The Facts About Reproductive Health

The World Health Organization (WHO) defines reproductive health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes."

Reproductive health is the condition of your reproductive systems throughout all life stages. It encompasses sex, fertility, organ health, reproductive conditions and having control over family-building.

It's a lifelong consideration that can also impact other aspects of your physical and mental health and well-being.

Several organs make up the female reproductive system and they are responsible for sexual activity, producing certain sex hormones, your menstrual cycle and fertility.

In the United States, 44 million women—3 out of every 4 women of reproductive age—receive one or more sexual or reproductive health services every year, according to the Guttmacher Institute, a national research and policy organization. Looking after your reproductive system helps your overall health and gives you some control over whether you want to become pregnant and how to manage that pregnancy.

There are five main parts of the female reproductive system:

1. Ovaries produce, store and release eggs. They also produce female sex hormones including estrogen and progesterone.
2. Fallopian tubes provide a pathway from the ovaries to the uterus. Once an egg is released from the ovaries, it travels down the fallopian tubes to the uterus.
3. The uterus, or womb, is where a baby grows. It has the ability to expand to accommodate the fetus. It's composed of the cervix (neck of the womb) and corpus (body of the womb).
4. The vagina joins the cervix to the outside of the body. It has an opening that allows for the release of menstrual blood or the birth of a baby, as well as entry for a penis or a tampon.
5. The external genital organs are collectively known as the vulva and include: labia majora, mons pubis, labia minora, clitoris and glands, that is, the paraurethral glands and greater vestibular glands.

Although the primary purpose of the reproductive system is its involvement in fertility, conception and childbirth, it also impacts other aspects of general health. For example, the hormones created in the reproductive system can affect cholesterol, bone density and mood.

The menstrual cycle is a natural process comprising four predominate phases:

1. Menstruation is commonly referred to as "having your period." It's the time of the month when the lining of your uterus and unfertilized egg shed and flow out of your vagina in the form of blood. For most people, a period can last anywhere from two to seven days, but it can be longer for some.
2. The follicular phase starts on the first day of your period and lasts until you ovulate. During this phase, around day 10 of your menstrual cycle, the pituitary gland releases follicle-stimulating hormone (FSH). This causes the ovaries to produce tiny sacs called follicles, which contain an immature egg. One egg matures and is ready for ovulation, and the rest are reabsorbed into the body.
3. Ovulation occurs when one of your ovaries releases a mature egg, also known as an ovum. Ovulation happens around 12 to 16 days before the start of your next period and lasts for approximately 12 to 24 hours. However, you can get pregnant in the days leading up to or after ovulation.
4. The luteal phase happens once you have ovulated. After ovulation, cells in the ovaries release progesterone and a small amount of estrogen. These hormones cause the uterus lining to thicken and prepare for pregnancy. If pregnancy doesn't happen, progesterone levels drop, the uterus lining sheds along with the egg, and you have a period.

The entire menstrual cycle lasts around 28 days on average, although it can be normal for women to experience a cycle for anywhere from 25 to 35 days.

Male reproductive health is an essential part of managing your health and well-being. Although fertility and contraception issues are most often associated with women, they are equally applicable to men.

There is a global crisis in male reproductive health, with research showing declining sperm counts and increasing male reproductive system abnormalities. Understanding how to look after your reproductive health can protect both you and your partner.

The male reproductive system produces, stores and transports semen—containing sperm—from the testes to the female reproductive tract. It also produces and secretes essential sex hormones, and is made up of organs inside and outside the body.

External organs include the following:

• The penis is the main organ involved in sexual intercourse.
• The scrotum is the external sack of skin that houses and protects the testes.
• The testes, or testicles, sit in the scrotum and are responsible for making testosterone—the primary male sex hormone—and producing sperm.
• The epididymis is a narrow tube at the back of each testicle. Sperm moves from the testicle into the epididymis, where it is stored and matured.

Internal organs include the following:

• The vasa deferentia are two tubes that carry sperm to the testes.
• Ejaculatory ducts are formed by the union of the duct from the seminal vesicle and the vas deferens. Sperm are mixed with secretions from the seminal vesicles and prostate glands in the ducts. Sperm move through the ejaculatory ducts to the urethra and out of the penis during ejaculation.
• Seminal vesicles are glands that secrete fluid that mixes with sperm to create semen.
• The prostate gland is located between the penis and the rectum and supplies part of the seminal fluid that mixes with sperm before ejaculation to help sperm survive and travel.
• The urethra is a long tube that runs down the penis. It connects the penis to the bladder, allowing men to pass urine. It also carries semen, which passes through during ejaculation.
• Bulbourethral glands—also called Cowper's glands—are beneath the prostate gland and also add fluid to semen during the process of ejaculation.

