A woman can have difficulty conceiving or be unable to conceive for a number of reasons. Problems with ovulation account for approxi­mately 20% of infertility (Urman & Yakin, 2006). Increasing age reduces fertility significantly (Brandes et al., 2011; Schmidt et al., 2012): A woman’s fertility peaks between ages 20 and 24 and begins to decrease rapidly after age 30. Fertility rates in women ages 35 to 39 are up to 46% lower, and in ages 40 to 45 are 95% lower than women at their peak fertility (Fritz & Speroff, 2010). Women over age 35 are twice as likely to have unexplained infertility than are younger women (Maheshwari et al., 2008).

I Hormone imbalances, severe vitamin deficiencies, metabolic disturbances, poor nutrition, genetic factors, emotional stress, or medical conditions can contribute to ovulatory problems. Ovula­tion, and thus pregnancy, can also be inhibited by a below-normal percentage of body fat, which results from excessive dieting or exer­cise. Being even 10-15% below normal weight is sufficient to inhibit

Some fertility specialists think that celebrity moms who

ovulation. Women who smoke cigarettes are less fertile and take

have babies later in life, such as Tina Fey, give the false

longer to become pregnant than nonsmokers, and alcohol and drug

impression that conception at any age is easy.

_____________________________________________ abuse reduces fertility in women. Environmental toxins—including

CHAPTER 11

chemicals in carpets, food packaging, nonstick cookware, and pesticides—may also impair female fertility (Fei et al., 2009; Hannon, 2009). Ovulation problems can some­times be treated with a variety of medications that stimulate ovulation. Although often successful and generally safe, these drugs can produce certain complications, including a greatly increased chance of multiple births.

If tests indicate that the woman is ovulating and that her partner’s semen quality is satisfactory, the next step often is a postcoital test to see whether the sperm remain via­ble and motile in the cervical mucus. A woman’s cervical mucus can contain antibodies that attack her partner’s sperm, or it can form a plug that blocks their passage (Ginsburg et al., 1997). Intrauterine insemination (placing semen directly into the uterus) can be helpful in some cases.

Infections and abnormalities of the cervix, vagina, uterus, fallopian tubes, or ovaries can destroy sperm or prevent them from reaching the egg. Scar tissue from old infec – tions—in the fallopian tubes or in or around the ovaries—can block the passage of sperm and eggs. Sexually transmitted infections (STIs) are a common cause of these problems. Tubal problems can sometimes be resolved by surgically removing the scar tissue around the fallopian tubes and ovaries.