There are many reasons you might wait to have kids. You may want to focus on your career. Or save some money first. About 20% of women in the U.S. now have their first child after age 35.

You may have heard that getting pregnant can be more difficult as you age. Or that it’s riskier for both the mom’s and the baby’s health. While these can be issues when having children later in life, many concerns are manageable.

Getting Pregnant

It can be more difficult to get pregnant with age. There are many reasons for that. One is that fertility decreases as you get older—for both men and women.

Women are born with a set number of eggs. Each month, a woman’s ovary releases an egg to be fertilized. This process is called ovulation. But before that, her body recruits many eggs in preparation for this process. A handful of eggs are developed and matured, but usually only one makes it to ovulation.

“As women age, they’re still fertile, but their odds of pregnancy are decreased because they’re not making as many good eggs that will fertilize and divide normally and turn out to be an embryo,” explains Dr. Alan Decherney, an NIH fertility expert.

After age 30, a woman’s fertility decreases every year. The number and quality of her eggs goes down until she reaches menopause. Menopause usually happens around age 45 to 55. During that time, women stop having their periods and are no longer fertile.

Older men may make fewer sperm or lower-quality sperm. The age-related decline in egg and sperm quality is associated with a higher chance of the child developing certain health conditions. This includes autism spectrum disorder, Down syndrome, and schizophrenia.

But most healthy women who give birth in their 30s and 40s have healthy babies.

Pregnancy Problems

If you’re over 35 and haven’t gotten pregnant after trying for six months, talk with your health care provider. You may be experiencing issues with infertility. Infertility is when a couple can’t get pregnant or a woman hasn’t been able to carry a pregnancy to term.

NIH-funded researchers are studying the causes of infertility for both men and women. There are many reasons for infertility.

“The most common cause of infertility in women is related to ovulation abnormalities,” says Dr. Esther Eisenberg, who oversees reproductive medicine and infertility research at NIH.

Many factors influence your ovulation cycle. Being older is one of them. You may not ovulate regularly, or sometimes not at all.

Another cause of infertility is endometriosis. This is a disease in which tissue normally found in the uterus (womb) grows outside it. Endometriosis can cause painful periods, urination, or bowel movements. It accounts for at least a third of infertility in women. It’s more common for women in their 30s and 40s.

Fibroids are also more likely as you age. These are abnormal growths made from the uterus’s muscle cells. They can grow inside or outside of the wall of the uterus. These growths can prevent a woman from getting pregnant. Most women get at least one fibroid in their lifetime. But they’re most common between the ages of 40 to 50.

Other causes of infertility can be treatments for certain health conditions. “Women who have been treated for cancer might have a reduced number of eggs,” Eisenberg says. “If you’ve had other conditions that require surgery to remove an ovary or fibroids—in which you’ve had surgery on the uterus—that might impact your fertility as well.”

Seeking Help

“If being able to have a child becomes an issue, there are treatments,” Eisenberg says. “The majority of women are able to have a child with help.”

Treatments for infertility depend on the cause. Endometriosis and fibroids can be treated with drugs, surgery, and other methods. Medicines can help stimulate ovulation. These are called fertility drugs. Some are taken orally and others are injected.

Other options may be assisted reproductive technologies. Examples include in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). These procedures help you get pregnant using different methods of fertilizing an egg.

Decherney’s group studies egg preservation, which involves freezing eggs. It may help some women facing health conditions that can reduce fertility. “But it’s expensive,” he notes.

Staying Healthy

Infertility isn’t the only issue older couples face. “Whether a woman can have a baby as she ages also depends on her health,” Decherney says. “The chances of having diabetes or high blood pressure—which are the two major diseases that impact pregnancy—are higher.”

Obesity, heart conditions, and cancer can also interfere with a woman’s ability to get pregnant or stay pregnant. They can lower men’s fertility, too.

Talk with your health care provider before becoming pregnant. They can help you plan for a safer pregnancy.

Being older when you’re pregnant also makes you more likely to experience health problems from being pregnant or giving birth. These include heart disease, infection, bleeding, high blood pressure, and blood clots.

High blood pressure puts pregnant women at higher risk for preeclampsia. Preeclampsia is a serious medical condition that can cause you to go into labor early. It can also lead to death.

No matter your age, you have a better chance of getting and staying pregnant by living a healthy lifestyle.

For a Healthy Pregnancy

No matter your age, certain things can help you have a healthier pregnancy:

• Talk with your health care provider about your nutrition, medications, and any health conditions. Get prenatal check-ups regularly.

• Take folic acid supplements. Get at least 400 micrograms of folic acid daily.

• Do not use alcohol, tobacco, or drugs such as marijuana.

