A top doc reveals common fertility misconceptions

By Joshua U. Klein, MD

As an infertility specialist, the first, and sometimes hardest, thing I have to accomplish is to assess a couple's understanding of how the whole getting pregnant thing-naturally or otherwise-works. Despite widespread sex education and increased public awareness of the issue of infertility, many people still don't really get it; a study from New Zealand, for instance, showed that 74% of women presenting to a fertility clinic had inadequate fertility awareness.

An extreme example: I once had a couple come in for an infertility consultation, and only after probing some of the most esoteric-and as it turns out, irrelevant-minutiae of the biology of reproduction did I find out that the husband wasn't able to ejaculate during vaginal intercourse. (Yes, this is generally considered a prerequisite to conception.)

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So if you're in the baby-making market, here are some of the more common mistakes I see people make. And don't be embarrassed if you learn something new; you may or may not save yourself a consultation, but either way, you're certainly not alone.

1. 40 is the new 30
Since the days of Adam and Eve, never have so many women deferred childbearing until their mid-30s or later. The Centers for Disease Control and Prevention reported that in 2006, about 1 out of 12 births in the U.S. were to first-time mothers older than 35, compared to 1 out of 100 in 1970. In other words, only about 1% of first-time mothers were 35 or older in 1970; this number increased eightfold to about 8% in 2006.

The same social and economic forces that have contributed to this reality have also led many women to believe that fertility typically lasts into their 40s. Unfortunately, there's bad news: Historical data suggests that the overall risk for infertility-defined as more than one year of regular unprotected intercourse without conception-increases with age, from 6% between ages 20 and 24 to a whopping 64% between ages 40 to 44. Need more evidence? Take a look in my waiting room. Women in their 20s are few and far between, and most are there to donate eggs-to women in their 40s and 50s.

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2. There's no rush
A groundbreaking study of more than 5,000 couples in the 1940s and 1950s showed that at least 85% conceived within one year of trying for a baby. Historically, this one-year landmark has defined infertility, and many couples postpone evaluation until they have met this milestone.

This is a reasonable rule of thumb for women younger than 35 who are in otherwise perfect health. But anyone older than 35, or anyone with gynecologic or medical problems (irregular or painful periods, diabetes, thyroid problems, or just about anything else), should seek evaluation by a fertility specialist or her ob-gyn. There are numerous fertility problems that can be treated easily but make it nearly impossible to conceive without medical assistance. The key is to be informed. Don't wait, as time is precious when it comes to fertility.

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3. We have sex often enough
It never ceases to amaze me how much our fast-paced lifestyles and schedules interfere with conception. I have met so many busy professional couples who are surprised they aren't pregnant, yet they only sleep together in the same bed, let alone on the same continent, once every month or two.

Just remember: Even someone very fertile and her partner, both in their 20s and in perfect health, will, at best, have about a 25% chance of conceiving in any given month, even with perfectly timed intercourse. This so-called fertile window is open four to five days prior and through ovulation, and it's suggested you have intercourse every 24 to 48 hours during that period. Statistically speaking, this rate of success decreases to about 10% to 15% per month if you're not pregnant within three months, and 5% or less if you're not pregnant after a year.

Now think about this same woman; let's call her Jane. She's 36 and has irregular periods. If she doesn't check her ovulation and plan accordingly, it will be very difficult to conceive during the occasional conjugal visit from her partner (no matter how romantic and passionate his visit may be).


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Joshua U. Klein, MD, is a board-certified OB/GYN and a Clinical and Research Fellow in Reproductive Endocrinology and Infertility at Columbia University Medical Center, in New York City. After earning his medical degree at Harvard Medical School, he completed residency at Harvard's Brigham and Women's Hospital and Massachusetts General Hospital.