Atlanta Best Self Magazine recently turned to SGF Atlanta’s Dr. Natalie Stentz to answer common questions surrounding the topic of infertility, revealing what she wants both men and women to know when struggling to conceive. Read the full Q&A below for more information on causes of infertility, how to improve your fertility, treatment options, and finding emotional support throughout the process.
Causes of Infertility
Q: What are the key facts people should know regarding the causes of infertility?
Dr. Stentz: Approximately 40% of infertility is caused by male factors, 40% is caused by female factors, and the remaining 20% is a combination of male and female factors or unexplained infertility.
Q: What are some of the common myths regarding the causes of infertility?
Dr. Stentz: Contrary to a popular myth, birth control has no negative impact on fertility. However, it is easy to understand why there are myths about birth control pills causing infertility as some women experience a delay in resuming ovulation and menses following prolonged birth control use. For some women it may take months after stopping birth control for their menses to return.
Another popular myth is the boxers vs. briefs debate. The real concern regarding sperm is if the temperature is too high within the testicles, it can affect sperm production and motility, or movement. Patients have expressed the concern that if a man wears briefs instead of boxers, their scrotal temperature will increase, which can impact their fertility. This is an old wives’ tale. It has not been shown that either boxers or briefs make any particular difference.
Q: What are the most common medical causes of infertility?
Dr. Stentz:
- Ovulatory dysfunction (PCOS, hypothalamic amenorrhea)
- Endometriosis
- Blocked Fallopian tubes
- Increased age (fertility rates sharply decline after the age of 35)
- Structural problems with the female reproductive tract (fibroids, polyps, scarring)
- Male factor (low sperm number, low sperm motility, abnormal sperm shapes)
How to Improve Your Fertility
Q: What are some of the common myths about improving your fertility?
Dr. Stentz: There are many things that we can do to improve our overall health including exercise, diet, taking multivitamins, and meditating. Unfortunately, none of these healthy habits stop the clock on ovarian aging, which is a primary contributor to infertility and accelerates after the age of 35.
Q: What are the key facts you want men and women to know about improving their fertility?
Dr. Stentz: Maintain a normal body mass index (18.5-24.9). This is important for both male and female partners. Fertility treatment is not as successful in underweight or overweight individuals.
Do not smoke. The rate of infertility is approximately twice as high in male and female tobacco smokers. Marijuana also impacts both sperm and egg quality.
Use a condom and get regular screening for sexually treated infections (STI). Especially before you are in a monogamous relationship in which you intend to conceive, protect yourself against STIs, which can contribute to both blocked Fallopian tubes and male factor infertility.
Come for fertility evaluation early. Schedule an appointment with a reproductive endocrinologist if you have been having unprotected intercourse for 1 year without becoming pregnant if you are under the age of 35, or after 6 months if you are over 35, or after 3 months or immediately if you are 40 or older. You should also consult a reproductive endocrinologist if you would like to learn more about fertility preservation, particularly for women in their early- to mid-30s.
Treating Infertility
Q: What are today’s most common treatments for infertility?
Dr. Stentz: There are three primary treatments for infertility. First is cycle awareness in which a woman closely follows her ovulation and works to time ovulation with intercourse. Second is ovulation induction with or without insemination in which we typically give oral medications to stimulate egg development and time ovulation with an in-office insemination of concentrated sperm. Finally, in vitro fertilization, or IVF, in which injectable medications are given to stimulate egg development and eggs are collected and fertilized outside the body (in vitro) before replacing the embryo in the uterus.
Q: What do you want people to know about IVF?
Dr. Stentz: IVF is a process that takes approximately 2 weeks. After a short course of birth control pills, we start daily injectable fertility medications with a very small needle (like insulin). During this time period, you come for approximately 6-9 ultrasound appointments before your eggs are ready to be collected in an outpatient procedure during which you are fully asleep. The eggs are then frozen or inseminated to create embryos that may then either be replaced into the uterus or frozen for later use.
Q: What do you want people to know about surgery as a treatment option?
Dr. Stentz: Historically the field of reproductive endocrinology and infertility relied largely upon surgical treatment. Now, with the advent of IVF, most infertility treatment includes medications and small procedures reserving surgery for those women with extensive endometriosis or uterine fibroids.
Q: What do you want people to know about hormone treatments?
Dr. Stentz: Oral fertility medications work by helping your body increase its own production of the hormones that tell your ovaries to develop eggs. Injectable fertility medications contain the same hormones that your body makes to develop eggs but delivered in concentrated doses. It is important to know that studies have shown that fertility medications do not increase a woman’s risk of cancer.
Q: What steps are LGBTQIA+ individuals and couples taking to build their families?
Dr. Stentz: We often work with the LGBTQIA+ community to help individuals and couples create the families they desire. For lesbian couples, we help coordinate donor sperm insemination and also do cCo-IVF in which embryos are created from the eggs from one female partner and are transferred into the other female partner to carry the pregnancy.
We work with male couples to coordinate IVF with their sperm and a donor egg, then transfer the embryo into a gestational carrier.
Finally, we work with the transgender community to assist with fertility preservation of eggs or sperm prior to gender transitioning and help with assisted reproduction after gender transitioning.
Finding Emotional Support throughout Infertility
Q: What are the most common tough topics surrounding infertility? Is blaming one partner for being the cause prevalent? If so, how can they overcome this?
Dr. Stentz: Many people with infertility struggle with self-blame, feelings of hopelessness, depression, anxiety, and sexual difficulties. Please know that in addition to seeking fertility care there are several reproductive mental health specialists who can provide great help to those in need. You can learn more about SGF’s patient support program here.
Q: How can couples navigate the pressure and questions from loved ones as they struggle to conceive?
Dr. Stentz: You are not alone—more than one in eight couples have struggled with infertility. It is likely that many of your family or friends have dealt with similar issues, but due to social pressures they have not disclosed their struggles. Rely upon your inner circle of friends and family and remember that you do not owe anyone an explanation.
Q: What is the number one piece of information you want couples dealing with infertility to remember?
Dr. Stentz: While the path to parenthood may not always be straightforward, there is always hope. Some couples conceive on their own, some with fertility treatment, others with donor eggs or embryos, and others adopt to create their family. As fertility specialists, we are here to help every step of the way. Read our inspiring patient success stories here.
Q: What is the number one takeaway you want people to know about fertility and infertility?
Dr. Stentz: It is never too early to be evaluated by a fertility specialist, even if you are single! The hardest thing to overcome with fertility treatment is age. Family planning is not just about contraception, it is about having a plan in place in advance to create the family you want in the future.
Dr. Natalie Stentz sees patients in SGF’s Marietta, Buckhead – Piedmont, and Atlanta – Northside offices. To learn more or to schedule an appointment with Dr. Stentz or any other SGF physician, please call our New Patient Center at 1-877-971-7755 or complete our online form.