• Avoid exposure to toxic substances, like lead, radiation, or chemicals called solvents that are used in many workplaces.

• Follow a healthy diet and maintain a healthy weight.

• Avoid certain foods that could be dangerous during pregnancy, such as raw fish, undercooked meat, deli meats, and unpasteurized cheeses.

• Get enough physical activity. Talk with your doctor about what’s safe for your pregnancy.

• Limit caffeine intake.

• Get regular dental checkups.

• Take steps to prevent infections that can affect your pregnancy.

Preconception Health

Preconception health refers to the health of people during their reproductive years, or the years they can have a child. It focuses on taking steps now to protect the health of a baby they might have some time in the future.

All people can benefit from the principles of preconception health, whether or not they plan to have a baby one day. Preconception health is about people getting and staying healthy overall, across their lifespan. In addition, no one expects an unplanned pregnancy. But it happens often. About half of all pregnancies in the United States are not planned.

Preconception Health Care

Preconception health care is the medical care a person receives from their doctor or other health professionals that focuses on the parts of health that have been shown to increase the chance of having a healthy baby.

Preconception health care is different for every person, depending on their unique needs. Based on a person’s health, the doctor or other health care professional will suggest a course of treatment or follow-up care as needed. Ask your healthcare provider about preconception health care, especially if you plan to become pregnant.

Did you know?

There have been important advances in medicine and prenatal care in recent years. Despite these advances, birth outcomes are worse in the United States than in many other developed countries. Many babies are born early or have low birthweight. Among some groups of people, the problems actually are getting worse. Preconception health and preconception health care can make a difference.

Preconception Health for Women

Preconception health is important for every woman―not just those planning a pregnancy. It means taking control and choosing healthy habits. It means living well, being healthy, and feeling good about your life. Preconception health is about planning for the future and taking steps to get there!

Preconception Health for Men

Preconception health is important for men, too. It means choosing to get and stay as healthy as possible―and helping others to do the same as well. As a partner, it means encouraging and supporting your partner’s health. As a father, it means protecting your children. Preconception health is about providing yourself and your loved ones with a bright and healthy future. Taking care of your health now will help to ensure a better quality of life for yourself and your family in the coming years.

As you age, you have an increasing chance of having a baby born with a birth defect. Yet most women in their late 30s and early 40s have healthy babies. See your doctor regularly before you even start trying to get pregnant. She will be able to help you prepare your body for pregnancy. She will also be able to tell you about how age can affect pregnancy.

During your pregnancy, seeing your doctor regularly is very important. Because of your age, your doctor will probably suggest some extra tests to check on your baby's health.

More and more women are waiting until they are in their 30s and 40s to have children. While many women of this age have no problems getting pregnant, fertility does decline with age. Women over 40 who don't get pregnant after six months of trying should see their doctors for a fertility evaluation.

Experts define infertility as the inability to become pregnant after trying for one year. If a woman keeps having miscarriages, it's also called infertility. If you think you or your partner may be infertile, talk to your doctor. Doctors are able to help many infertile couples go on to have healthy babies.

Infertility: Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 years of age or older. Women who can get pregnant but are unable to stay pregnant may also be infertile.

Assisted Reproductive Technology (ART): Learn about infertility rates and success rates for ART, and find links to more information.

Bleeding Disorders: Bleeding and clotting disorders can cause serious problems for women because of the relationship of these disorders to reproductive issues. These problems include heavy menstrual bleeding (termed menorrhagia), bleeding and clotting complications of pregnancy, and recurrent fetal loss.

Genetics: Couples who are having trouble getting pregnant might want to get genetic counseling.

Sexually Transmitted Diseases (STDs): Chlamydia and gonorrhea are the most important preventable causes of infertility. Untreated, up to 40% of women with these infections will develop pelvic inflammatory disease (PID). PID can lead to infertility and potentially fatal tubal (ectopic) pregnancy.

For those who dream of being parents, pregnancy problems can be tremendously frustrating and disappointing. In recent decades, scientists have developed a wide range of approaches to help struggling couples have healthy babies. And NIH-funded studies are continuing to search for even better ways to overcome the challenges of infertility.

Infertility is a fairly common condition. It affects about 1 in 10 couples who are trying to have a baby. Infertility can be traced to the man in about a third of these cases and to the woman in another third. The rest of the time, the difficulties lie with both partners or no cause can be found.

“Although there are many known causes of infertility, there are still some cases of fertility impairments that we don’t understand,” says NIH’s Dr. Louis V. DePaolo, an expert in fertility research. “We’re constantly discovering new molecules that are vital to the fertility-regulating process.” By learning more about these molecules and other factors, scientists hope to find new and improved ways to prevent or treat infertility.

