What Is Infertility?
Most people will have the strong desire to conceive a child at some point during their lifetime. Understanding what defines normal fertility is crucial to helping a person, or couple, know when it is time to seek help. Most couples (approximately 85%) will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months. Only an additional 7% of couples will conceive in the second year. As a result, infertility has come to be defined as the inability to conceive within 12 months. This diagnosis is therefore shared by 15% of couples attempting to conceive. We generally recommend seeking the help of a reproductive endocrinologist if conception has not occurred within 12 months. However, there are various scenarios where one may be advised to seek help earlier.
Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile.
Pregnancy is the result of a process that has many steps. To get pregnant:
- A woman’s body must release an egg from one of her ovaries (ovulation).
- The egg must go through a Fallopian tube toward the uterus (womb).
- A man’s sperm must join with (fertilize) the egg along the way.
- The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
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.
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 About Infertility Treatments And Insurance?
Fifteen states have either an insurance mandate to offer or an insurance mandate to cover some level of infertility treatment. Eight of those states have an insurance mandate that requires qualified employers to include IVF coverage in their plans offered to their employees: Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island.
A study published in the New England Journal of Medicine (August 2002) found that the percentage of high-order pregnancies (those with three or more fetuses) was greater in states that did not require insurance coverage for IVF. The authors of the study noted that mandatory coverage is likely to yield better health outcomes for women and their infants since high-order births are associated with higher-risk pregnancies.
The Affordable Care Act (ACA) does not require coverage for infertility treatments. Those states with an infertility mandate that covers IVF may have chosen an Essential Health Benefits (EHB) benchmark plan that includes the IVF mandate. The EHB impacts the individual and small group markets only in each state.
What Are The Types of Infertility?
For many couples, having a child or children is one of the most important goals in their lives. Many people long to be parents and understandably so. Having children can bring great joy and purpose to our lives. Unfortunately, it is not easy for every couple to get pregnant and have a child.
In other cases, a couple may be able to have a child but then struggle to conceive or carry a second child. When a couple struggles to have a child, it is called infertility.
Infertility can take two forms: primary and secondary, but many of the causes and treatments are the same for each type of infertility.
They vary slightly, but overall are caused by the same problems and treated in the same ways. The biggest difference with these two different forms of infertility is the way that they may be perceived by others and the way that they may make you, as a couple, feel.
This resource page will focus upon Primary Infertility.
1.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. Primary infertility refers to the type of infertility that a couple would be diagnosed with when they are unable to have a child at all. A couple suffering with primary infertility is a childless couple that has never been able to conceive a pregnancy or has never been able to carry a pregnancy in order to achieve a live birth.
Having primary infertility can often lead perspective parents into a truly hopeless feeling. If you are unable to have a child, you may feel like it is impossible for you and that you will never have a child at all. You may long desperately to know what it is like to be a parent and have a child, and it is likely that you fear that you will never know that feeling.
These are all completely normal and understandable feelings.
2.Secondary Infertility occurs when couples have been pregnant at least once, but are unable to become pregnant again. This is the type of infertility that many people are unaware of. It is not uncommon to not realize that a couple that already has a child or children can suffer from infertility which is exactly what secondary infertility is.
Secondary Infertility is diagnosed when a couple has conceived a pregnancy and achieved a live birth before but is unable to achieve another pregnancy and live birth. Basically, the couple has a child or children, but is now unable to continue having children.
Secondary infertility comes with its own specific set of problems. It is not uncommon for people to lack understanding of what you are going through. Many people may look at it like since you already have a child or children, that it isn’t a big deal that you aren’t able to have more.
You even may struggle with a feeling of guilt for being unhappy about not being able to have more children. You may feel like you should be happy just having the child or children that you already have. It is important to remember that just because you want more children, it does not mean that you aren’t happy with the child or children that you do have.
It is still hard and unfair when you are unable to choose the size of your family, even if you are able to have one or some children.
Risk Factors for Infertility:
While these are all risk factors for infertility, many times, couples find that none or many of these apply to their situation
Age. A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility. Men over age 40 may be less fertile than younger men are and may have higher rates of certain medical conditions in offspring, such as psychiatric disorders or certain cancers.
