus on a calendar. Label the days, “Sticky,” “Dry,” or “Wet.” You are most fertile at the first sign of wetness after your period or a day or two before wetness begins.To most accurately track your fertility, use a combination of all three methods. This is called the symptothermal method. You can also purchase over-the-counter ovulation kits or fertility monitors to help find the best time to conceive. These kits work by detecting surges in a specific hormone called luteinizing hormone, which triggers ovulation.

Infertility

Some women want children but either cannot conceive or keep miscarrying. This is called infertility. Lots of couples have infertility problems. About one-third of the time, it is a female problem. In another one-third of cases, it is the man with the fertility problem. For the remaining one-third, both partners have fertility challenges or no cause is found.

Causes of infertility

Some common reasons for infertility in women include:

Age—Women generally have some decrease in fertility starting in their early 30s. And while many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35. As a woman ages, normal changes that occur in her ovaries and eggs make it harder to become pregnant. Even though menstrual cycles continue to be regular in a woman’s 30s and 40s, the eggs that ovulate each month are of poorer quality than those from her 20s. It is harder to get pregnant when the eggs are poorer in quality. As a woman nears menopause, the ovaries may not release an egg each month, which also can make it harder to get pregnant. Also, as a woman and her eggs age, she is more likely to miscarry, as well as have a baby with genetic problems, such as Down syndrome.

Health problems—Some women have diseases or conditions that affect their hormone levels, which can cause infertility. Women with polycystic ovary syndrome (PCOS) rarely or never ovulate. Failure to ovulate is the most common cause of infertility in women.

• With primary ovarian insufficiency (POI), a woman’s ovaries stop working normally before she is 40. It is not the same as early menopause. Some women with POI get a period now and then. But getting pregnant is hard for women with POI.
• A condition called luteal phase defect (LPD) is a failure of the uterine lining to be fully prepared for pregnancy. This can keep a fertilized egg from implanting or result in miscarriage.

Common problems with a woman’s reproductive organs, like uterine fibroids, endometriosis, and pelvic inflammatory disease can worsen with age and also affect fertility. These conditions might cause the fallopian tubes to be blocked, so the egg can’t travel through the tubes into the uterus.

Lifestyle factors—Certain lifestyle factors also can have a negative effect on a woman’s fertility. Examples include smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder. Stress also can affect fertility.

Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm. They also have a slightly higher risk of sperm gene defects. Or they might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man’s sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility. Men also can have health problems that affect their sexual and reproductive function. These can include sexually transmitted infections (STIs), diabetes, surgery on the prostate gland, or a severe testicle injury or problem.

When to see your doctor

You should talk to your doctor about your fertility if:

• You are younger than 35 and have not been able to conceive after one year of frequent sex without birth control.
• You are age 35 or older and have not been able to conceive after six months of frequent sex without birth control.
• You believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant).
• You or your partner has a problem with sexual function or libido.

Happily, doctors are able to help many infertile couples go on to have babies.

If you are having fertility issues, your doctor can refer you to a fertility specialist, a doctor who treats infertility. The doctor will need to test both you and your partner to find out what the problem is. Depending on the problem, your doctor might recommend treatment. About 9 in 10 cases of infertility are treated with drugs or surgery. Don’t delay seeing your doctor as age also affects the success rates of these treatments. For some couples, adoption or foster care offers a way to share their love with a child and to build a family.

Infertility treatment

Some treatments include:

• Drugs—Various fertility drugs may be used for women with ovulation problems. It is important to talk with your doctor about the drug to be used. You should understand the drug’s benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur.
• Surgery—Surgery is done to repair damage to a woman’s ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.
• Intrauterine insemination (IUI), also called artificial insemination—Male sperm is injected into part of the woman’s reproductive tract, such as into the uterus or fallopian tube. IUI often is used along with drugs that cause a woman to ovulate.
• Assisted reproductive technology (ART)—ART involves stimulating a woman’s ovaries; removing eggs from her body; mixing them with sperm in the laboratory; and putting the embryos back into a woman’s body. Success rates of ART vary and depend on many factors.
• Third party assistance—Options include donor eggs (eggs from another woman are used), donor sperm (sperm from another man are used), or surrogacy (when another woman carries a baby for you).

Finding the cause of infertility is often a long, complex, and emotional process. And treatment can be expensive. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Some states have laws that mandate health insurance policies to provide infertility coverage.

Birth Control Methods

Birth Control Methods: Reversible and Permanent

In the United States, almost half of all pregnancies are unintended. Yet, several safe and highly effective methods of contraception (birth control) are available to prevent unintended pregnancy. Since 2000, several new methods of birth control have become available in the United States, including

• the levonorgestrel-releasing intrauterine system,
• the hormonal contraceptive patch,
• the hormonal contraceptive ring,
• the hormonal implant, a 91-day regimen of oral contraceptives, two new barrier methods, and
• a new form of female sterilization.

