June 1, 2020

Is getting pregnant taking longer than expected? A Vanderbilt expert answers some common questions.


Trying to get pregnant is fun, right? Not for everyone. For couples who struggle with conceiving, the process can be frustrating and heartbreaking. Expert Donna Session, M.D., director of Vanderbilt University Medical Center’s Division of Reproductive Endocrinology and Infertility, answers some common questions about fertility.


First things first: When should I start to worry about infertility?

Infertility is defined as the inability to conceive after one year of regular intercourse without contraception in women under 35 and 6 months in women over 35. If there is a known reason for infertility, such as irregular periods, one should seek care right away. Approximately 10 to 20 percent of couples are infertile in the United States and the number of women using infertility services is rising.


Are there any lifestyle changes we should make or watch out for?

Smoking is associated with poorer sperm quality, loss of eggs and earlier menopause, lower pregnancy rates and increased chance of miscarriage. (Read about strategies to quit smoking here.) Heavy alcohol consumption and the use of recreational drugs can lower the chance of pregnancy. Heavy metals found in fish may lower the chance of pregnancy.

Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, can cause the egg to be trapped in the ovary. Women should try to use acetaminophen around the time of ovulation instead of nonsteroidal anti-inflammatory medications.

Antioxidants such as vitamins E and C may increase sperm count and movement. Testosterone will significantly lower the sperm count. However, the effect is reversible. High temperatures may affect sperm count and shape. The effect of boxer underwear is inconclusive; however, it is best for men to avoid high temperatures (such as hot tubs, saunas and computers on your lap).


Can caffeine hurt my chances of getting pregnant?

With such widespread consumption of caffeine, the potential health impact of caffeine use cannot be underestimated. Multiple studies have suggested that caffeine consumption increases the risk of miscarriage.

Women consuming greater than 200 mg of caffeine per day may have twice the miscarriage rate. Women who drink more than one cup of coffee a day are half as likely to become pregnant per month as compared to women who consume less. Patients undergoing in vitro fertilization who consumed even modest amounts of caffeine were likely to have decreased live birth rates.

In men, caffeine has been shown to improve sperm movement, which could increase the chance of pregnancy.


What are the chances my husband is the source of infertility?

There is about a 35 percent chance that a male partner will have a problem that contributes to infertility. The semen analysis assesses the physical characteristic of the sperm, such as count, shape and movement. Long durations between ejaculations are associated with poor sperm quality. The highest quality of sperm is at intervals of 1-2 days.

Since the cycle of sperm production lasts approximately 70 to 80 days, an acute illness or exposure to toxic substances during this time may have adverse consequences on an isolated semen analysis. Abnormalities of the semen analysis should be confirmed by repeat testing on two or more occasions.

Treatment options may include insemination for mild and assistive reproductive technology for severe male factor infertility.


What are some options if we’re having problems conceiving?

In addition to advances in micro manipulation —  including intracytoplasmic sperm injection (which allows people to conceive with very low sperm counts or abnormally shaped sperm) and preimplantation genetic diagnosis (which allows testing for genetic disorders) — recent developments in assistive reproductive technology have included freezing eggs in patients to preserve fertility.

Oocyte (egg) freezing has recently been recommended as standard of care before chemotherapy or radiation therapy. Both can cause menopause. Since 1995, assistive reproductive technology success rates have been collected by the Centers for Disease Control and Prevention, which provides a public national summary of assistive reproductive technology centers.

Many people considering assistive reproductive technology will use this report to find the “best clinic.” However, comparing clinic success rates with each other may be misleading because (1) success rates are reported in various ways, are not simple to interpret and may not reflect the most recent years; (2) no reported success rate is absolute, due to statistical margins of error; and (3) some clinics may see more patients with complex medical issues and difficulties.

Vanderbilt Women’s Health provides care for women at all stages of their lives at locations across Middle Tennessee. Learn more here or call 615-343-5700.

Donna R. Session, M.D., is the director of the Vanderbilt Reproductive Endocrinology and Infertility program, which offers a broad range of expertise for treating infertility and complex problems related to reproduction. Dr. Session sees patients at the Vanderbilt Fertility Clinic in Franklin.