Infertility refers to a reproductive health issue where an individual or couple is unable to conceive after consistently attempting for a year. This condition may arise from problems such as irregular ovulation, endometriosis, diminished sperm production, or low testosterone levels. Age is a significant factor, with fertility challenges increasing over time. Thankfully, numerous medical interventions exist to assist individuals facing infertility.
Overview
Understand how fertility is impacted by aging.
Defining Infertility
Infertility is a dysfunction of the reproductive system that hinders a woman’s ability to conceive. This condition can affect individuals of any gender and may stem from various underlying causes. Conception requires the successful completion of several biological events:
- The brain must release hormones that regulate the ovaries.
- An egg must develop within the ovary.
- The ovary must expel the mature egg (a process called ovulation).
- The egg must be collected by the fallopian tube.
- Sperm must reach the egg by traveling through the vagina and uterus into the fallopian tube.
- Fertilization must occur to create an embryo.
- The embryo must then move into the uterus and successfully implant itself.
If any of these steps are disrupted, pregnancy will not occur.
For individuals under 35, a diagnosis of infertility is typically made after 12 months of unprotected, regular intercourse without conception. For those 35 and older, this period shortens to six months.
Infertility is more widespread than often assumed, but there are many effective treatments to help those who want to start or grow their families.
Different Forms of Infertility
Infertility can be categorized into several types:
- Primary infertility: Inability to become pregnant after at least one year (or six months for women over 35) of regular, unprotected sex, without ever having conceived before.
- Secondary infertility: Difficulty conceiving again following a previous successful pregnancy.
- Unexplained infertility: When tests do not identify any clear reason why pregnancy hasn’t occurred.
Prevalence of Infertility
Infertility affects both men and women and is fairly common. In the U.S., approximately 20% of women aged 15 to 49 face primary infertility, while nearly 5% struggle with secondary infertility. Globally, around 48 million couples experience fertility challenges.
Symptoms and Causes
Indicators of Infertility
The clearest indication of infertility is the inability to achieve pregnancy after six to twelve months of regular, unprotected intercourse. While many experience no other signs, some men and women may notice symptoms such as:
- Discomfort in the lower abdomen or pelvic region.
- Irregular, absent, or abnormal menstrual cycles or bleeding.
- Issues related to ejaculation or penile function.
Root Causes of Infertility
Infertility may result from a wide array of causes, and sometimes no singular reason is found. Only a medical professional can identify the specific cause and recommend appropriate treatments.
Statistical studies show that:
- One-third of infertility cases originate from female factors.
- Another third are due to male-related issues.
- The remaining third either involve both partners or lack a defined cause.
Moreover, 25% of couples facing infertility may have multiple contributing issues.
General Risk Factors for Infertility
Some infertility risk factors impact just one partner, while others can affect both. These include:
- Advancing age — particularly for women over 35 and men over 50.
- Disordered eating behaviors like anorexia or bulimia.
- Heavy alcohol consumption.
- Exposure to harmful environmental substances such as pesticides, lead, and industrial chemicals.
- Excessive physical training.
- Cancer treatments like radiation or chemotherapy.
- Sexually transmitted infections.
- Tobacco use — linked to 13–15% of infertility cases.
- Drug abuse.
- Body weight extremes — both obesity and being underweight.
- Hormonal imbalances due to brain disorders.
- Chronic illnesses and health conditions.
Female-Specific Causes
Problems with ovulation are the leading contributors to infertility in women. Ovulation must occur for fertilization to take place. Other potential causes include:
- Endometriosis.
- Malformations in the reproductive tract.
- Autoimmune conditions like lupus or celiac disease.
- Renal disease.
- Chronic pelvic infections.
- Disorders affecting the hypothalamus or pituitary gland.
- Polycystic ovary syndrome (PCOS).
- Premature ovarian failure or suboptimal egg quality.
- Sickle cell disease.
- Fibroids or polyps in the uterus.
- Thyroid gland disorders.
- Surgical sterilization procedures.
- Genetic anomalies.
- Sexual dysfunction.
- Congenital or surgically removed ovaries.
- Irregular or missed menstrual cycles.
Male-Specific Causes
For men, infertility typically stems from issues with sperm — including their shape, count, or motility. Other causes include:
- Varicocele, or enlarged veins in the scrotum.
- Genetic diseases like cystic fibrosis.