Most women of reproductive age in the United States use birth control. Between 2006–2008, 99% of women who had ever had sexual intercourse had used at least one method of birth control; however, 7.3% of women who were currently at risk of unintended pregnancy were not using a contraceptive method. The most popular method of birth control was the oral contraceptive pill, used by 10.7 million women in the United States, followed by female sterilization, condoms, male sterilization, and other methods of birth control. Approximately 10% of women had ever used emergency contraception.

Types of Birth Control

The effectiveness of birth control methods is critically important for reducing the risk of unintended pregnancy. Intrauterine contraception and the contraceptive implant remain effective for years once correctly in place. The effectiveness of hormonal, barrier, and fertility awareness-based methods depends on correct and consistent use. For each of these methods, a range of effectiveness estimates is provided; lower estimates are based on typical use and higher estimates are based on perfect use.

Reversible Methods of Birth Control

Intrauterine Contraception* Copper T intrauterine device (IUD) —An IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. This IUD is more than 99% effective at preventing pregnancy.

• Levonorgestrel intrauterine system (IUS)—The IUS is a small T-shaped device like the IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The IUS stays in your uterus for up to 5 years. The IUS is more than 99% effective at preventing pregnancy.

Hormonal Methods

• Implant—The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. It is 99% effective at preventing pregnancy.
• Injection or “shot”—Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. It is 94–99% effective at preventing pregnancy.Combined oral contraceptives—Also called “the pill,”combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. The pill is 91–99% effective at preventing pregnancy.
• Progestin only pill—Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It is a good option for women who can’t take estrogen. They are 91–99% effective at preventing pregnancy.Patch—This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. The patch is 91–99% effective at preventing pregnancy, but it appears to be less effective in women who weigh more than 198 pounds.
• Hormonal vaginal contraceptive ring—The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. It is 91–99% effective at preventing pregnancy.
• Emergency contraception—Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.
  • Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in the United States. Some emergency contraceptive pills are available over the counter for women 17 years of age or older. If younger than 17 years, emergency contraceptive pills are available by prescription.
  • Another type of emergency contraception is having your doctor insert the Copper T IUD into your uterus within seven days of unprotected sex. This method is 99% effective at preventing pregnancy.

Barrier Methods

• Male condom—Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy and HIV and other STDs as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Male condoms are 82–98% effective at preventing pregnancy. Condoms can only be used once. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break.
• Female condom—Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Female condoms are 79–95% effective at preventing pregnancy, and also may help prevent STDs.
• Diaphragm or cervical cap—Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup.Before sexual intercourse, you insert them with spermicide to block or kill sperm. The diaphragm is 84–94% effective at preventing pregnancy. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes
• Spermicides—These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. Spermicides alone are about 72–82% effective at preventing pregnancy. They can be purchased at drug stores.

Fertility Awareness-Based Methods

• Natural family planning or fertility awareness—Understanding your monthly fertility pattern can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a barrier method of birth control on those days. These fertility awareness-based methods are 75–96% effective at preventing pregnancy.

Permanent Methods of Birth Control

Contraceptive sterilization is a permanent, safe, and highly effective approach for birth control. These methods are meant for people who are sure that they do not desire a pregnancy in the future.

The following methods are more than 99% effective at preventing pregnancy.

• Female Sterilization—Tubal ligation or “tying tubes”—A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately.
• Transcervical Sterilization— A thin tube is used to thread a tiny device into each fallopian tube. It irritates the fallopian tubes and causes scar tissue to grow and permanently plug the tubes. It can take about three months for the scar tissue to grow, so use another form of birth control during this time. Return to your doctor for a test to see if scar tissue has fully blocked your fallopian tubes.
• Male Sterilization–Vasectomy—This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero.

Although most women and men who undergo contraceptive sterilization do not regret having had the procedure, the permanence of the method is an important consideration, as regret has been documented in studies. For example, the U.S. Collaborative Review of Sterilization (CREST) study found that women who were younger at the time of the procedure were more likely to experience regret.

An additional issue addressed by the CREST study was the question of whether women who underwent contraceptive sterilization developed a “post-tubal ligation syndrome” of menstrual abnormalities, something that had been debated for years. Results indicated that menstrual abnormalities were no more common among women who had undergone tubal sterilization than among women who had not.

When considering a vasectomy, it’s important to understand that failures can occur. CDC research has estimated there is a probability of 11 failures per 1,000 procedures over 2 years; half of the failures occurred in the first three months after the vasectomy, and no failures occurred after 72 weeks. CDC research also examined regret among women whose partner underwent a vasectomy. In interviews with female partners of men who received vasectomies, CDC found that while most women did not regret their husband’s vasectomies, the probability of regret over 5 years was about 6%. This is why it is important to know facts about this and other permanent forms of birth control before making a decision.