Knowing the underlying causes of infertility is important because it can help couples choose the best therapy. “Since there are many causes, a treatment that works for one person might not be the best choice for another,” DePaolo says. The most common treatments today are surgery or medication.

Fertility troubles can arise in any of the steps needed for a successful pregnancy. To get pregnant, a woman’s body must first release an egg from one of her ovaries, a process called ovulation. The man’s sperm then has to join with, or “fertilize,” the egg. The egg must then travel through a passageway known as the fallopian tube and head toward the woman’s uterus (womb). The fertilized egg must then attach to the inside of the uterus (implantation).

Infertility can be related to a man if there are problems with the number, shape, or movement of sperm. These glitches can make it hard for the sperm to fertilize the egg. About 1 in 5 infertile men have sperm troubles because of a hormone imbalance, which can sometimes be corrected with medication.

“Another common identifiable cause of male infertility occurs when a man has large veins around the testicle, which makes the whole scrotum warmer than it should be. The heat decreases the production and quality of sperm,” says Dr. Peter N. Schlegel, who specializes in treating male infertility at Cornell University. This condition, called varicoceles, is usually harmless, but it can be corrected with surgery if it’s causing infertility. Surgery can also help to remove blockages that prevent sperm release.

“There are also genetic causes of low sperm production, which are probably more common than we can identify, because we don’t yet understand all the causes of male infertility,” Schlegel says.

For women, the most common cause of infertility has to do with ovulation problems, which affect about 40% of women who have pregnancy trouble. “Ovulatory problems occur when a woman ovulates irregularly or not at all,” says Dr. Linda Giudice, a reproductive health expert at the University of California, San Francisco. “Causes can include stress-related lack of or irregular periods, polycystic ovary syndrome (PCOS), advanced maternal age, and a variety of other possible factors, like hormone issues that can interrupt normal ovulation.”

Other common causes of female infertility include blocked fallopian tubes or conditions that affect the health of the egg or its implantation after fertilization.

In the United States, older maternal age is a growing contributor to fertility problems. About 1 in 5 women nationwide now have their first child after age 35. Once a woman reaches this age, fertility complications arise in about 1 of every 3 couples trying to have a baby. Studies suggest that after age 30, a woman’s chances of getting pregnant decrease every year, especially after age 37.

“One of the biggest challenges in infertility treatment is related to advanced maternal age, when the egg quality and egg numbers decrease,” Giudice says. “For older women, treatment can usually help to achieve ovulation, but the problem usually lies in not having good-quality eggs.”

Aging not only reduces the likelihood of having a baby. It also raises the chances of miscarriage or having a child with certain health problems. High-risk pregnancies are also more likely as women get older.

In some cases, infertility can be corrected through lifestyle changes, such as losing weight or stopping tobacco use. If this doesn’t work, doctors may recommend medication, surgery, artificial insemination (in which a woman is injected with specially prepared sperm), or assisted reproductive technology, which is usually the most expensive and complex option. Assisted reproductive technology includes different methods for fertilizing eggs, usually outside of the body.

Giudice and her colleagues are among many NIH-supported scientists studying the pregnancy process. “We’re examining what happens during certain stages of egg development, what happens when women are of advanced maternal age or when they have a condition called endometriosis, which affects egg quality and the lining of the uterus and its receptiveness to implantation,” Giudice says.

Schlegel and his coworkers are among those focusing on the underlying causes of male infertility. “We’re looking at factors called micro-RNAs, which are small bits of genetic material that are made by the body to help regulate how a wide variety of body parts work, including the areas of the testicle involved in sperm production,” Schlegel says. “We’re also looking at other genetic causes of infertility and ways to improve or create sperm for men who can’t make them.”

For couples who have tried to have a baby without success, experts recommend seeking medical help after at least a year of trying if the woman is younger than 35, or after 6 months if the women is age 35 or older. It’s also a good idea for couples to talk with a health care provider before even trying to get pregnant.

“If you’re planning to start a family, your health before you begin trying is very important,” DePaolo says. “By being healthy, you have a better chance of being able to conceive within a normal amount of time, and you’re more likely to have healthy offspring as well.”

What Raises Your Risk for Infertility?

Both men and women:

• Excess alcohol use
• Smoking
• Older age

Men:

• Environmental toxins, including pesticides and lead
• Health issues such as diabetes, hormone problems, or kidney disease
• Certain medicines
• Radiation treatment and chemotherapy for cancer

Women:

• Stress
• Poor diet
• Being over- or under-weight
• Sexually transmitted infections
• Health problems that cause hormonal changes, such as polycystic ovary syndrome or primary ovarian insufficiency

Adapted from U.S. Office on Women’s Health

The uterus, or womb, is where a fetus grows in a person's body when they are pregnant. The uterus is lined with tissue known as the endometrium, which is key for implantation and growth of a fetus and the placenta. The endometrium is critical to a healthy pregnancy.

