Trying to get pregnant can be, well, trying. If you’re having trouble, it can bring on sadness, frustration, despair, and even guilt. On top of the emotional toll, it can also be hard to pinpoint the cause of fertility issues — which are more common than you might think. Around 10% to 15% of couples in the U.S. deal with infertility. That’s the inability to get pregnant after a year of regular unprotected sex.

In some cases, medical issues may make it hard for a person to get pregnant. Other times, the struggle may stem from the natural tendency of fertility to wane over time. Here’s what you need to know about how fertility changes over the years, plus what you can do to maximize your chances of having a baby.

How Fertility Changes Over Time

If you have ovaries, they had all the eggs your body will ever make on the day you were born. On average, that’s about 1 million eggs. Over time, the number slowly goes down. Peak fertility happens in your 20s, says Ilana Ressler, M.D. Dr. Ressler is a reproductive endocrinologist with Reproductive Medicine Associates of Connecticut. Then, starting in your 30s, it begins to slide. “The eggs are affected by age in regard to both quantity and quality,” says Dr. Ressler.

As eggs age, they’re more likely to have chromosomal abnormalities, or changes in DNA. That can lower the chances of getting pregnant. It can also raise the chance of pregnancy loss. This is more common after the age of 35, which is known as “advanced maternal age.” That said, there’s nothing magical about the number 35. Plenty of people can get pregnant naturally after that age.

Still, on average, it’s easier to conceive and carry out a pregnancy before age 35. According to the American College of Obstetricians and Gynecologists, fertility decreases “gradually but significantly” around age 32. Then it goes down “more rapidly” after age 37.

Even so, younger people with ovaries may find it hard to get pregnant. This could happen for several reasons, including:

• Polycystic ovary syndrome (PCOS). This hormonal imbalance gets in the way of normal ovulation. It’s the top cause of infertility in people with ovaries. 
• Uterine fibroids. They may stop fertilized eggs from implanting in the uterus.
• A history of pelvic inflammatory disease. It’s caused by sexually transmitted infections such as chlamydia and gonorrhea. It can block or damage the fallopian tubes. As a result, sperm might not be able to reach the egg. Or a fertilized egg might not be able to get to the uterus.
• An unhealthy body weight. Being severely underweight or having obesity can cause problems with ovulation.

Age also affects sperm. It can:

• Decrease the amount of sperm.
• Lower motility. That’s the ability of sperm to swim well.
• Cause structural problems in the sperm.

Compared with eggs, sperm health declines at a slower and less severe rate, says Dr. Ressler. “Some studies have shown that when a man is over 35, these effects may appear. But it typically does not affect fertility before the age of 50.”

People with testicles who are older than 45 take about 5 times as long to contribute to a pregnancy as those who are younger than 25, says Mark P. Trolice, M.D. Dr. Trolice is director of Fertility CARE: The IVF Center. He’s also a professor at the University of Central Florida College of Medicine. Dr. Trolice adds that the risk of miscarriage, birth defects, and autism increases slightly with “advanced paternal age.” That’s often cited as 40 years old, although there’s no formal definition.

Age doesn’t have as strong an impact on sperm quantity and quality as it does on eggs. Yet 40% to 50% of conception problems stem from issues with producing or delivering enough healthy sperm. “Any fertility assessment should also include a semen analysis,” says Dr. Trolice.

Diagnosing and Treating Infertility

Talk to a specialist if you’ve been trying to get pregnant for more than 12 months without success. (Wait only 6 months to call a specialist if you’re 35 or older. If you’re in your 40s, it’s a good idea to see a specialist right at the start.) Whether you have ovaries or testicles, both partners should be evaluated.

If you have ovaries, a basic fertility evaluation starts with bloodwork. This helps check the number of eggs you have left. You may also have radiology tests. These look at your fallopian tubes and uterus for any health issues or abnormalities.

If you have testicles, the specialist will ask about anything in your health history that could affect fertility. They may also do a semen analysis. This will measure the number of sperm and look for any abnormalities.

There’s a wide variety of fertility treatments that can fit each person or couple, based on the situation. These may include:

• Medications. They can be used to stimulate ovulation or treat infections or hormone imbalances that affect sperm production.
• Surgery. It can correct obstructions to sperm movement, open blocked fallopian tubes, remove fibroids, or treat endometriosis.
• Intrauterine insemination. This involves placing sperm directly inside the uterus to help fertilization.
• In vitro fertilization. This procedure starts with stimulating many eggs to grow. Then they are removed from the body. The eggs are inseminated with sperm to create embryos. Then an embryo is put into the uterus.
• Egg or sperm donation.

“If you are not considering conception in the near future, consider fertility preservation, like freezing eggs or embryos. And consult with a specialist to get more information,” says Dr. Ressler.

Tips for Boosting Fertility at Any Age

So how can you increase your chances of getting pregnant? Live a healthy lifestyle. “Good nutrition and routine physical activity are important,” says Dr. Ressler. Here are other keys to supporting fertility:

• Keep a healthy weight. Obesity and being underweight can prevent ovulation.
• Don’t smoke. It can reduce egg stores prematurely. And it may contribute to infertility.
• Avoid drugs. And limit drinking to no more than 2 alcoholic drinks a day. Excessive alcohol use is linked with a higher risk of ovulation disorders. It may also contribute to male infertility.
• Watch your coffee habit. Drinking as much as 200 mg of caffeine per day (about 1 or 2 cups of coffee) is fine. But some studies suggest that more than that could affect fertility.
• If you have testicles, stay out of hot tubs. The high heat can temporarily affect sperm production and motility.

Finally, try to relax. Stress doesn’t cause infertility, but it doesn’t help. Take a deep breath every now and then. And remember: You’ve got options.

[Sources:]

[1] “Infertility.” Mayo Clinic, September 1, 2021, https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317. Accessed December 3, 2021.

[2] “Female Age-Related Fertility Decline.” The American College of Obstetrics and Gynecologists, 2020, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/03/female-age-related-fertility-decline. Accessed December 3, 2021.

[3] “Infertility.” Office on Women’s Health, U.S. Department of Health & Human Services, April 1, 2019, https://www.womenshealth.gov/a-z-topics/infertility. Accessed December 3, 2021.

[4] “When Should You See a Fertility Specialist?” University of Utah, https://healthcare.utah.edu/fertility/when-should-you-see-a-fertility-specialist.php. Accessed December 22, 2021.

[5] Kumar N and Singh AK. “Trends of Male Factor Infertility, an Important Cause of Infertility: A Review of the Literature.” Journal of Human Reproductive Sciences, vol. 8, no. 4, 2015, pp: 191-196. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691969/

[6] “Weight, Fertility, and Pregnancy.” Office on Women’s Health, U.S. Department of Health & Human Services, December 27, 2018, https://www.womenshealth.gov/healthy-weight/weight-fertility-and-pregnancy. Accessed December 3, 2021.