The Modern Fertility Crisis: Why It's Not Your Fault You're Having Trouble Getting Pregnant
Here at mbg, we're all about shining a light on complicated health issues that aren't adequately or thoroughly discussed elsewhere. A prime example: fertility struggles. The truth is, fertility struggles are an uncomfortable topic, and as a result, people don't talk about it. This leads to couples experiencing more anxiety, stress, and confusion than they ever should on their journey to starting a family—with women often bearing the brunt of the burden. So, as part of Fertility Awareness Week, we're shining the light on the surprising, lesser known contributors to the growing fertility problem in this country so we're all more informed and empowered.
Once upon a time, you probably spent a lot of time and energy trying to avoid pregnancy at all costs—after all, going to college or grad school, paying off student loans, or launching a career with a little one in tow just isn’t feasible, or even desirable, for many couples. So, it can be a weird shift when you do want to have a baby (and have lots of unprotected sex to make one) and nothing happens.
For more and more people, trying and trying with zero results is becoming a reality. Over 6 million couples in the U.S. (or 1 in 6) struggle becoming pregnant or sustaining pregnancy—and that number isn’t likely to drop anytime soon. “Fertility challenges are definitely on the rise,” says Felice Gersh, M.D., OB/GYN, founder of the Integrative Medical Group of Irvine and the author of PCOS SOS. “About 10 to 15 percent of couples are stated to have fertility struggles, but in my personal observation, it’s higher than that.”
Women often blame themselves for fertility struggles, but it’s not their fault.
Of course, we always hear one common (and incredibly oversimplified) explanation for not being able to conceive: fertility naturally declines with age and women are waiting longer to have children than ever before. But, while it’s true that both egg quality and quantity diminish with age, it’s only one piece of a very complex fertility puzzle.
While roughly a third of these cases can be attributed to solely the woman (not all of which are even due to age), a third can be attributed solely to the man, and the other third are due to combination of unknown factors stemming from both partners, says Rachel A. McConnell, M.D., a fertility specialist at Columbia University Fertility Center.
“Many women shoulder the responsibility of being unable to conceive,” says Aumatma Shah, N.D., naturopathic doctor and author of Fertility Secrets: What Your Doctor Didn't Tell You About Baby-Making. “They’re quick to assume it's their fault or that their bodies are failing them, but there are so many factors at play, whether it’s sperm quality, age, egg quality, hormonal imbalances, or even lifestyle and environmental factors that used to be less of a concern in previous generations such as higher levels of toxins our environment.”
And while there are some very clear-cut issues that couples struggle with that may contribute to fertility challenges, like a very low sperm count or a structural abnormality that blocks the fallopian tubes and prevents implantation, a full one-third of cases can't really be explained by any one thing—and that's where things get a little confusing.
5 ways our modern world makes it more difficult to conceive than ever.
The fact is, so many aspects of our modern world—and health issues that result from them—are compounding in a way that makes it more difficult to have a baby than ever before. “It’s often several minor problems, none of which would be too debilitating on their own, that are ganging up on you statistically to create fertility challenges,” says Jill Blakeway, DACM, LAc, doctor of Chinese medicine, founder of the Yinova Center in New York City, and co-author of Making Babies.
So, what are these aspects of our modern, fast-paced life that may be contributing the most to fertility issues? We asked the experts to weigh in. While many of these factors are not directly within your control, knowing what they are can help to free you of the burden of guilt and arm you (and your partner) with the knowledge you need to ask for help.
1. Men’s sperm quality and quantity is plummeting.
As mentioned above, male-factor fertility troubles are responsible for couples not being able to conceive in about a third of all cases. But it’s actually the leading cause of secondary fertility struggles—the inability to have another baby after you’ve already had one. “Men labor under the illusion that if they once got someone pregnant, they’re fine. But their reproductive status is not static. It goes up and down with lifestyle and stress and diet, and so they can be contributing,” says Blakeway. “I always encourage couples to look at the man, too, because there’s no point in us poking and prodding some poor woman if it turns out there’s a problem with her partner.”
