Approximately one in five American couples will struggle with infertility in their attempts to get pregnant, according to data from the Centers of Disease Control and Prevention (CDC). But despite this problem being common, infertility can feel incredibly isolating, and knowing what to do in the face of it isn’t always clear due in no small part to the fertility myths that abound, especially online. But Google isn’t always your friend, says Dr. Phillip Romanski, Director of Research for Shady Grove Fertility. “Reproductive health is very complex and the general population doesn't always have a great understanding of that process and how that works,” he tells Romper by phone. “The internet isn't necessarily always the greatest place to get that information because there are certainly some general rules that apply, but every person, and really couple, has enough variables that each case is very unique.”
Romper spoke to Dr. Romanski, as well as Dr. Melanie Altizer, MD, Chief of OB/GYN at St. Mary’s Medical Center in West Palm Beach, Florida and regional director of OB hospitalists for TeamHealth, to help debunk some of the most persistent fertility myths we’ve found and that they see in their practices.
Being on the pill for a long time negatively affects fertility.
The idea that hormonal birth control, especially when used over a period of years, adversely affects fertility is a common belief, and we can understand the concern. After all: the pill is tremendously effective at preventing pregnancy — between 93% and 99% effective per Planned Parenthood — does that efficacy linger after you stop using it?
Fortunately this is a myth that prospective parents don’t have to worry about.
“When I was in private practice, I used to get this question quite a bit,” says Altizer. “But you could be on the pill for years: the moment you stop taking it, it takes about 30 days for your body to re-regulate itself — your natural cycles and ovarian hormones kick right back in. So you can stay on the pill indefinitely and then expect to return to normal fertility when you stop taking the pill.”
This is because the birth control pill is “just little hormonal manipulation” that “tricks” your body into not ovulating as usual. But it only works as long as you’re on it and it does not have any other lasting side effects that would affect fertility.
“It doesn't affect the egg quality, it doesn't affect the egg quantity,” agrees Romanski. He does note that for some people, it might take longer than a month for cycles to regulate. Once they return, however, their chances of conception are the same as they would be for anyone in their age bracket.
There’s a “best position” to get pregnant.
We know your woo-woo friend who’s into astrology has very strong positions on this and your bestie urged you to prop up your hips for a few minutes after you’re done, but it turns out that neither active nor resting positions are going to do anything for you in trying to conceive.
“Patients ask about that one a lot, but there's no data to support that,” Romanski explains. With millions, maybe even hundreds of millions of sperm, which can move every which way, position doesn’t matter. “There can be sperm practically at the egg within five minutes of ejaculation. It's not something that's hampered by gravity or position or anything like that.”
Granted, you don’t want to cleanse your vagina immediately after your partner ejaculates, but standing up won’t do much to hinder your efforts. Neither will lying in a certain position, though it doesn’t hurt. Case in point: Altizer’s intrauterine insemination (IUI) patients are encouraged to remain prone for a few minutes after insemination, but ultimately it probably won’t make a difference between getting pregnant and not.
“All it takes is one healthy sperm coming into contact with one healthy egg,” she says. “The position really doesn't matter a great deal.”
It’s much harder to get pregnant after 35.
This one is a bit of a mixed bag in that it’s not entirely a myth, but both Altizer and Romanski believe that it’s more nuanced than many of us have been led to believe.
“I think people have an idea that with each increasing year of age, there's this cliff that they fall off,” Romanski says, “That all of a sudden the day you turn 35 or 36, there's this dramatic shift in the quality of eggs. That's definitely a bit dramatic.”
While such a decline in egg quality is, sadly, not a myth, it’s a gradual process that becomes more pronounced the older you get. “For example, if a 35-year-old does IVF and makes a cohort of embryos, we expect about 60% of them to be tested as chromosomally normal. With 37-year-olds, it might be more like 55%. So it's kind of subtle decreases like that.” By the time a woman gets to about 43 years old, only about 10% to 15% of embryos can be expected to be “normal.”
This isn’t to say that pregnancy well into your 40s isn’t possible, as Altizer attests.
“Probably the largest number of patients I saw when I was in private practice that showed up with a surprise pregnancy were patients that were over 35 that thought that things just magically shut off after that,” she says. “That is not true.”
So while she notes that 35 is “an important number” for fertility specialists, as it does generally mark a decrease in egg quality and an increased difficulty falling pregnant, it is nevertheless “very common” to get pregnant well into the late 30s and even early 40s.
You can’t get pregnant when you’re breastfeeding or shortly after birth.
“Both of those things are false,” Altizer says. “I've seen many, many patients come back with a short-interval pregnancy. Three months after delivery, and oops! They're pregnant.”
Not only can ovulation resume as soon as 21 days after delivery (though that isn’t, strictly speaking, common), but weeks or months after delivery is a time when menstrual cycles aren’t as reliable as they might have been prior to pregnancy. Some people can get pregnant again without ever resuming a regular period.
The idea that you can’t get pregnant while breastfeeding is another one Altizer runs into frequently. “Breastfeeding can be an adjunct to birth control; it can certainly help suppress ovulation a bit, but it is not a good standalone method of contraception.” She says she urges breastfeeding patients to use a reliable form of contraception, either barrier methods like condoms or a copper intrauterine device (IUD), or progesterone-only hormonal birth control, which can come in the form of an IUD, a Depo-Provera injection every three months, an arm implant called Nexplanon (that’s good for three years), or a pill, often called “the mini-pill”. These progesterone-only options are preferred by nursing parents because unlike hormonal birth control that contains estrogen, progesterone-only birth control does not affect milk supply.
Healthy people won’t face infertility
Romanski says that some patients have difficulty accepting the idea that they’re facing infertility in the first place.
“A lot of people think, ‘But that’s impossible: I'm so healthy. I've always treated my body so well. There's no way that my eggs cannot be healthy,’” he says. Unfortunately, while a healthy diet and regular exercise can make your muscles and heart stronger, eggs and ovaries are a different story. “You can't prevent the decline in egg quality that happens with age. There's really nothing that you can do.”
It can be a discouraging truth, but it can also be comforting to know that infertility isn’t the result of anything you have or haven’t done.
Infertility is always going to be difficult to address, expensive, & invasive.
For people hoping to build a family, infertility will probably always be emotionally difficult and stressful, but Altizer wants folks to take heart and not jump to the worst case scenario right away. In fact, “most of the time,” there are steps that will get a person through their fertility struggles before having to resort to in-vitro fertilization (IVF), which is especially invasive and expensive.
“I always like to reassure patients that usually there is something relatively simple that we can do —we can give medications to help induce ovulation, or we can assist patients in the appropriate timing of intercourse,” she says. In cases of male infertility — lower than average sperm count or poor motility of sperm — intrauterine insemination (IUI) can be a good option, which is less strenuous (and expensive) than IVF. In some cases, it may be an issue of addressing an unknown thyroid issue, so physical examinations are important.
“I think it's important to know that it's never too early to reach out and meet with reproductive endocrinologists, somebody who — this is what we do every single day,” Romanski agrees. “A lot of my initial visits with patients are just helping them understand the process. They might not necessarily even need any sort of treatment. Sometimes there are modifications that they can make to increase their success rate.”
Altizer puts it succinctly: “There's always lots of hope out there for patients.”
Dr. Melanie Altizer, MD, Chief of OB/GYN at St. Mary’s Medical Center in West Palm Beach, Florida and regional director of OB hospitalists for TeamHealth.
Dr. Phillip Romanski, MD, MSc, Director of Research for Shady Grove Fertility.