What Men and Women 35 and Older Must Know About Fertility, Infertility, and Getting Pregnant

男人和女人n over age 35 experience a decline in fertility. But age-related fertility declines are more pronounced in women.

Fertility，或受孕和生孩子的能力，随着年龄的增长而变化。根据国家不育症协会的说法，大约有八对夫妇在怀孕和留下怀孕时遇到了麻烦。（（1)

The Role of Age in Pregnancy, and Fertility Basics

Normal, age-related declines in fertility are most pronounced in women over age 35.

Before pregnancy can occur, fertilization must take place. Fertilization is when a man’s sperm joins up with a woman’s egg. A number of steps need to take place before a man ejaculates into a woman’svaginaduring sex for fertilization to happen. (2)

Semen is the substance that comes out of the penis during ejaculation. It contains millions of tiny sperm cells combined with other fluids.

Most sperm won’t make it all the way from the vagina through the cervix and uterus and into the fallopian tubes, where fertilization takes place. In fact, only a single sperm will fertilize an egg.

When Sperm Reaches the Fallopian Tubes Around the Time a Woman Ovulates, Fertilization May Occur

There are two fallopian tubes. Each connects one of a woman’s two ovaries to her uterus. Once a month, one egg will leave one of a woman’s ovaries and travel into the connecting fallopian tube. This is called ovulation.

If sperm are present in the fallopian tube when ovulation occurs, fertilization can happen. Fertilization can take place anywhere from a few hours to a few days after sex. (2)

Age and Aging Are Important Fertility Factors

Pregnancy happens when a man’s sperm fertilizes a woman’s egg and the fertilized egg attaches itself successfully to the wall of the women’s uterus, where it will continue to grow for the next nine months.

Unlike men, who will continue to make more sperm throughout their lifetime, women are born with all the eggs they will ever have. As women enter their late thirties, there’s a steep drop off in the quantity — and quality — of remaining eggs. The risks of miscarriages and chromosomal abnormalities in the child (for instance,Down syndrome) also increase with advancing maternal age, according to a paper published in March 2014 in the journalFertility and Sterility。（（3)

That’s why the American College of Obstetricians and Gynecologists (ACOG) recommends an infertility evaluation for couples in which the woman is over 35 and who have not become pregnant after six months of trying. (4)

Related:The Truth About Miscarriage, Pregnancy Loss, and Fertility

Women typically reachmenopause— when the menstrual cycle stops permanently — around age 50. It’s a common misconception that women remain fertile until that time, says the American Society for Reproductive Medicine (ASRM). (5,6) Most women will lose the ability to have a successful pregnancy by their mid-forties. (5)

In fact, the ASRM estimates that by age 40, a woman has about a 5 percent chance of becoming pregnant each month she tries. (5,6,7）约有35岁以上的女性大约一半（54％）在尝试一年后自然怀孕。（3）

Age causes a decrease in male fertility, too. The decline is less pronounced and appears to happen later in life. But some men may begin to experience age-related changes in their sperm as early as their mid-to-late forties. (5,8) These changes can cause fertility problems and issues with chromosomal or developmental abnormalities in the child, according to the ASRM. (6)

Common Factors That Can Limit Fertility

男人和女人n can have fertility problems. While you can’t change your age, there are other steps couples can take to optimize fertility, even in their late thirties. Some causes of infertility can be reversed.

• Being Overweight or ObeseOverweight and obesity are clearly linked to fertility problems in both men and women. (Women who are underweight may be at risk of infertility, too.) Reaching and maintaining a healthy weight through exercise and healthy eating can help to reverse many fertility problems associated with weight. (6,7,8)
• SmokingMen that smoke are more likely to have sperm that are shaped abnormally or don’t swim properly. Women that smoke reach menopause earlier than women who don’t smoke. (5,8)
• Heavy Alcohol Consumption or Recreational Drug UseThese behaviors can lead to fertility problems in both men and women. (7,8)
• Certain MedicationUse of certain drugs, including some antibiotics,high blood pressure medicines, and anabolic steroids, has been linked to infertility in men. (8)
• Too Much Heat on the GenitalsSome studies suggest that activities exposing a man’s genitals to excessive heat, including wearing briefs or other snug underwear, using hot tubs, or using a laptop on the lap, can raise scrotal temperature and harm sperm production. But evidence from these studies is inconclusive. (8)

Medical Factors That Can Limit Fertility

Some causes of infertility in women and men are medical. Luckily, many of these problems can be fixed with medicine or surgery.