We also know for a fact that male sperm count is drastically lower than it used to be. “Pretty much all men today would have been considered infertile two generations ago,” says Blakeway. To give you an idea of just how serious an issue this is: In 1940, the average man had 113 million sperm per milliliter of semen; but by 1990, that plummeted to 66 million—a 45 percent drop. The percentage of men with normal sperm morphology (shape) has also dropped.
And the downward trend has continued. In fact, it has become such an issue that doctors have redefined what is considered normal. “Twenty years ago, men were expected to have about 40 million sperm per milliliter of semen to be considered fertile, and today we consider 20 million normal—so we’ve just kind of moved the goal post,” says Blakeway. It’s hard to know exactly what’s causing this, which is kind of scary, but Blakeway and McConnell believe exposure to environmental toxins may be largely at play, along with lifestyle factors such as obesity and inactivity.
2. We're overstressed and under-rested
There’s no denying the fact that we’re more stressed out and sleep-deprived than ever before, and most experts see an association between this and difficulty getting pregnant. “I always tell people that we’re evolutionarily programmed to have less babies in times of war and famine—and we’re sort of replicating that in some ways with our stressful lives,” says Blakeway.
To see the impact stress can have on fertility, just look at zoo animals—some of the most stressed-out creatures of all. In one study, which Blakeway references in her book, 10 percent of psychologically stressed monkeys stopped menstruating altogether; and when the stress let up, they began to menstruate again. And while stress (along with other psychological disorders like depression and anxiety) hasn't been directly implicated in fertility challenges in humans, many functional medicine experts believe chronic stress can lead to a cascade of hormonal imbalances that lower fertility.
"When your body is in 'stress' mode or 'fight or flight’ mode, you actually have lower adrenal hormones and progesterone, which will inhibit ovulation," says Bindiya Gandhi, M.D., functional medicine physician and women’s health expert. That's because, in a process known as "pregnenolone or progesterone steal," the body actually prioritizes the creation of the stress hormone cortisol over sex hormones like progesterone.
Chronic stress is also thought to be a major contributor to thyroid problems, which can negatively impact fertility, as well as polycystic ovarian syndrome (PCOS)—one of the most common hormonal conditions among women, which affects 5 to 10 percent of women of childbearing age and is considered the number one cause of fertility problems in the U.S.
Lack of quality sleep is another major stressor on the body. And exposure to blue light from our smartphones, tablets, TVs, and laptops during the evening hours is not only messing with our sleep, it also interferes with the natural light-dark cycle and causes our bodies to produce less melatonin as a result. In addition to helping you fall asleep, melatonin is a natural antioxidant that protects the brain and ovaries. In fact, some studies have shown that messing with the light-dark cycle in women can delay or even stop ovulation.
3. We're exposed to more toxins than ever before.
Another issue today that was nearly non-existent just a few generations ago: Exposure to a variety of toxins in our air, soil, food, and water, which may contribute to chronic diseases and conditions known to impair fertility. “A rapid increase of autoimmune conditions such as celiac disease, thyroid diseases, diabetes, and PCOS are being reported, and these chronic conditions can have implications for pregnancy outcomes,” says McConnell. “In many cases, the increased incidence of these diseases may be linked to the many toxins in food, water, and the air.”
What exactly are these toxins that are contributing to fertility problems? Because we’re exposed to so many different chemicals on a daily basis, there are likely many contributors, and it’s difficult to tease out exactly what’s having the biggest impact, but experts have a few theories.
