What Is Infertility?
Infertility is a disease of the reproductive system that impairs the ability to conceive a child. Infertility may be diagnosed after a couple has been having well-timed, unprotected sexual intercourse for a full year.
If the woman is over thirty-five, infertility may be diagnosed after six months of well-timed, unprotected sexual intercourse.
Infertility may also be diagnosed if a woman is under age thirty-five and has suffered multiple miscarriages (also called “recurrent pregnancy loss” or RPL).
While infertility can be one of the most isolating challenges a couple can face, being infertile is not uncommon. In fact, 10-15 percent of couples in the US are infertile.
Infertility can be caused by one single problem in either partner, or a combination of factors that lead to a couple being unable to conceive – or carry – a pregnancy to term.
There are many safe treatments that can help a couple overcome infertility and successfully carry a child to term.
What Are The Types of Infertility?
Infertility can take two forms: primary and secondary, but many of the causes and treatments are the same for each type of infertility. This resource page will focus upon Primary Infertility.
Primary Infertility is a diagnosis for couples who haven’t been able to conceive after a year of well-timed, unprotected sexual intercourse without any other children.
Secondary Infertility occurs when couples have been pregnant at least once, but are unable to become pregnant again.
Risk Factors for Infertility:
Maternal Age – after age thirty-two, the fertility potential in women decline as their eggs age. Risk of miscarriage increases with age as well.
Paternal Age – men over age 40 are less fertile than men younger than 40.
Alcohol Use: there has been no established safe dose for alcohol during pregnancy or conception. Moderate to heavy alcohol use may impact fertility.
Being overweight – both men and women can have their fertility impacted if they are overweight.
Being underweight – women who have eating disorders or follow low-calorie restrictive diets may have difficulty becoming pregnant.
Smoking cigarettes – if either partner smokes cigarettes, the chance for successful conception decreases. Smoking also decreases any possible benefits of IF treatments.
Exercise – Too much exercise can lead to ovulation problems.
What Are The Symptoms Of Infertility?
Most couples are able to conceive a pregnancy within the first six months of well-timed, unprotected sexual intercourse. After 12 months of well-timed, unprotected sexual intercourse, about 90% of couples will achieve a pregnancy.
The remaining 10% will eventually conceive – with or without ART (assisted reproductive technology).
The primary symptom of infertility is the inability for a couple to become pregnant after a year of well-timed sexual intercourse. Other symptoms – such as abnormal menstrual cycles or hormonal problems – may not be noticed until after a couple has been unable to achieve pregnancy.
It’s time to make an appointment to see a doctor (begin with your normal gynecologist who may refer you to a doctor who specializes in fertility treatments) if any of the following symptoms are noted:
- Maternal age is over 34 and the couple has been trying to conceive for at least six months.
- Irregular menstruation
- Intense pain with menstruation
- Past history of endometriosis or pelvic inflammatory disease.
Men should see a doctor if he has:
- Known low sperm count
- History of testicular, sexual, or prostate problems.
What Causes Infertility?
Conception involves a complex process of ovulation and fertilization. Conception is not an isolated event but part of a sequential process involving ovulation (release of egg from ovary) gamete formation, fertilization (union of sperm and egg) and implantation into the uterine wall.
Infertility is caused by a problem somewhere in this process and may be due to problems with one or both partners.
1/3 cases of infertility are due to problems with the female partner.
1/3 cases of infertility are due to problems with the male partner.
1/3 cases of infertility are caused by both male and female problems.
What Are The Causes of Male Factor Infertility?
There are a great deal of things that can affect production of sperm, sperm count, sperm motility or the ability of the sperm to effectively fertilize the egg. The most common causes of male factor infertility are:
Paternal age over forty. Fertility may decrease with age for some men.
Abnormal spermatogenesis (creation of sperm) or function of the sperm. This can be caused by genetic defects, scarring from infections, or undescended testicles.
Issues with sperm delivery, which can include premature ejaculation, painful intercourse, retrograde ejaculation, genetic diseases, or structural problems with the male reproductive system.
Environmental overexposure to things like chemicals, pesticides
Heat (such as frequent use of a sauna or hot tubs) which can lower sperm count and impact sperm production.
Lifestyle issues: obesity, poor nutrition, smoking, substance abuse, or overuse of alcohol.
What Are The Causes of Female Factor Infertility?
