Why is it so hard to get pregnant? Some pressing infertility questions answered

Getting pregnant might sound easy, but it can actually be a struggle especially for couples with infertility issues.

In a recent press conference "The Art of Getting Pregnant," fertility doctors Virgilio Novero Jr. and Eileen Manalo shared a few tidbits and misconceptions about infertility.

Citing a Synovate survey from 2013, Novero said the incidence of infertility in the Philippines is about 8-10%.

The percentage for conceiving in any cycle is about 20-22% with ovulation, fertilization, and implantation as necessary key events.

Any condition that would interfere in these necessary events can result in infertility.

So how would you know if it's infertility or it's just one of the three? Novero and Manalo answer these often whispered questions.

How to know if you are having infertility problems?

Citing Centers for Diseases (CDC), Novero said a couple is considered having infertility problems when they fail to "conceive with unprotected intercourse after one year for those below 35 years old and 6 months for those above 35 or with comorbidities."

So that's one year of trying for people below 35, and 6 months for those above 35 or with comorbidities.

What causes infertility?

According to Novero, some of the common factors that cause infertility include:

• the timing and frequency of intercourse
• the presence of sexually transmitted disease or other infections
• lifestyle factors such as nutrition, obesity, smoking, alcohol intake and caffeine
• age

Novero said the most important and common factor is the age of the couple trying to conceive, adding "the older the woman, the more difficult it is for her to get pregnant."

Novero also said some of the basic categories that cause infertility include pure female factors at 35%, pure male factors at 30%, combined female and male factors at 27%, and 8% for the unexplained.

What are these female factors, you may ask? They are tubal factors, ovulation disorders (PCOS, endometriosis), uterine factors, and advanced maternal age.

Male factors meanwhile include Primary Testicular Disease, Secondary Testicular Diseases, sperm transport disorder, sexual dysfunction, and idiopathic sperm abnormalities.

Why is it harder for women to get pregnant the older they get?

Novero said "fertility decreases the older the woman tries to get pregnant" because ovarian reserve drops in quantity especially for women over 40, and then there is also the quality of eggs for those advanced in maternal age. 

According to Novero, ages 37-38 are somewhat critical. "If [a woman doesn't] get pregnant at that age, there will be a sudden drop at the woman’s fertility."

Manalo however said "for as long as your blood pressure is controlled, sugar is controlled, we can still work on your pregnancy."

Still, she says, "it’s always good to try to achieve when your ovarian function is at its peak — which is roughly between 20-25 years old. That would be the best."

As such, women who marry late or those who marry after 35 or after 40 are encouraged to seek professional advice should they want to get pregnant.

What should you do next if you suspect that you are infertile?

Manalo said before seeking treatment, a person should be diagnosed first. The best thing to do is seek the help of a fertility doctor.

A fertility doctor would look into the history of the patient, look at her physical attributes, if she might be obese or have androgen excess.

"So if you see signs of androgen excess like acne or excess hair, she probably has anovulatory cycles," she said.

Manalo said the woman would also undergo an ovarian reserve test to check and move things up if they have a low ovarian reserve.

But that's not saying infertility is a woman's problem.

Manalo said men should also have a semen analysis to check his sperm quality, sharing an anecdote about a female patient seeking help for nearly a year when her husband hasn't even had a semen analysis yet.

When they finally got him to do it, they learned he didn't have sperms. 

"The man will have to join in," Manalo emphasizes because "half of the problem [might] come from the male."

When they've located the infertility problem, doctors will give treatments including medication that can be taken to boost the sperm count and for women improving or treating ovulation problems.

What are some of the things you can do to avoid infertility problems?

Novero points to four lifestyle factors that cause infertility:

• smoking
• obesity
• alcohol
• caffeine intake

"As far as lifestyle is concerned, those are the things that may affect your fertility, depending on the evidence," Novero said.

"As for the diet, there are particular diets that will be high in estrogen and when you have a high estrogen diet, it might mess up on the woman's fertility. When that's the case, she may have problems with her ovulation," he added.

Manalo adds there is some evidence that says a Mediterranean diet, which consists of "fresh fruits and vegetables, a lot of nuts, low in carbs and low in oils but if you wanna use oil, olive oil would be good [a good option]" can help.

"Sometimes we give anti-oxidants, supplements, which can boost the sperm count of our patients. It can be given to patients who are a little bit of an advanced age, who are more than 35 years old or even older in their 40s," he said.

Manalo said obesity is a major factor that causes infertility because apart from "poor quality eggs," obesity can also increase a person's chance of miscarriage. It can cause limitation in pregnancy and complications during pregnancy.

"A 5-10% weight loss can go a long way in producing good quality eggs," Manalo added.

Do positioning and frequency matter during sexual intercourse matter when trying to get pregnant?

For Manalo, it is "not so much of an issue unless there’s something anatomically wrong with your cervix or uterus. It’s not too much of an issue."

But just the same, Manalo said frequent sexual intercourse won't result in infertility and neither will it increase a person's chance of getting pregnant.

Instead, Manalo advises couples to have intercourse "at the time they are most fertile" which she said is called the time coitus concept.

"It doesn't harm if you have contact on a daily basis just on the time that they are ovulating — maybe 3 days in a row that would be fine," she said.

When should I consider fertility preservation?

Fertility preservation — like egg freezing — should be considered if you're under these four categories, Novero said: 

1. undergoing cancer treatment and are subjected to gonadotoxic therapy or surgery
2. young women with benign disease who are also undergoing gonadotoxic therapy or surgery
3. transgender patients who are assigned females at birth,
4. age-related fertility loss

"Each of these groups are subjected to certain factors that will require them to preserve their fertility ahead of the subjected factors," he said.

"The concept is when you identify patients at risk ,before they go through cancer therapy, their disease progression, gender reassignment you get their fertility tissues, you do fertility preservations, you preserve their tissues and these are safe in storage and would be used for future use," he added. — LA, GMA News