Dioxins—byproducts of all sorts of industrial processes from bleaching paper to manufacturing herbicides and cleaning products—have been shown to alter the menstrual cycle, increase the risk of endometriosis (which can itself lead to these issues by blocking the fallopian tubes), and lower testosterone levels and sperm count in men, says Blakeway. Xenoestrogens, chemicals that mimic estrogen in the body, are another problem. Found in everything from conventional cosmetics to cleaning products to plastic food containers, xenoestrogens are a big contributor to estrogen dominance and can therefore lead to problems such as irregular menstruation and ovulation. And don’t forget BPA (found in plastics marked PC and recycling #7). This known endocrine disruptor can damage eggs and induce PCOS in susceptible women, says Gersh.
While these chemicals are quite pervasive in our lives, you can significantly reduce your exposure by using a high-quality water filter (reverse osmosis is the gold standard), eating mostly organic (particularly animal products, as conventional animal products are one of the biggest dietary sources of dioxins), opting for natural cosmetics and cleaning products, drinking from glass, ceramic, or metal (instead of plastic bottles), and reheating your food in glass containers instead of plastic.
4. We have fewer opportunities to move our bodies.
Our modern lifestyles and workplaces make natural movement throughout the day nearly impossible—and our fertility is suffering for it. For one, obesity rates are at an all-time high, and women who are overweight tend to have estrogen dominance, as fat tissue generates estrogen in the body, which can lead to irregular menstruation and ovulation, says Blakeway. Women who are overweight are also more likely to be insulin-resistant, and approximately 40 percent of women who are insulin-resistant have PCOS.
But even women who are in a normal weight range (and eating healthy) can suffer the consequences of a sedentary lifestyle. “We often spend too much of our day sitting, which actually blocks off blood flow to the uterus and ovaries,” says Shah.
5. We may be unknowingly masking problems with birth control.
According to recent estimates, about 28 percent of women of reproductive age take hormonal birth control pills. And while they were once viewed as a cure-all for a variety of unwanted premenstrual and menstrual symptoms, many functional experts are now beginning to understand the complexity of this popular method of contraception. While there are no studies showing that hormonal birth control directly leads to difficulty becoming pregnant, it can mask symptoms of other conditions like PCOS. This, in turn, can cause women to put off dealing with the root cause of their condition for years, putting them behind the eight ball when they do eventually decide they want to get pregnant.
“Taking hormonal birth control for symptoms like irregular, absent, or abnormal periods in order to ‘regulate’ your period does not address the root cause of the issue,” says Jolene Brighten, N.M.D., women’s health and hormone expert and author of Beyond The Pill. “While hormonal birth control can give you a predictable withdrawal bleed, this isn’t fixing what’s causing your period problems. These underlying conditions can be due to PCOS, hypothalamic amenorrhea, thyroid disease, or other medical conditions that can lead to difficulty conceiving.”
This means that if you use birth control for symptom management, then you may find it difficult to get pregnant when you stop.
The need for an integrative, whole-body approach to fertility.
The fact is, we're living in a time and place that seems to be working against our fertility and overall health goals at every turn. But while all of these (and likely other) modern-day issues may set us up for a perfect storm of fertility challenges, that’s definitely not to say things are hopeless.
While we may not be able to avoid some of these factors, there are always ways to help counter and manage them. Awareness is the first step. Once you understand some of the issues that can impact fertility, you can talk with your doctor about your specific situation and ask about the lifestyle factors you may be able to tweak to increase your chances of conception. You can also start by getting your partner's sperm tested, which is a quick, non-invasive way to either confirm or rule out a potential cause of these issues before exploring more expensive or invasive procedures.
You should also take comfort in the fact that a growing number of naturopaths, OB/GYNs, reproductive endocrinologists, registered dietitians, and Chinese medicine practitioners at clinics like Yinova are helping guide even the most “hopeless” couples toward reproductive success with a more holistic and integrative approach, rather than viewing the reproductive system in isolation and jumping straight to something like in vitro fertilization (IVF). “Helping address all the underlying factors, or root causes, that are out of balance in our bodies, is not only a more effective approach to fertility optimization," says Shah, "it's often a more efficient approach."
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