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Despite the fact that many couples experience fertility struggles, when you’re the one having a difficult time conceiving, it can feel very frustrating and isolating. You may wonder why it’s taking so long to get pregnant or if there is something you could be doing to better your chances for a future pregnancy.
When it comes to your reproductive health, it’s not one-size-fits-all. It’s complex, and causes of infertility can stem from male factors, female factors, or a combination of both. And, to complicate things further, there usually aren’t any early signs of infertility (Lindsay, 2015).
In fact, most healthcare professionals only recommend fertility evaluations if a couple has been trying to get pregnant without success for a year. Anything short of that usually doesn’t warrant a fertility evaluation, unless there’s reason to believe that there’s a health issue that could lead to infertility (ACOG, 2020; Walker, 2021).
There are some things that may be suggestive of future fertility problems, so if you’re concerned about your ability to have kids, here’s what you need to know.
What are the signs of infertility?
In most cases, an inability to become pregnant is the first and only sign or symptom of infertility (Lindsay, 2015).
Experts usually define infertility as the inability to become pregnant after 12 months of regular, unprotected sex. However, that time threshold drops to six months if you’re older than 35. That’s because infertility is more common once women reach this age. Among women who are 34 or younger, rates of infertility range from 7% to 9%. This jumps to 25% among women aged 35 to 39. (Chandra, 2013, ACOG, 2020).
In couples under age 30 who are generally healthy, 20% to 37% are able to conceive in the first three months (ASRM, 2012).
Meanwhile, around 12% to 18% of couples struggle with fertility challenges, and males contribute to 50% of infertility cases overall (Agarwal, 2015; Thoma, 2013).
Now that you have a better understanding of the numbers surrounding infertility, let’s take a closer look at what the signs of infertility may look like in women and in men.
Signs of infertility in women
Apart from the inability to become pregnant, irregular periods are a warning sign of female infertility (Lindsay, 2015). If a woman’s menstrual cycles are regular, predictable, and associated with common symptoms such as bloating, fatigue, and breast tenderness, these are all signs of healthy ovulation. However, if her periods are irregular or absent, or if she has painful periods, these may be warning signs of possible fertility concerns (Filip, 2020; Walker, 2021).
A history of past miscarriages is also a warning sign of infertility (Walker, 2021).
There are also some health issues or prior medical conditions (as well as a family history of certain medical problems) that are associated with an increased risk for infertility.
Fertility tests for women: types, results, cost
While none of these medical issues is a direct sign or symptom of fertility problems, they could all be considered risk factors. These include (Lindsay, 2015):
- Family history of early menopause
- Past ovarian surgery
- Past diagnosis of a sexually transmitted infection (STI), such as chlamydia or gonorrhea (Tsevat, 2018)
- History of chemotherapy or radiation treatment
- Unexplained fatigue, hair loss, or weight gain, which may all be signs of an ovulatory disorder
- History of pelvic infections or endometriosis
- History of polycystic ovary syndrome (PCOS)
Again, these are not direct signs of infertility. They are better thought of as risk factors (Lindsay, 2015).
Infertility following an abortion
If you’ve had an induced abortion in the past, you might be wondering what impact, if any, it could have on your fertility in the future.
When it comes to abortions performed by a licensed medical professional, researchers have found no evidence of increased fertility risks or challenges (Johnson, 2020). The American College of Obstetricians and Gynecologists (ACOG) also states that having an abortion will not impact your fertility (ACOG, 2021).
However, if abortions are performed outside of licensed medical clinics or facilities, they can result in damage to a woman’s reproductive organs and infertility.
Signs of infertility in men
Male fertility is dependent on a man’s ability to produce and deliver healthy sperm via ejaculation. If a man can’t ejaculate, there’s really no way to detect low sperm count or other signs of infertility without some kind of medical test or examination.
However, some conditions that affect male fertility—including genetic syndromes or hormonal imbalances—may produce signs or symptoms. These could be thought of as indirect or secondary signs of infertility (Agarwal, 2020).
Semen without sperm (azoospermia): causes and treatments
For example, several hormone-related conditions can reduce male fertility. These conditions can, in some cases, cause noticeable physical changes in a man’s appearance. Low amounts of facial hair growth, gynecomastia (enlarged breasts), or an unusually small penis or testicles may be indicators of hormone deficiencies that can reduce fertility.
