For one in eight couples looking to grow a family, trying to conceive will be hindered by unexpected fertility issues.
While most will not experience challenges, being able to pinpoint potential fertility issues early on can save time and lessen frustration and uncertainty.
As you embark on your family planning journey, determine if any of the following symptoms apply to you or your partner.
Some of these issues may have been present for years - a proper diagnosis and evaluation can bring much-needed relief and guide next steps for boosting fertility potential.
Prolonged Menstrual Bleeding
Symptom: Bleeding that lasts longer than a week, needing one or more tampons or sanitary pads every hour for several consecutive hours, passing blood clots larger than a quarter, needing to change sanitary protection during the night, restricting regular activities due to period flow, bleeding between periods.
Cause: Prolonged period bleeding can point towards a number of conditions or may be unknown. Example causes include hormone imbalance as a result of polycystic ovary syndrome, thyroid issues, insulin resistance, obesity, ovarian dysfunction, the growth of benign tumors in the uterus known as fibroids, benign growths on the lining of the uterus known as polyps, pregnancy loss, thickening of the uterus due to adenomyosis, inherited bleeding disorders, prescription medication or other medical conditions.
Significant Menstrual Cramping
Symptom: Cramping during a period is caused by uterine contractions that happen just before or during the onset of a menstrual cycle. They can feel like a throbbing pain, cramping pain or a dull ache in the lower abdomen. They normally last for two to three days, with pain being the most severe on the first day.
Severe menstrual cramping doesn’t improve with over-the-counter pain medication and impacts daily activities. Women with severe cramping may also experience heavy bleeding and pain.
Cause: Severe cramping can be a symptom of conditions such as endometriosis, PCOS, fibroids, pelvic inflammatory disease, a closed cervix or adenomyosis.
Severely Painful Periods
Symptom: Most women experience some level of pain for a day or two every month during menstruation. For others, the pain becomes so severe it impacts activities, sometimes for several days a month.
Severe pain, known as dysmenorrhea, may be accompanied by other symptoms such as diarrhea, nausea, vomiting, headache and dizziness. Primary dysmenorrhea comes before or during a period and lessens as the period progresses. Secondary dysmenorrhea is a disorder in the reproductive organs that causes pain to get worse over time and last longer than normal menstrual cramps, and may continue after a period ends.
Cause: Painful periods can be a symptom of conditions including endometriosis, fibroids, issues present in the female reproductive organs and other conditions such as urinary disorders.
Irregular Menstrual Cycles
Symptom: Menstrual periods usually last four to seven days in cycles that range 21-35 days. When periods occur less than 21 days or more than 35 days apart, they are considered irregular.
Additional symptoms include missing three or more periods in a row, experiencing a lighter or heavier menstrual flow than is normal, periods that last longer than seven days, bleeding or spotting between periods and cycles that include pain, cramping, nausea or vomiting.
Cause: Irregular cycle causes can include polyps or fibroids on the uterus, endometriosis, pelvic inflammatory disease, PCOS, ovarian dysfunction, prescription medication or other medical conditions such as thyroid issues or hormonal imbalance.
Two (or More) Pregnancy Losses
Symptom: While one in four women will experience a pregnancy loss, approximately 2% of women will experience two consecutive losses with 0.5% of women experiencing a third consecutive loss. After two or more losses, a medical examination is recommended to determine a cause.
Cause: Most pregnancy losses are random and the result of abnormalities that may come from the egg, sperm, or developing embryo. It is important for women to understand that a pregnancy loss is not their fault.
The cause of a pregnancy loss can be complex to determine given the multiple factors involved. Causes may include advancing maternal age, an abnormality in the uterus, immune system or thyroid issues, blood clotting abnormalities and diabetes. Stress or occupational or environmental factors do not seem to cause pregnancy loss.
Prior Pelvic Surgery
Symptom: The female reproductive area is delicate and a history of prior surgery must be considered. An ultrasound of the pelvic area can assess reproductive potential and the impact of prior surgery.
Cause: There are many reasons to undergo pelvic surgery for health or fertility reasons. Examples include removing pelvic adhesions, scarring from endometriosis, polyps in the uterus, fibroids in the pelvic area or removing a blockage in the fallopian tubes.
Symptom: If a man has trouble achieving or maintaining an erection, fertilization of an egg by sperm will not be possible through sexual intercourse without medical intervention. While this may happen from time to time, if it becomes an ongoing issue and is accompanied by a low sex drive, it can be a cause for concern.
Cause: The causes of erectile dysfunction can be psychological and a result of stress, depression, anxiety or relationship issues. Causes can also be physical and may point to a larger health issue such as heart disease, high blood pressure, high cholesterol, diabetes, obesity or low testosterone. Tobacco, alcohol or substance abuse can contribute to erectile dysfunction. Injuries or surgeries impacting the pelvic area or spinal cord can also be a cause.
Dr. Jane Nani is board certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility (REI), and has been practicing medicine since 1996.