Ask the Experts: Fall 2024

Can men and women both have fertility issues?

Yes, both men and women can have fertility issues. Infertility is the medical term for when you can't get pregnant despite having unprotected sex for a year or more.

Infertility may happen because of a health issue with either you or your partner, or a mix of factors that prevent pregnancy. But many safe and effective treatments can boost your chances of getting pregnant.

About 9% of men and about 11% of women of reproductive age in the United States have had fertility problems. In one-third of infertile couples, the problem is with the man. In one-third of infertile couples, the problem cannot be found, or is with both the man and woman.

Fertility decreases with age in both men and women, but the effects of age are much greater in women. In their 30s, women are about half as fertile as they are in their early 20s, and a woman's chance of getting pregnant goes down significantly after age 35. Male fertility also goes down with age, but at a much slower rate.

Female infertility can be caused by factors such as:

• Problems with ovulation
• Damaged or blocked fallopian tubes
• Older age
• Other gynecologic conditions, such as endometriosis, prior infections or prior surgeries
• Having no periods, or irregular or very painful periods
• Having more than one miscarriage
• Having had cancer treatment such as chemotherapy or radiation

Male Infertility can be caused by factors such as: 

• Hormone abnormalities
• Ejaculation problems
• Sexually Transmitted Infections (STIs)
• A low number of sperm or other problems with sperm
• A history of testicular, prostate or sexual conditions
• Treatment for cancer such as chemotherapy or radiation
• Hernia surgery
• Testicles that are smaller than the typical adult size, or swollen veins in the bag of skin that holds the testicles, called the scrotum
• Family members with infertility problems

Men may also be at a higher risk of fertility issues if they have a history of smoking, excessive drug or alcohol use, injury to the reproductive organs or exposure to environmental toxins such as lead and pesticides. 

Dr. Akanksha Mehta, a urologist at Emory University School of Medicine, specializes in male reproductive and sexual medicine.

Can I still have kids after having a vasectomy? 

Yes, you have options if you've had a vasectomy but now want a child. There are many procedures available, such as vasectomy reversal or sperm aspiration that can give you the chance to add to your family. Vasectomy is a minor surgery to block sperm from reaching the semen that is ejaculated from the penis. Semen is still made by ejaculation, but after vasectomy it has no sperm in it. The testes still make sperm after vasectomy, but they are disposed of by the body.

There are two surgical procedures to reverse a vasectomy. Surgeons can reconnect the severed ends of the vas that were cut during vasectomy in a surgery called a vasovasostomy. In more rare cases, surgeons instead attach the cut end of the vas directly to the epididymis in a procedure called a vasoepididymostomy. The epididymis is a long tube that transfers sperm from the testes to the vas deferens. This procedure is more advanced, harder to perform and has a lower success rate. Doctors turn to vasoepididymostomy if vasovasostomy is unlikely to work.

If you don't want to have vasectomy reversal, sperm can be taken from the testicle (testicular sperm extraction, or TESE) or epididymis (microepididymal sperm aspiration, or MESA) and used for in vitro fertilization (IVF). With IVF, a clinic extracts an egg and sperm to create a fertilized embryo outside the body. A doctor then implants the new embryo in the woman’s womb. This method can be used to conceive while keeping the vasectomy in place. Sperm extracted using this method may be both immature and low in sperm count.

These procedures are costly and may not be covered by your health plan. They don't always work. If you think you may want to have children one day, you should look into non-permanent forms of birth control and talk with your health care team before deciding to have a vasectomy. 

Dr. Martin Gross, a urologist and Associate Professor of Surgery (Urology) at Dartmouth Hitchcock Medical Center, specializes in men’s sexual health.

How does fertility change with age? 

A growing number of adults are waiting to have children later in life, until their late 30s or even 40s in some cases. But, as adults age, they may become less fertile. 

Women’s Age and Fertility 

A woman is most fertile when she is between her late teens and late 20s. A woman’s fertility begins to decline around age 30. This drop in fertility continues as women age. A healthy fertile woman trying to get pregnant in her 20s and early 30s has around a 25% chance of success each month. By age 40, that declines to about 10%. For most women, getting pregnant is much less likely by age 45. 

A woman is born with a fixed number of eggs in her ovaries – about one to two million. The number of eggs decreases as women get older. By the time a female starts menstruation, only about 400,000 of those eggs remain. As a woman continues to age, she is may also be more likely to have health conditions that can affect fertility such as endometriosis and uterine fibroids. 

Men’s Age and Fertility 

Unlike women, men continue to make sperm throughout their lives. While a man’s fertility also goes down with age, the drop cannot be detected as easily. Research suggests the count and quality of sperm goes down with a man’s age. Research also suggests that the DNA quality of sperm goes down as men age and there may be a rise in potential health risk to future children. While there is no specific cut-off, a man’s fertility may begin to go down around age 40 or 45. 

Sperm can also be affected by other health factors. These include exposure to extreme heat or unhealthy habits such as drinking more than three alcoholic beverages a day and using tobacco, marijuana or cocaine. Many medications may also impact a man’s sperm quality. 

It is always best to speak with your health care team early on about your fertility, especially if you are thinking about having a child later in life. 

Dr. Nahid Punjani MD, MPH is a urologist at Mayo Clinic Arizona who specializes in men’s health, male sexual dysfunction and male infertility.