Fertility is the ability to produce a child through natural conception. Fertility depends on:

• Being able to make healthy sperm
• Being able to produce healthy eggs
• Healthy fallopian tubes (not damaged or blocked) to allow sperm to reach the egg 
• Healthy sperm to fertilize a healthy egg
• The fertilized egg (embryo) implanting in the womb
• The development of a healthy embryo
• A uterine environment that assists embryo growth

Fertility isn't a given part of your reproductive health, and infertility affects around 10 percent to 15 percent of American couples. The cause of infertility can be either male, female, a mix of the two or simply unknown:

• 30 percent of infertility cases are attributed solely to women
• 30 percent are attributed solely to men
• 30 percent are due to a combination of factors in both partners
• 10 percent of cases have an unknown cause

Fertility problems can be complicated, but many treatments, surgeries, lifestyle changes and assisted reproductive technologies (ART) can help.

Reproductive health is a lifelong consideration. How you look after your reproductive health may change at different life stages.

The following general risk factors can affect your reproductive health:

• Exposure to reproductive hazards. Exposure to chemicals such as pesticides, polychlorinated biphenyls (PCBs), organic solvents and carbon disulfide can affect your reproductive health.
• Having unprotected sex. This act can put you at risk of sexually transmitted infections (STIs)—which can cause infertility and chronic health problems—and unwanted pregnancy.
• Lifestyle choices. Poor diet, smoking, excessive alcohol consumption and recreational drug use can all impact fertility.
• Your family history. Certain conditions of the reproductive systems—such as breast, colon, ovarian and prostate cancer—can have a genetic link.

Reproductive health problems in women include:

• Cervical cancer. This cancer was estimated to be diagnosed in around 14,100 women in the United States in 2022. You should start Pap tests at age 21, regardless of when you first start having sex, then continue to have Pap tests every three years.
• Endometriosis. This is a condition where tissue similar to the endometrium (the uterine lining) grows outside the uterus in the pelvic tissues.
• Menopause. This process can cause many challenging symptoms, but treatments are available, including hormone replacement therapy (HRT).
• Menstrual problems. More than 31 million women in the U.S. reported period pain or premenstrual syndrome (PMS) in 2020, according to Statista.
• Ovarian cancer. This cancer affects 1.2 percent of women at some point in their lives.
• PCOS. As many as 5 million American women of reproductive age are affected by polycystic ovary syndrome (PCOS), which causes symptoms such as irregular periods, excess body hair, acne and fertility issues.
• Uterine cancer. This is the most common gynecological cancer, usually occurring in people ages 50 and older.

You can look after your reproductive health by knowing your menstrual cycle and reproductive organs. Keep track of your periods so you'll always know if a period is late or missed. Get to know your vaginal discharge, check your genitals and breasts, and stay up to date with Pap smears to help you stay healthy sexually.

Some reproductive health problems in men to be aware of are:

• Benign prostatic hyperplasia (BPH) is a common, nonmalignant enlargement of the prostate gland.
• Balanitis is inflammation of the head of the penis.
• Peyronie's disease causes curvature and pain when the penis is erect.
• Erectile dysfunction (ED) affects around 5 percent of men by the time they turn 40. It is defined as the consistent inability to achieve and maintain erections firm enough for penetrative sex.
• Prostate canceraffects around 13 percent of American men.
• Testicular cancer is the most common cancer in men ages 20 to 40.

You should not have to suffer from urinary, erectile, ejaculatory or other sexual dysfunction. Get to know your male reproductive anatomy, understand what's normal and what's not, and seek help from your healthcare provider if you are experiencing problems.

Assisted reproductive technologies (ART) are fertility treatments where either eggs or embryos are handled. They can be used to help people with infertility or to assist same-sex couples or single people in family-building.

The most common types of ART include:

• Egg donation. This method can be used by women who can't get pregnant using their own eggs.
• Gamete intrafallopian transfer. This procedure involves removing the egg and sperm and mixing them into the fallopian tube.
• Intracytoplasmic sperm injection (ICSI). This approach involves a single sperm being injected directly into the egg's cytoplasm to accomplish fertilization.
• Intrauterine insemination (IUI). In this procedure, sperm is placed directly inside the womb.
• In vitro fertilization (IVF). During IVF, a woman's eggs and a man's sperm are combined in a laboratory to create an embryo.
• Surrogacy. A woman carries and gives birth to a child for another person or family.

ART can be used to address infertility but can be costly. Some insurance companies cover IVF but often have certain limitations in place. It's helpful to explore the different options, review the costs, and talk with a fertility expert about which option is the most suitable for you before making any decisions.

Reproductive health problems are the leading cause of illness and death in women of reproductive age worldwide, according to an article in the Journal of Clinical and Diagnostic Research.