When someone of reproductive age is not pregnant, that tissue, along with some blood and mucus, sheds each month. This process is known as menstruation, or a period.

For people with a condition called endometriosis, tissue that is similar to the lining of the uterus grows in other places in their body, including:

• On the ovaries
• On the fallopian tubes, which carry eggs from the ovaries to the uterus
• Behind the uterus
• On the tissues that hold the uterus in place
• On the bowels or bladder

When this tissue grows in other places in the body, it can cause inflammation, bleeding, pain or irritation, and other complications.

Who is affected?

Endometriosis can affect anyone who has a period. Endometriosis is common. It occurs in about 10% of women of reproductive age.

What are some risk factors?

• Periods that started at an early age (before age 11)
• Short monthly cycles (fewer than 27 days)
• Heavy periods that last more than 7 days
• Having other family members with endometriosis

What are the symptoms?

The main symptoms of endometriosis are pelvic pain and infertility or problems getting pregnant. This pain can happen anytime and is usually worse during menstruation. Other common symptoms include:

• Extreme lower abdominal pain or bloating
• Low back pain
• Pain with bowel movements or urination
• Nausea, vomiting, or feeling lightheaded
• Heavy periods or spotting in between periods
• Pain during sex
• Fatigue

Those with endometriosis may have some or many of these symptoms. Because endometriosis can be difficult to diagnose, be sure to discuss all of your symptoms with your health care provider to make sure you are diagnosed correctly.

How is endometriosis diagnosed?

First, a health care provider will take a full medical history and give a complete physical and medical exam. They will do this before performing a surgery, which is the only way to diagnose endometriosis.

The most common type of surgery to diagnose endometriosis is called a laparoscopy. In this surgery, a surgeon uses a tiny camera attached to a thin tube (called a laparoscope) to see inside the uterus, fallopian tubes, ovaries, and bladder and around the intestines. Sometimes a small sample of tissue, called a biopsy, is taken during surgery to confirm the diagnosis.

Doctors can also use imaging techniques such as an ultrasound or magnetic resonance imaging (MRI) to help diagnose the condition.

How is endometriosis treated?

Although endometriosis can’t be cured or prevented, it can be treated.

Certain medications that contain hormones, including pills, injections, or nasal spray, can help lessen pain and bleeding. However, symptoms can come back if the medicine is stopped. Over-the-counter pain medication may also be helpful.

Surgical treatments, including laparoscopies and laparotomies, to remove small sections of scar tissue are also available. A laparotomy is a more invasive surgery, where a cut is made in the abdomen to explore or remove scar tissue. Surgeons may also cut nerves in the pelvis to help with endometriosis pain.

If you suspect you may have endometriosis, talk to your doctor or gynecologist. They can review your medical history, discuss your symptoms with you, and help with diagnosis and potential treatment.

Polycystic ovary syndrome (PCOS) is a health problem that affects 1 in 10 women of childbearing age. Women with PCOS have a hormonal imbalance and metabolism problems that may affect their overall health and appearance. PCOS is also a common and treatable cause of infertility.

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be.

PCOS can cause missed or irregular menstrual periods. Irregular periods can lead to:

• Infertility (inability to get pregnant). In fact, PCOS is one of the most common causes of infertility in women.
• Development of cysts (small fluid-filled sacs) in the ovaries

Who gets PCOS?

Between 5% and 10% of women between 15 and 44, or during the years you can have children, have PCOS. Most women find out they have PCOS in their 20s and 30s, when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty.

Women of all races and ethnicities are at risk of PCOS. Your risk of PCOS may be higher if you have obesity or if you have a mother, sister, or aunt with PCOS.

What are the symptoms of PCOS?

Some of the symptoms of PCOS include:

• Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods.
• Too much hair on the face, chin, or parts of the body where men usually have hair. This is called "hirsutism." Hirsutism affects up to 70% of women with PCOS.
• Acne on the face, chest, and upper back
• Thinning hair or hair loss on the scalp; male-pattern baldness
• Weight gain or difficulty losing weight
• Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
• Skin tags, which are small excess flaps of skin in the armpits or neck area

What causes PCOS?

The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role:

• High levels of androgens. Androgens are sometimes called "male hormones," although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than normal. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.
• High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body's cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who have overweight or obesity, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.

Can I still get pregnant if I have PCOS?

Yes. Having PCOS does not mean you can't get pregnant. PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). If you don't ovulate, you can't get pregnant.