Medical conditions that can decrease a woman’s fertility: (9)

• 排卵的问题About a quarter of female infertility can be traced to absent orirregular periods。
• Fallopian Tube BlockageAn obstruction of one or both fallopian tubes can make it harder for a fertilized egg to get to the uterus.
• 子宫的身体问题Uterine fibroids are noncancerous tumors that can develop on the walls of the uterus. They can cause infertility or problems with pregnancy. Women over age 40 and African-American women are at highest risk of developing uterine fibroids.
• EndometriosisThe growth of uterine tissue outside the uterus, endometriosiscan cause menstrual irregularities or blockages in the fallopian tubes or ovaries that can impact fertility.
• 多囊卵巢综合征(PCOS)PCOSor other hormonal conditions can cause ovulation problems.

Medical conditions that can decrease fertility in men: (10)

• Testicular ProblemsHaving an undescended testicle, a gonadal disorder, or an injury to a testicle can cause problems fortesticular functionand sperm production.
• 激素失衡激素疾病，包括性腺功能不全（这种疾病会导致身体不足够testosterone) orthyroidproblems, can lead to fertility problems.
• Sperm ProblemsSome men have problems producing enough sperm or may produce sperm that are abnormally shaped or that aren’t “good.” These sperm may have a hard time reaching and fertilizing the egg.
• Blockages堵塞的管道进行精子的testiclescan result in fertility problems.
• Problems Ejaculating
• 精索静脉曲张This enlargement of veins in the scrotum may harm sperm production and is present in about 40 percent of men with fertility problems, noted the ASRM in a paper published in December 2014 in the journalFertility and Sterility。（（11)

How to Optimize Fertility Naturally

怀孕需要时间。即使对于二十多岁和三十多岁的完全肥沃的夫妇，怀孕也可能需要几个月的时间。在三十多岁的时候，您可能会觉得自己不再有奢侈的时间。幸运的是，您可以采取一些步骤来优化自然的生育能力并尽快构想。

Understand Fertility and How Fertility Awareness Methods Work so You Can Strategize

• Track ovulation.
• Time sexual intercourse around ovulation.

The best way toget pregnantis to have sex every one to two days during the fertile window, says the ASRM. (5,7)

What Is the So-Called Fertile Window?

拿来的tile window is the five or six days of a woman’s cycle just before ovulation when sex is most likely to result in fertilized egg. (5,7)

Typically, a woman ovulates a single egg each month. During ovulation the egg passes from the ovary into the fallopian tube. If sperm are present in the fallopian tube, fertilization may happen. A man’s sperm can survive in a woman’s body up to five days. (12)

Ovulation happens a couple of weeks before a woman gets her period. A woman with a 28-day cycle, for instance, might expect to ovulate on or near day 14 of her cycle, placing the fertile window between (and including) days 9 through 14. (7)

Not all women have a 28-day cycle. Normal menstrual cycle length varies between women, and some women have a menstrual cycle length that changes from month to month.

To Leverage the Fertile Window, Learn Why 'Well-Timed Sexual Intercourse' Is Key

Fertility awareness-based methods can help couples better understand a woman’s monthly cycle and when she’s ovulating so that they can make the most of the fertile window.

Fertility awareness-based methods用于跟踪排卵包括以下内容：（12）

• Keep a menstrual calendar.
• Take your basal body temperature each morning. A woman’s body temperature may fluctuate around 0.5 degrees F around the time of ovulation, so tracking when that change occurs can help to observe your body’s monthly pattern.
• Check the cervicalmucus。As a woman get close to ovulation, her cervical mucus goes from being thick and cloudy to thinner, clearer, and more slippery.
• 使用排卵预测套件。这些撒尿的套件检测到luteinizing hormone (LH), a hormone that peaks just before ovulation.

选择对生育友好的阴道润滑或润滑

一些阴道润滑剂已被证明可以使精子移动较慢或降低其在阴道内生存的能力。根据2017年1月发表的一篇文章，其中包括商业，水基润滑剂，唾液和橄榄油Fertility and Sterility。（（13)

You may want to opt instead for a personal lubricant that’s fertility-friendly. The ASRM and Society for Reproductive Endocrinology recommend the following lubricants as safe for sperm: (13)

• Cellulose-based lubricants, includingPre-SeedandConceivEase
• Mineral oil
• Canola oil

Be Open to a Fertility Evaluation and Treatment of Infertility

Couples struggling with age-related fertility declines or other causes of infertility may opt to get evaluated by a reproductive endocrinologist, also known as an infertility specialist.

生殖内分泌学家可以进行测试以确定不孕症的原因，并推荐未来的治疗方法。

A reproductive endocrinologist may also assess ovarian reserve, or the number and quality of remaining eggs. But some studies, including research published in October 2017 in the美国医学协会杂志, have suggested that measures of ovarian reserve may not be good predictors of how likely a woman is to conceive — either naturally or with treatment. (14)