However, the quality and availability of healthcare are not the only influences on reproductive health. It's a multifactorial issue. The determinants can include socioeconomic status, medical history, family history, access to sex education, access to sexual healthcare services, misinformation, political influence, religious influence, where you live, environmental conditions, working conditions, peer behaviors, social support, age, lifestyle choices and more.

Some of the most influential socioeconomic factors, as highlighted in several studies, are:

• Access to equal and affordable healthcare and sexual health services
• Age
• Employment status
• Housing, basic amenities and environment
• Level of education
• Level of income
• Marital status
• Social inclusion and nondiscrimination

Socioeconomic status is often associated with corresponding low use of health services. According to the WHO, social determinants can influence health more than healthcare or lifestyle choices.

Aging is a significant factor to consider regarding fertility.

For women, the quality and quantity of eggs gradually decline as they age. The decrease in egg quantity in the ovaries is known as the loss of ovarian reserve. According to the American Society for Reproductive Medicine, many women are not able to have a successful pregnancy at age 40, and by 45, very few women can have a successful pregnancy. Of course, there are exceptions.

It's not just women whose fertility is affected by age, though. Sperm motility (movement) and concentration decrease as men age, with the biggest changes happening after age 50. Research indicates that sperm motility is best before age 25 and worst after age 55.

In addition, recent studies indicate that babies born to men of older paternal age have an increased risk of congenital disabilities and mental disorders.

For all sexes, a reproductive health diagnosis starts with a healthcare provider taking a complete medical history, family history and lifestyle overview. They also conduct a physical examination. Depending on what the doctor determines from these initial examinations, they may refer the patient for further tests.

Typical fertility-related tests for men may include:

• Hormone testing. This testing looks at levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone in your blood.
• Semen analysis. This testing checks sperm count, concentration, volume, motility and morphology (shape).
• STI testing. Some STIs can lead to fertility problems.
• Ultrasound scan. A scan checks for any anatomical issues or obstructions.
• Urinalysis. This analysis can be used to test for normozoospermic infertility by tracking biomarkers in urine. Normozoospermic refers to the presence of normal sperm.
• Testicular biopsy. This procedure may be one of the final tests if all others are inconclusive.

Fertility-related tests for women may include:

• Hormone testing. This testing checks for a hormone called progesterone to see whether you're ovulating.
• Hysterosalpingogram. During this procedure, a particular type of X-ray looks at your womb and fallopian tubes after the injection of a special dye.
• Hysteroscopy. A tiny camera is inserted in the cervix to view the uterus.
• Laparoscopy. A laparoscope—a thin tube with a camera at the end—is placed through a small cut in your tummy to examine your fallopian tubes, ovaries and uterus.
• STI testing. Some STIs can lead to fertility problems.
• Ultrasound scan: A scan checks your fallopian tubes, ovaries and uterus.

Your fertility specialist might also offer genetic testing to determine if any genetic abnormalities are the underlying cause of fertility problems.

If you are thinking of starting your family-building journey, you can take many steps to give yourself the best chance of conceiving:

• Cut down or stop drinking alcohol
• Eat a healthy diet
• Get regular exercise
• Get tested for STIs and get treatment as soon as possible if you have an STI
• Have sex every two to three days without using contraception
• Maintain a healthy weight
• Stop taking any recreational drugs
• Stop smoking
• Track your cycle and get to know when you ovulate so you can have sex at this time
• Women should take folic acid daily as soon as they start trying to conceive

Once pregnant, all of the above tips still apply. However, you should also:

• Attend all scans and checkups as advised by your healthcare provider
• Cut out smoking and alcohol completely
• Do gentle, regular exercise
• Eat a healthy diet and be aware of food hygiene. Avoid certain foods, such as pâté, mold-ripened cheese, blue-veined cheese, raw or undercooked meat, raw fish and unpasteurized milk.
• Limit your caffeine intake
• Rest when you feel the need
• See your doctor, OB-GYN or midwife as soon as possible to start your pregnancy care
• Take folic acid and vitamin D daily

How can you increase the chance of getting pregnant naturally?

Tips to help you get pregnant naturally include:

• Eating a healthy diet
• Exercising regularly
• Having unprotected sex every two to three days
• Maintaining a healthy weight
• Monitoring ovulation and having sex just before and during ovulation
• Reducing stress and anxiety
• Stopping smoking, excessive consumption of alcohol and use of recreational drugs
• Taking prenatal vitamins, including folic acid

What are the male reproductive organs?

External male reproductive organs include the penis, scrotum, testes and epididymis.

Internal male reproductive organs include the vas deferens, ejaculatory ducts, urethra, seminal vesicles, prostate gland and bulbourethral glands, the latter also known as Cowper's glands.

What is the most important organ of the female reproductive system?

The uterus is the most prominent organ in the female reproductive system. It's responsible for your menstrual cycle, it's where a fertilized egg implants during pregnancy, and it's where a baby develops until birth. It also contracts to assist with childbirth.