Your doctor can talk with you about ways to help you ovulate and to raise your chance of getting pregnant. You can also use our Ovulation Calculator to see which days in your menstrual cycle you are most likely to be fertile.

Is PCOS linked to other health problems?

Yes, studies have found links between PCOS and other health problems, including:

• Diabetes. More than half of women with PCOS will have diabetes or prediabetes (glucose intolerance) before the age of 40. Learn more about diabetes on our Diabetes page.
• High blood pressure. Women with PCOS are at greater risk of having high blood pressure compared with women of the same age without PCOS. High blood pressure is a leading cause of heart disease and stroke. Learn more about heart disease and stroke.
• Unhealthy cholesterol. Women with PCOS often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. High cholesterol raises your risk of heart disease and stroke.
• Sleep apnea. This is when momentary and repeated stops in breathing interrupt sleep. Many women with PCOS have overweight or obesity, which can cause sleep apnea. Sleep apnea raises your risk of heart disease and diabetes.
• Depression and anxiety. Depression and anxiety are common among women with PCOS.
• Endometrial cancer. Problems with ovulation, obesity, insulin resistance, and diabetes (all common in women with PCOS) increase the risk of developing cancer of the endometrium (lining of the uterus or womb).

Researchers do not know if PCOS causes some of these problems, if these problems cause PCOS, or if there are other conditions that cause PCOS and other health problems.

Will my PCOS symptoms go away at menopause?

Yes and no. PCOS affects many systems in the body. Many women with PCOS find that their menstrual cycles become more regular as they get closer to menopause. However, their PCOS hormonal imbalance does not change with age, so they may continue to have symptoms of PCOS.

Also, the risks of PCOS-related health problems, such as diabetes, stroke, and heart attack, increase with age. These risks may be higher in women with PCOS than those without.

How is PCOS diagnosed?

There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of your symptoms, your doctor may talk to you about your medical history and do a physical exam and different tests:

• Physical exam. Your doctor will measure your blood pressure, body mass index (BMI), and waist size. They will also look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).
• Pelvic exam. Your doctor may do a pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.
• Pelvic ultrasound (sonogram). This test uses sound waves to examine your ovaries for cysts and check the endometrium (lining of the uterus or womb).
• Blood tests. Blood tests check your androgen hormone levels, sometimes called "male hormones." Your doctor will also check for other hormones related to other common health problems that can be mistaken for PCOS, such as thyroid disease. Your doctor may also test your cholesterol levels and test you for diabetes.

Once other conditions are ruled out, you may be diagnosed with PCOS if you have at least two of the following symptoms:

• Irregular periods, including periods that come too often, not often enough, or not at all
• Signs that you have high levels of androgens:
  • Extra hair growth on your face, chin, and body (hirsutism)
  • Acne
  • Thinning of scalp hair
• Higher than normal blood levels of androgens
• Multiple cysts on one or both ovaries

How is PCOS treated?

There is no cure for PCOS, but you can manage the symptoms of PCOS. You and your doctor will work on a treatment plan based on your symptoms, your plans for having children, and your risk of long-term health problems such as diabetes and heart disease. Many women will need a combination of treatments, including:

• Steps you can take at home to help relieve your symptoms
• Medicines

What steps can I take at home to improve my PCOS symptoms?

You can take steps at home to help your PCOS symptoms, including:

• Losing weight. Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10% loss in body weight (for example, a 150-pound woman losing 15 pounds) can help make your menstrual cycle more regular and improve your chances of getting pregnant. Learn more about healthy weight.
• Removing hair. You can try facial hair removal creams, laser hair removal, or electrolysis to remove excess hair. You can find hair removal creams and products at drugstores. Procedures like laser hair removal or electrolysis must be done by a doctor and may not be covered by health insurance.
• Slowing hair growth. A prescription skin treatment (eflornithine HCl cream) can help slow down the growth rate of new hair in unwanted places.

What types of medicines treat PCOS?

The types of medicines that treat PCOS and its symptoms include:

• Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD). For women who don't want to get pregnant, hormonal birth control can:
  • Make your menstrual cycle more regular
  • Lower your risk of endometrial cancer
  • Help improve acne and reduce extra hair on the face and body (Ask your doctor about birth control with both estrogen and progesterone.)
• Anti-androgen medicines. These medicines block the effect of androgens and can help reduce scalp hair loss, facial and body hair growth, and acne. They are not approved by the Food and Drug Administration (FDA) to treat PCOS symptoms. These medicines can also cause problems during pregnancy.
• Metformin. Metformin is often used to treat type 2 diabetes and may help some women with PCOS symptoms. It is not approved by the FDA to treat PCOS symptoms. Metformin improves insulin's ability to lower your blood sugar and can lower both insulin and androgen levels. After a few months of use, metformin may help restart ovulation, but it usually has little effect on acne and extra hair on the face or body. Recent research shows that metformin may have other positive effects, including lowering body mass and improving cholesterol levels.