Other medical conditions or concerns that may cause or contribute to male infertility include (Agarwal, 2020):
- Erectile dysfunction or low sex drive
- Kallmann syndrome
- A history of genital or urinary tract infections
- Scrotal cysts, varicoceles, blockages, or other abnormalities of the genitals
- A history of chemotherapy or radiation
- Past testicular trauma (injury)
- Lifestyle risk factors such as obesity, smoking, or alcoholism
Once again, most of these are not strong indicators of infertility. These are better thought of as risk factors.
When to see a healthcare professional
Most experts in reproductive medicine don’t recommend a fertility evaluation unless a couple has been trying to get pregnant—meaning they’re having regular, unprotected sex—for at least 12 months. Again, this drops to six months among women older than age 35 (Walker, 2021).
Getting pregnant with PCOS: fertility treatment options
If you are struggling with infertility, know that this does not necessarily mean that you can’t get pregnant in the future. There are infertility treatments available—like various fertility drugs or in vitro fertilization (IVF)—that may work. Your healthcare provider will help you come up with a plan so that you can continue on your journey to conceive.
While the risk factors or symptoms mentioned above might, in some cases, point to fertility issues, most of them are not strong indicators that a couple will struggle to get pregnant.
- Agarwal, A., Majzoub, A., Parekh, N., & Henkel, R. (2020). A Schematic Overview of the Current Status of Male Infertility Practice. The World Journal of Men’s Health, 38(3), 308–322. doi: 10.5534/wjmh.190068. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308239/
- Agarwal, A., Mulgund, A., Hamada, A., & Chyatte, M. R. (2015). A unique view on male infertility around the globe. Reproductive Biology and Endocrinology:RB&E, 13, 37. doi: 10.1186/s12958-015-0032-1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25928197/
- American College of Obstetricians and Gynecologists (ACOG). (2020). Evaluating Infertility. Retrieved Dec. 22, 2021 from https://www.acog.org/womens-health/faqs/evaluating-infertility
- American College of Obstetricians and Gynecologists (ACOG). (2021). Induced abortion. Retrieved Dec. 22, 2021 from https://www.acog.org/womens-health/faqs/induced-abortion
- American Society for Reproductive Medicine (ASRM). (2012). Optimizing natural fertility. Retrieved Dec. 22, 2021 from https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/optimizing_male_fertility_factsheet.pdf
- Atuhaire, S. (2019). Abortion among adolescents in Africa: A review of practices, consequences, and control strategies. The International Journal of Health Planning and Management, 34(4), e1378–e1386. doi: 10.1002/hpm.2842. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/hpm.2842
- Chandra, A, Copen, C. E., Stephen, E. H. (2013). Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth. National Health Statistics Reports, (67), 1–19. Retrieved from https://www.cdc.gov/nchs/data/nhsr/nhsr067.pdf
- Filip, L., Duică, F., Prădatu, A., et al. (2020). Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches. Medicina (Kaunas, Lithuania), 56(9), 460. doi: 10.3390/medicina56090460. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559069/
- Johnson, K., et al. (2021) The Infertility-Abortion Nexus: Does Having Had an Abortion Influence Distress and Help-Seeking for Infertility? Women’s Reproductive Health, 8(4), 233-247, doi: 10.1080/23293691.2021.1976046. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/23293691.2021.1976046
- Leslie, S. W., Siref, L. E., Soon-Sutton, T. L., & Khan, M. (2021). Male Infertility. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK562258/
- Lindsay, T. J. & Vitrikas, K. R. (2015). Evaluation and treatment of infertility. American Family Physician, 91(5), 308–314. Retrieved from https://www.aafp.org/pubs/afp/issues/2015/0301/p308.html
- Pike, G. K. (2020). Abortion and Infertility. Issues in Law & Medicine, 35(2), 173–195. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33950600/
- Thoma, M. E., McLain, A. C., Louis, J. F., et al. (2013). Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertility and Sterility, 99(5), 1324–1331.e1. doi: 10.1016/j.fertnstert.2012.11.037. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/23290741/
- Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American Journal of Obstetrics and Gynecology, 216(1), 1–9. doi: 10.1016/j.ajog.2016.08.008. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193130/
- Walker, M. H. & Tobler, K. J. (2021). Female Infertility. (2021). StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK556033/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.