People in their twenties and thirties are considered young adults. If you are in your early twenties, good news - you are probably at the peak of your physiological development. Your reproductive system, motor ability, strength, and lung capacity are operating at their best. Now here is the bad news. These systems will now start a slow, gradual decline so that by the time you reach your mid to late 30s, you will begin to notice signs of aging. This includes a decline in your immune system, your response time, and in your ability to recover quickly from physical exertion. For example, you may have noticed that it takes you quite some time to stop panting after running to class or taking the stairs. But, here is more good news. Getting out of shape is not an inevitable part of aging; it is probably due to the fact that you have become less physically active and have experienced greater stress. How is that good news, you ask? It’s good news because it means that there are thing you can do to combat many of these changes. So keep in mind, as we continue to discuss the life span that many of the changes we associate with aging can be turned around if we adopt healthier lifestyles.
Doctor’s visits are less frequent in early adulthood than for those in midlife and late adulthood and are necessitated primarily by injury and pregnancy (Berger, 2005). However, among the top five causes of death in young adulthood are non-intentional injury (including motor vehicle accidents), homicide, and suicide (Heron, M. P. & B. L. Smith, 2007). Cancer and heart disease complete the list. Rates of violent death (homicide, suicide, and accidents) are highest among young adult males, and vary among by race and ethnicity. Rates of violent death are higher in the United States than in Canada, Mexico, Japan, and other selected countries. Males are 3 times more likely to die in auto accidents than are females (Frieden, 2011).
Rates of violent death are influenced by substance abuse which peaks during early adulthood. Illicit drug use peaks between the ages of 19 and 22 and then begins to decline (Berk, 2007). And twenty-five percent of those who smoke cigarettes, a third of those who smoke marijuana, and 70 percent of those who abuse cocaine began using after age 17 (Volkow, 2004). Some young adults enagage in substance use as a way of coping with stressors from family, personal relationships, or concerns over being on one’s own. Others do so because they have friends who use and in the early 20s, there is still a good deal of pressure to conform. Half of all alcohol consumed in the United States is in the form of binge drinking (Frieden, 2011).
Drugs impair judgment, reduce inhibitions, and alter mood, all of which can lead to dangerous behavior. Reckless driving, violent altercations, and forced sexual encounters are some examples. Binge drinking on college campuses has received considerable media and public attention. The role alcohol plays in predicting acquaintance rape on college campuses is of particular concern. In the majority of cases of rape, the victim knows the rapist. Being intoxicated increases a female’s risk of being the victim of date or acquaintance rape (Fisher et als. in Carroll, 2007). And, she is more likely to blame herself and to be blamed by others if she was intoxicated when raped. Males increase their risk of being accused of rape if they are drunk when an incidence occurred (Carroll, 2007).
The use of alcohol and other drugs is also associated with an increase in the risk of sexually transmitted infections because people are more likely to engage in risky sexual behavior when under the influence. This includes having sex with someone who has had multiple partners, having sex without the use of a condom, having multiple partners, or having sex with someone whose history is unknown. The use of alcohol and other drugs during pregnancy may also have a teratogenic effect.
Men and women tend to reach their peak of sexual responsiveness at different ages. For men, sexual responsiveness tends to peak in the late teens and early twenties. Sexual arousal can easily occur in response to physical stimulation or fantasizing. Sexual responsiveness begins a slow decline in the late twenties and into the thirties although a man may continue to be sexually active. Through time, a man may require more intense stimulation in order to become aroused. Women often find that they become more sexually responsive throughout their 20s and 30s and may peak in the late 30s or early 40s. This is likely due to greater self-confidence and reduced inhibitions about sexuality.
For many couples, early adulthood is the time for having children. However, delaying childbearing until the late 20s or early 30s has become more common in the United States.
Couples delay childbearing for a number of reasons. Women are more likely to attend college and begin careers before starting families. And both men and women are delaying marriage until they are in their late 20s and early 30s.
Infertility is defined as not being able to get pregnant after one year (or longer) of unprotected sex (sex without the use of contraceptives). Among women of reproductive age (15 - 49), 8.8% of married women are infertile and 12.7% of all women in this age range have received fertility services (National Survey of Family Growth 2015 - 2017, CDC). Male factors contribute to infertility in about a third of the cases. For men, the most common cause is a lack of sperm production or low sperm production. Female factors cause infertility in another third of cases. For women, one of the most common causes of infertility is the failure to ovulate. Another cause of infertility is pelvic inflammatory disease, an infection of the female genital tract (Carroll, 2007). Pelvic inflammatory disease is experienced by 1 out of 7 women in the United States and leads to infertility about 20 percent of the time. One of the major causes of pelvic inflammatory disease is Chlamydia trachomatis, the most commonly diagnosed sexually transmitted infection in young women. Another cause of pelvic inflammatory disease is gonorrhea. Both male and female factors contribute to the remainder of cases of infertility. While estimates of the incidence of infertility vary based on the source and type of data consulted, it is quite clear that infertility is quite common and appears to affect at least 10% of the population in the United States.
While women have more potential sources of infertility then men (as they need functioning ovaries, fallopian tubes, and a uterus to get pregnant), it is in no way a "woman's condition". The CDC summarizes the data as follows:
Many couples struggle with infertility and seek help to become pregnant, but it is often thought of as only a woman’s condition. However, in about 35% of couples with infertility, a male factor is identified along with a female factor. In about 8% of couples with infertility, a male factor is the only identifiable cause.
Almost 9% of men aged 25 to 44 years in the United States reported that they or their partner saw a doctor for advice, testing, or treatment for infertility during their lifetime.
The majority of infertility cases (85-90 percent) are treated using fertility drugs to increase ovulation or with surgical procedures to repair the reproductive organs or remove scar tissue from the reproductive tract. In vitro fertilization is used to treat infertility in less than 5 percent of cases. IVF is used when a woman has blocked or deformed fallopian tubes or sometimes when a man has a very low sperm count. This procedure involves removing eggs from the female and fertilizing the eggs outside the woman’s body. The fertilized egg is then reinserted in the woman’s uterus. The average cost of IVF is over $12,000 and the success rate is between 5 to 30 percent. IVF makes up about 99 percent of artificial reproductive procedures.
Less common procedures include gamete intra-fallopian tube transfer (GIFT) which involves implanting both sperm and ova into the fallopian tube and fertilization is allowed to occur naturally. The success rate of implantation is higher for GIFT than for IVF (Carroll, 2007). Zygote intra-fallopian tube transfer (ZIFT) is another procedure in which sperm and ova are fertilized outside of the woman’s body and the fertilized egg or zygote is then implanted in the fallopian tube. This allows the zygote to travel down the fallopian tube and embed in the lining of the uterus naturally. This procedure also has a higher success rate than IVF.
Insurance coverage for infertility is required in fourteen states, but the amount and type of coverage available varies greatly (ASRM, 2000-2007). The majority of couples seeking treatment for infertility pay much of the cost. Consequently, infertility treatment is much more accessible to couples with higher incomes. However, grants and funding sources are available for lower income couples seeking infertility treatment as well.