What are my treatment options for PCOS if I want to get pregnant?

You have several options to help your chances of getting pregnant if you have PCOS:

• Losing weight. If you have overweight or obesity, losing weight through healthy eating and regular physical activity can help make your menstrual cycle more regular and improve your fertility. Find a personalized healthy eating plan using the MyPlate Plan tool.
• Medicine. After ruling out other causes of infertility in you and your partner, your doctor might prescribe medicine to help you ovulate, such as clomiphene (Clomid).
• In vitro fertilization (IVF). IVF may be an option if medicine does not work. In IVF, your egg is fertilized with your partner's sperm in a laboratory and then placed in your uterus to implant and develop. Compared to medicine alone, IVF has higher pregnancy rates and better control over your risk of having twins and triplets (by allowing your doctor to transfer a single fertilized egg into your uterus).
• Surgery. Surgery is also an option, usually only if the other options do not work. The outer shell (called the cortex) of ovaries is thickened in women with PCOS and thought to play a role in preventing spontaneous ovulation. Ovarian drilling is a surgery in which the doctor makes a few holes in the surface of your ovary using lasers or a fine needle heated with electricity. Surgery usually restores ovulation, but only for 6 to 8 months.

Read more about treating infertility in PCOS.

How does PCOS affect pregnancy?

PCOS can cause problems during pregnancy for you and for your baby. Women with PCOS have higher rates of:

• Miscarriage
• Gestational diabetes
• Preeclampsia
• Cesarean section (C-section)

Your baby also has a higher risk of being heavy (macrosomia) and of spending more time in a neonatal intensive care unit (NICU).

How can I prevent problems from PCOS during pregnancy?

You can lower your risk of problems during pregnancy by:

• Reaching a healthy weight before you get pregnant. Use this interactive tool to see your healthy weight before pregnancy and what to gain during pregnancy.
• Reaching healthy blood sugar levels before you get pregnant. You can do this through a combination of healthy eating habits, regular physical activity, weight loss, and medicines such as metformin.
• Taking folic acid. Talk to your doctor about how much folic acid you need.

What is the latest research on PCOS?

Researchers continue to search for new ways to treat PCOS. Some current studies focus on:

• Genetics and PCOS
• Environmental exposure and PCOS risk
• Ethnic and racial differences in PCOS symptoms
• Medicines and supplements to restart ovulation
• Obesity and its link to PCOS
• Health risks for children of women with PCOS

Untreated sexually transmitted diseases (STDs) can cause pelvic inflammatory disease (PID), a serious condition, in women. 1 in 8 women with a history of PID experience difficulties getting pregnant. You can prevent PID if you know how to protect yourself.

What is PID?

Pelvic inflammatory disease is an infection of a woman’s reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID.

How do I get PID?

You are more likely to get PID if you

• Have an STD and do not get treated;
• Have more than one sex partner;
• Have a sex partner who has sex partners other than you;
• Have had PID before;
• Are sexually active and are age 25 or younger;
• Douche;
• Use an intrauterine device (IUD) for birth control. However, the small increased risk is mostly limited to the first three weeks after the IUD is placed inside the uterus by a doctor.

How can I reduce my risk of getting PID?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting PID:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

How do I know if I have PID?

There are no tests for PID. A diagnosis is usually based on a combination of your medical history, physical exam, and other test results. You may not realize you have PID because your symptoms may be mild, or you may not experience any symptoms. However, if you do have symptoms, you may notice

• Pain in your lower abdomen;
• Fever;
• An unusual discharge with a bad odor from your vagina;
• Pain and/or bleeding when you have sex;
• Burning sensation when you urinate; or
• Bleeding between periods.

You should

• Be examined by your doctor if you notice any of these symptoms;
• Promptly see a doctor if you think you or your sex partner(s) have or were exposed to an STD;
• Promptly see a doctor if you have any genital symptoms such as an unusual sore, a smelly discharge, burning when peeing, or bleeding between periods;
• Get a test for chlamydia every year if you are sexually active and younger than 25 years of age.
• Have an honest and open talk with your health care provider if you are sexually active and ask whether you should be tested for other STDs.

Can PID be cured?