Tobacco use. Smoking tobacco or marijuana by either partner reduces the likelihood of pregnancy. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men.
Alcohol use. For women, there’s no safe level of alcohol use during conception or pregnancy. Avoid alcohol if you’re planning to become pregnant. Alcohol use increases the risk of birth defects, and may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.
Being overweight. Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. A man’s sperm count may also be affected if he is overweight.
Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.
Exercise issues. Insufficient exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight. Too much exercise can lead to ovulation problems.
Stress – unfortunately, we all face an enormous amount of stress in our lives and stress is thought to be a factor in infertility for some
Poor diet – eating a proper diet is imperative for both partners in order to achieve – and maintain – pregnancy
Sexually transmitted infections (STIs) – many times a person has an STI and is unaware of it. Unfortunately, some of these STIs can lead to infertility if left untreated
Hormonal Issues – Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency
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.
- You’re age 35 to 40 and have been trying to conceive for six months or longer
- You’re over age 40
- You menstruate irregularly or not at all
- Your periods are very painful
- You have known fertility problems
- You’ve been diagnosed with endometriosis or pelvic inflammatory disease
- You’ve had multiple miscarriages
- You’ve undergone treatment for cancer
- 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.
- You have a low sperm count or other problems with sperm
- You have a history of testicular, prostate or sexual problems
- You’ve undergone treatment for cancer
- You have testicles that are small in size or swelling in the scrotum known as a varicocele
- You have others in your family with infertility 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.
All of the steps during ovulation and fertilization need to happen correctly in order to get pregnant. Sometimes the issues that cause infertility in couples are present at birth, and sometimes they develop later in life.
Infertility causes can affect one or both partners. In general:
- In about one-third of cases, there is an issue with the male.
- In about one-third of cases, there is an issue with the female.
- In the remaining cases, there are issues with both the male and female, or no cause can be identified
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.
Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect the quality of sperm.
Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana or taking certain medications, such as select antibiotics, antihypertensives, anabolic steroids or others, can also affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise the core body temperature and may affect sperm production.
Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.
What Are The Causes of Female Factor Infertility?
While the causes may overlap or vary, these are the most common cause of female infertility:
Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — may also interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include excessive exercise, eating disorders, injury or tumors.
Uterine or cervical abnormalities, including abnormalities with the opening of the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may rarely cause infertility by blocking the fallopian tubes. More often, fibroids interfere with implantation of the fertilized egg.
Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.
Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, radiation or chemotherapy treatment, and smoking.
Endometriosis – the tissue lining the uterus grows and implants itself outside of the uterus, causing damage to the major organs, including the reproductive organs.
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.
Other conditions. Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, poorly controlled diabetes and some autoimmune diseases such as lupus, can affect a woman’s fertility. Genetic abnormalities also can make conception and pregnancy less likely
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 Is Infertility Prevented?
It’s extremely important to remember that most causes of infertility have nothing to do with you and your partner not practicing proper habits. Most of the time, infertility is not preventable. However, here are some things you can try to do to prevent infertility:
Have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Having intercourse beginning at least 5 days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs at the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.
For men, although most types of infertility aren’t preventable, these strategies may help:
- Avoid drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility.
- Avoid high temperatures, as this can affect sperm production and motility. Although this effect is usually temporary, avoid hot tubs and steam baths.
- Avoid exposure to industrial or environmental toxins, which can impact sperm production.
- Limit medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don’t stop taking prescription medications without medical advice.
- Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.
For women, a number of strategies may increase the chances of becoming pregnant:
- Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
- Avoid alcohol and street drugs. These substances may impair your ability to conceive and have a healthy pregnancy. Don’t drink alcohol or use recreational drugs, such as marijuana or cocaine.
- Limit caffeine. Women trying to get pregnant may want to limit caffeine intake. Ask your doctor for guidance on the safe use of caffeine.
- Exercise moderately. Regular exercise is important, but exercising so intensely that your periods are infrequent or absent can affect fertility.
- Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility
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.
March of Dimes – Guidance and information for couples who are trying to get pregnant.
Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss – a book 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.
Page last audited 8/2018