- Chromosomal abnormalities, such as Klinefelter syndrome.
- Excessive heat exposure from tight garments, hot tubs, or heated electronics near the groin.
- Physical trauma to the testicles or scrotum.
- Insufficient testosterone levels.
- Improper use of anabolic steroids.
- Sexual dysfunctions including erectile issues or abnormal ejaculation.
- Undescended testes.
- Past cancer therapies.
- Missing testicles due to birth defects or surgery.
- Prior vasectomy.
Diagnosis and Tests
Diagnostic Methods for Female Infertility
To evaluate infertility, doctors begin by gathering a comprehensive overview of a woman’s health and sexual history.
Fertility requires regular ovulation and proper hormonal signaling between the brain and ovaries. A variety of diagnostic tools help pinpoint any disruption in these processes:
- Pelvic exam: Detects any structural or pathological abnormalities.
- Hormone testing: Blood samples help assess if hormonal imbalances exist and whether ovulation is occurring.
- Ultrasound scan: A transvaginal probe provides detailed images of the reproductive organs.
- Hysteroscopy: A small camera is inserted vaginally to examine the uterus.
- Saline sonohysterogram (SIS): Uses saline to expand the uterus for clearer ultrasound imaging.
- Sono HSG: Combines saline and air bubbles to evaluate the fallopian tubes for blockages.
- X-ray HSG: Dye is injected into the uterus and tubes, which are then imaged to detect obstructions.
- Laparoscopy: A minor surgical procedure involving a camera-equipped tube to identify issues like endometriosis or scarring.
Diagnostic Methods for Male Infertility
Identifying infertility in men generally focuses on examining sperm quality and production.
- Semen analysis: Measures sperm count and movement. In some cases, sperm is extracted directly from the testicles.
- Blood testing: Evaluates hormonal health and checks for genetic abnormalities.
- Scrotal ultrasound: Detects structural issues such as varicocele.
Management and Treatment
How is infertility treated?
The approach to treating infertility is primarily guided by its root cause and what the individual or couple hopes to achieve. Factors such as age, duration of attempts to conceive, and personal treatment preferences all play a role in determining the appropriate course of action. Sometimes, only one partner may need intervention, but in other cases, both partners may require treatment.
Most women and couples facing infertility have promising prospects for achieving pregnancy. Options such as hormonal therapy, surgical interventions, and assisted reproductive technologies (ART) offer significant help. Additionally, lifestyle improvements and optimizing sexual timing and frequency can enhance the likelihood of conception. Often, a tailored blend of these methods yields the best results.
Options for Female Infertility
Women experiencing fertility challenges may explore several types of treatments:
- Adopting a healthier lifestyle: Making adjustments such as reaching a healthy weight, quitting smoking or drugs, and managing underlying medical conditions can support reproductive health.
- Fertility medications: These drugs encourage ovulation by stimulating the ovaries to release more eggs, thereby boosting pregnancy chances.
- Surgical procedures: Operations can remove blockages in the fallopian tubes or eliminate fibroids, polyps, and scar tissue.
Medical professionals might also suggest ways to enhance natural fertility, including:
- Monitoring ovulation by tracking basal body temperature, observing cervical mucus consistency, or using fertility apps.
- Employing over-the-counter ovulation predictor kits to identify the most fertile days.
Treatment for Male Infertility
Men dealing with infertility may benefit from the following treatments:
- Hormonal or erectile dysfunction medications: These can improve testosterone levels or assist in maintaining an erection during intercourse.
- Surgical solutions: Some procedures can remove blockages in the sperm ducts or repair anatomical abnormalities. Surgery to correct varicocele may also enhance sperm quality and fertility outcomes.
Popular Fertility Treatments
When basic methods aren’t sufficient, couples often turn to assisted reproductive technology (ART), which involves medical handling of eggs or sperm. Prior to ART, ovulation-stimulating drugs may be used to maximize success rates. Common ART procedures include:
- In vitro fertilization (IVF): Eggs are collected from the ovaries and combined with sperm in a lab setting. Fertilized eggs (embryos) are then implanted into the uterus.
- Intracytoplasmic sperm injection (ICSI): Typically part of IVF, this technique injects a single sperm directly into an egg. The resulting embryos are placed into the uterus.