Yes, if PID is diagnosed early, it can be treated. However, treatment won’t undo any damage that has already happened to your reproductive system. The longer you wait to get treated, the more likely it is that you will have complications from PID. While taking antibiotics, your symptoms may go away before the infection is cured. Even if symptoms go away, you should finish taking all of your medicine. Be sure to tell your recent sex partner(s), so they can get tested and treated for STDs, too. It is also very important that you and your partner both finish your treatment before having any kind of sex so that you don’t re-infect each other.

You can get PID again if you get infected with an STD again. Also, if you have had PID before, you have a higher chance of getting it again.

What happens if I don’t get treated?

If diagnosed and treated early, the complications of PID can be prevented. Some of the complications of PID are

• Formation of scar tissue both outside and inside the fallopian tubes that can lead to tubal blockage;
• Ectopic pregnancy (pregnancy outside the womb);
• Infertility (inability to get pregnant);
• Long-term pelvic/abdominal pain.

What is primary ovarian insufficiency (POI)?

Primary ovarian insufficiency (POI), also known as premature ovarian failure, happens when a woman's ovaries stop working normally before she is 40.

Many women naturally experience reduced fertility when they are about 40 years old. They may start getting irregular menstrual periods as they transition to menopause. For women with POI, irregular periods and reduced fertility start before the age of 40. Sometimes it can start as early as the teenage years.

POI is different from premature menopause. With premature menopause, your periods stop before age 40. You can no longer get pregnant. The cause can be natural or it can be a disease, surgery, chemotherapy, or radiation. With POI, some women still have occasional periods. They may even get pregnant. In most cases of POI, the cause is unknown.

What causes primary ovarian insufficiency (POI)?

In about 90% of cases, the exact cause of POI is unknown.

Research shows that POI is related to problems with the follicles. Follicles are small sacs in your ovaries. Your eggs grow and mature inside them. One type of follicle problem is that you run out of working follicles earlier than normal. Another is that the follicles are not working properly. In most cases, the cause of the follicle problem is unknown. But sometimes the cause may be:

• Genetic disorders such as Fragile X syndrome and Turner syndrome
• A low number of follicles
• Autoimmune diseases, including thyroiditis and Addison disease
• Chemotherapy or radiation therapy
• Metabolic disorders
• Toxins, such as cigarette smoke, chemicals, and pesticides

Who is at risk for primary ovarian insufficiency (POI)?

Certain factors can raise a woman's risk of POI:

• Family history. Women who have a mother or sister with POI are more likely to have it.
• Genes. Some changes to genes and genetic conditions put women at higher risk for POI. For example, women Fragile X syndrome or Turner syndrome are at higher risk.
• Certain diseases, such as autoimmune diseases and viral infections
• Cancer treatments, such as chemotherapy and radiation therapy
• Age. Younger women can get POI, but it becomes more common between the ages of 35-40.

What are the symptoms of primary ovarian insufficiency (POI)?

The first sign of POI is usually irregular or missed periods. Later symptoms may be similar to those of natural menopause:

• Hot flashes
• Night sweats
• Irritability
• Poor concentration
• Decreased sex drive
• Pain during sex
• Vaginal dryness

For many women with POI, trouble getting pregnant or infertility is the reason they go to their health care provider.

What other problems can primary ovarian insufficiency (POI) cause?

Since POI causes you to have lower levels of certain hormones, you are at greater risk for other health conditions, including:

• Anxiety and depression. Hormonal changes caused by POI can contribute to anxiety or lead to depression.
• Dry eye syndrome and eye surface disease. Some women with POI have one of these eye conditions. Both can cause discomfort and may lead to blurred vision. If not treated, these conditions can cause permanent eye damage.
• Heart disease. Lower levels of estrogen can affect the muscles lining the arteries and can increase the buildup of cholesterol in the arteries. These factors increase your risk of atherosclerosis (hardening of the arteries).
• Infertility.
• Low thyroid function. This problem also is called hypothyroidism. The thyroid is a gland that makes hormones that control your body's metabolism and energy level. Low levels thyroid hormones can affect your metabolism and can cause very low energy, mental sluggishness, and other symptoms.
• Osteoporosis. The hormone estrogen helps keep bones strong. Without enough estrogen, women with POI often develop osteoporosis. It is a bone disease that causes weak, brittle bones that are more likely to break.

How is primary ovarian insufficiency (POI) diagnosed?

To diagnose POI, your health care provider may do:

• A medical history, including asking whether you have relatives with POI
• A pregnancy test, to make sure that you are not pregnant
• A physical exam, to look for signs of other disorders which could be causing your symptoms
• Blood tests, to check for certain hormone levels. You may also have a blood test to do a chromosome analysis. A chromosome is the part of a cell that contains genetic information.
• A pelvic ultrasound, to see whether or not the ovaries are enlarged or have multiple follicles

How is primary ovarian insufficiency (POI) treated?