While the causes may overlap or vary, these are the most common cause of female infertility:
Damage (or Blockage) to the Fallopian Tubes related to inflammation of the Fallopian Tube, often caused by Chlamydia (an STI).
Endometriosis – the tissue lining the uterus grows and implants itself outside of the uterus, causing damage to the major organs, including the reproductive organs.
Ovulatory Disorders – these may prevent the ovaries from releasing eggs and may be caused by injury, tumors, starvation, extreme exercise, and certain medications.
PCOS (Polycystic Ovarian Syndrome) – is a condition in which the hormone androgen is elevated and causes ovulatory disorders.
Hyperprolactinemia – elevated levels of the hormone that stimulates lactation in women who aren’t pregnant or nursing can also affect ovulation.
Uterine Fibroids – benign tumors in the wall of the uterus are common – rarely they can cause blockage to the Fallopian tubes, inhibiting ovulation. More frequently, fibroids interfere with the implantation of a fertilized egg into the wall of the uterus.
Pelvic Adhesions – bands of scar tissue from previous surgeries, appendicitis, or other infections of the pelvic region can impair fertility.
Thyroid Problems – Hypothyroidsim or hyperthyroidism can impact fertility by interrupting the normal menstrual cycle of a woman.
Cancer and Cancer Treatment – cancers – especially those that affect the reproductive system, can severely impact a woman’s fertility. And the treatment of cancers – radiation and chemotherapy – can affect a woman’s reproductive function.
Medications – certain medications can temporarily affect fertility in women. Generally speaking, when the medication is stopped, fertility returns to normal.
Early Menopause – defined as the absence of menstruation and depletion of ovarian follicles prior to age 40. While it’s unknown why some women enter early menopause, it can be caused by disease, radiation, smoking, or chemotherapy.
How Is Infertility Treated?
Treatment of infertility depends on the root cause for the infertility. Up to 60% of those considered technically infertile became pregnant (numbers do not include IVF) upon receiving fertility treatments of treatments aimed at curing the underlying cause.
One out of every five couples diagnosed as infertile eventually becomes pregnant without treatment.
Treatment for infertility may be as simple as education about the proper timing for sexual intercourse to become pregnant.
Medications may be prescribed to promote ovulation, treat infections, or clotting disorders.
Assisted Reproductive Technology Procedures like IUI (intrauterine insemination) and IVF (in vitro fertilization) may be used.
How To Cope With The Emotional Aspect of Infertility:
Whether you are coping with infertility or someone you love is trying to ride the roller coaster of infertility, there are a lot of emotions associated with infertility and the inability to get pregnant easily.
Here are some tips for coping with infertility:
Find and locate others (perhaps through a support group) that are experiencing the isolation and challenges of infertility. It’s a very lonesome time for many couples – having someone(s) around who are able to understand exactly what you are going through can be a lifesaver.
Don’t be afraid to tell others what you are going through – if they do not know, it’s impossible for them to be sensitive to what you are going through.
Be prepared to deal with the assholes who don’t understand WHY you feel so saddened about being unable to easily conceive. Prepare a list of comebacks to dish out to anyone who wants to trivialize what you’re going through.
Protect your feelings. If going to a baby shower is going to be tremendously challenging for you, simply do not go. Send a gift card and be done with it. You have enough things to deal with – don’t borrow trouble.
Be honest with your partner about your feelings, but do not expect your partner to mimic your feelings exactly. No two people grieve alike.
Speaking of grief, infertility is a loss and is allowed to be mourned. Being unable to conceive a child can be one of the greatest losses you will ever face.
If your grief and sadness become too powerful, don’t be afraid to talk to a mental health professional. He or she can help you as a sounding board and help to teach you coping strategies.
Additional Infertility Resources:
Resolve provides timely, compassionate support and information to people who are experiencing infertility and to increase awareness of infertility issues through public education and advocacy.
The InterNational Council on Infertility Information Dissemination, INC. (INCIID – pronounced “inside”) is a nonprofit organization that helps individuals and couples explore their family-building options. INCIID provides current information and immediate support regarding the diagnosis, treatment, and prevention of infertility and pregnancy loss, and offers guidance to those considering adoption or child-free lifestyles.
Still Standing Magazine – an online magazine focusing on encouraging women, men and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family and even medical professionals, to know how to support someone enduring child loss and/or infertility.
Last audited 7/2018