- Intrauterine insemination (IUI): Sperm is inserted directly into the uterus via a thin catheter, increasing the chances of fertilization.
- Assisted hatching: This process involves thinning or breaching the embryo’s outer shell to facilitate implantation.
- Third-party ART: This may include the use of donor eggs, sperm, or embryos. Some couples may also need a surrogate or gestational carrier.
Potential Treatment Risks
There are several possible complications related to fertility treatments:
- Multiple births (twins or more): Using fertility medications or transferring multiple embryos can increase the likelihood of multiple pregnancies, which are associated with a higher risk of miscarriage, premature delivery, and neonatal issues.
- Ovarian hyperstimulation syndrome (OHSS): An excessive response to fertility drugs can cause painful, swollen ovaries and may require urgent care.
- Ectopic pregnancy: Assisted reproductive methods like IVF slightly raise the risk of a fertilized egg implanting outside the uterus.
- Unsuccessful cycles: Sometimes, despite treatment, conception doesn’t occur.
Is Infertility Treatable?
In many instances, yes. Roughly 85% to 90% of infertility cases can be addressed through a combination of lifestyle changes, medications, surgery, or ART, allowing women to conceive successfully.
Prevention
Steps to Prevent Infertility
There are preventive measures you can take to safeguard your fertility while trying to conceive:
- Follow a nutritious diet and maintain a body weight that’s appropriate for your frame.
- Avoid tobacco, illicit drugs, and excessive alcohol.
- Seek timely treatment for sexually transmitted infections (STIs).
- Minimize contact with environmental toxins.
- Stay active but avoid overexertion in physical exercise.
- Try not to delay starting a family beyond your peak reproductive years.
- Consider fertility preservation, such as freezing eggs or sperm.
Outlook / Prognosis
Living With Infertility
Fertility treatments lead to pregnancy for about 90% of couples. However, success depends on factors like the underlying cause, the ages of those involved, and overall health.
Dealing with infertility can be emotionally and financially draining. Prioritize self-care and emotional wellbeing, and support each other through this process. Engaging with support groups—whether local or online—can also provide comfort and a sense of solidarity.
Living With
Insurance and Fertility Treatments
Coverage varies by insurance policy, so it’s essential to verify your plan’s specifics. Some policies include medically necessary treatments like surgeries for fibroids or endometriosis. While some may also cover IUI, others might exclude IVF or fertility drugs.
As of June 2022, according to Resolve, The National Infertility Association:
- Twenty U.S. states have laws requiring some form of fertility treatment coverage. Of those, 14 mandate IVF coverage, and 12 include fertility preservation for medically induced infertility.
If you live in a state with such legislation and are unsure of your benefits, reach out to your employer’s human resources or your insurance company.
When to Seek Fertility Help
If you’re under 35 and haven’t conceived after a year of unprotected sex, it’s time to consult a specialist. For those aged 35 to 39, seek help after six months. If you’re 40 or older, don’t wait more than a few months before getting evaluated. Fertility declines with age—while a 25-year-old woman has about a 25–30% chance per cycle, that figure drops below 5% by age 40.
Regardless of gender, early intervention is recommended if there are known risk factors or existing health conditions that could impair fertility. This includes a history of ovarian insufficiency, severe endometriosis, or uterine/tubal abnormalities.
Your primary care doctor or OB/GYN might refer you to a reproductive endocrinologist or urologist for specialized testing and treatment plans.
Important Questions for Your Provider
When discussing infertility with your doctor, consider asking:
- Would it be beneficial to consult a fertility expert?
- Should we both undergo fertility evaluations?
- Given our ages, when is the right time to start testing?
- What treatment approach do you recommend for us?
- What are the chances of success?
- What risks or side effects are associated with this treatment?
- Are there symptoms of complications we should watch for?
Additional Common Questions
Can Chlamydia Lead to Infertility?
Yes. In the U.S., chlamydia causes around 4 million infections annually. Left untreated, it can result in pelvic inflammatory disease (PID), which may irreparably harm reproductive organs such as the uterus, ovaries, and fallopian tubes.
Does Birth Control Affect Fertility?
No evidence suggests that birth control methods impair future fertility. Most individuals can conceive shortly after stopping contraception.
Is Endometriosis Linked to Infertility?
Yes. Endometriosis is a known contributor to infertility, affecting 30% to 50% of women diagnosed with the condition.