Currently, there is no proven treatment to restore normal function to a woman's ovaries. But there are treatments for some of the symptoms of POI. There are also ways to lower your health risks and treat the conditions that POI can cause:

• Hormone replacement therapy (HRT). HRT is the most common treatment. It gives your body the estrogen and other hormones that your ovaries are not making. HRT improves sexual health and decreases the risks for heart disease and osteoporosis. You usually take it until about age 50; that's about the age when menopause usually begins.
• Calcium and vitamin D supplements. Because women with POI are at higher risk for osteoporosis, you should take calcium and vitamin D every day.
• In vitro fertilization (IVF). If you have POI and you wish to become pregnant, you may consider trying IVF.
• Regular physical activity and a healthy body weight. Getting regular exercise and controlling your weight can lower your risk for osteoporosis and heart disease.
• Treatments for associated conditions. If you have a condition that is related to POI, it is important to treat that as well. Treatments may involve medicines and hormones.

Healthy diet and exercise can reduce risk of complications

A healthy pregnancy is one of the best ways to promote a healthy birth. Early and regular prenatal care can help prevent complications and educate women about things they can do to have a healthy pregnancy. Here are a few areas to consider:

Prenatal care

Women who suspect they may be pregnant should schedule a visit to their health care provider to begin prenatal care. These visits usually include a physical exam, weight checks, and providing a urine sample. Health care providers may also perform blood tests and imaging tests, such as ultrasound exams. Prenatal visits also include discussions about the mother's health, the fetus's health, and any questions about the pregnancy.

Healthy diet and exercise

With regular prenatal care, women can reduce the risk of pregnancy complications. This is done in part through following a healthy diet, getting regular exercise as advised by a health care provider, maintaining a healthy weight, and avoiding potentially harmful substances, such as lead and radiation.

Avoid alcohol and tobacco smoke

Women can also reduce the risk of complications to the fetus and infant. Tobacco smoke and alcohol, for example, may increase the risk of sudden infant death syndrome, or the unexplained death of an infant younger than 1 year old. Alcohol use increases the risk for fetal alcohol spectrum disorders, which can cause a variety of problems including birth defects and intellectual disabilities.

Prenatal vitamins

To promote a healthy pregnancy, the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend taking daily prenatal vitamins that contain 400 micrograms of folic acid. The vitamin folic acid is shown to reduce the risk for birth defects of the brain, spine, or spinal cord by 70%. These defects, called neural tube defects, develop in the first month of pregnancy, often before a woman knows that she is pregnant. Prenatal vitamins contain other vitamins that pregnant women and their developing fetus need, too.

Preeclampsia: What you need to know

High blood pressure, too much protein in urine, blurred vision are symptoms

 Researchers are working to understand what causes preeclampsia, a condition whose symptoms include high blood pressure.

Preeclampsia is a pregnancy-related disorder in which the mother's high blood pressure reduces the blood supply to the fetus. This means the fetus may get less oxygen and fewer nutrients.

What causes it?

The causes of preeclampsia are unknown. Researchers including those at the National Institute of Child Health and Human Development are working to understand what causes the condition so it can be prevented and better treated.

What are the risks to the mother?

Women with preeclampsia are at increased risk for organ damage or failure, preterm birth, pregnancy loss, and stroke. Preeclampsia can develop into eclampsia, which is characterized by seizures and coma.

What are the risks to the fetus?

Risks include lack of oxygen and nutrients, preterm birth, and stillbirth. Infants born preterm due to preeclampsia are at higher risk of some long-term health issues mostly related to being born early. These include learning disorders, cerebral palsy, epilepsy, deafness, and blindness.

What are the symptoms?

Preeclampsia symptoms include high blood pressure, too much protein in the urine, and systemic problems such as headache, blurred vision, and upper abdominal pain on the right side. Women may also experience swelling in the face and hands.

What are the treatments?

For women at high risk, the U.S. Preventive Services Task Force recommends taking a low-dose aspirin starting after the first trimester to prevent preeclampsia. Delivering the fetus can help resolve preeclampsia, but symptoms can continue even after delivery. If the pregnancy is at less than 37 weeks, health care providers may consider treatments that give the fetus more time to develop. These include close monitoring, intravenous medication to control blood pressure, and steroid injections to help speed up the development of the fetus's lungs.

Just because a woman is older does not mean she will definitely have a cesarean delivery. However, women 35 and older are more likely to have high-risk pregnancies because of their age, and research shows that older first-time moms are more likely to have caesarean deliveries than younger first-time moms. If you are an older first-time mom, it is possible that you will need a cesarean delivery. You should discuss any concerns you have about your pregnancy and your delivery with your healthcare provider.