Understanding Infertility

INFERTILITY

is not your fault.

You are not alone. We can help.

If you and your partner have been unable to have a baby on your own, it is important to know that you can get help. Over 6 million women and 15-20% of couples in the United States are unable to get pregnant. Infertility affects both women and men and all races, ethnicities and sexual orientations. 

What is infertility?

Infertility is commonly described as the inability to get pregnant after a year of not using a method to prevent pregnancy.

Is that one year a hard and fast rule? The answer is no. Couples who have a recognized cause for their infertility should seek attention immediately. 

Who should seek treatment right away?

• Women who have irregular and unpredictable cycles

• Women who have a history of pelvic inflammatory disease (PID), including chlamydia or gonorrhea

• Women with a history of surgery for moderate to severe endometriosis

• Women who have had a prior ectopic pregnancy or history of tubal surgery

• Men with a history of testicular cancer or prior significant surgery to the testicle

What does it take to become pregnant? 

Steps for pregnancy:

Problems with even just one of these steps may result in infertility.

Figure 1.1 Steps for pregnancy.

Risk factors for infertility

Certain factors put both women and men at a higher risk of infertility:

Age

Age should be a key factor in a woman’s decision to seek a fertility evaluation. 

Keep in mind that a woman’s egg supply forms while she is in her mother’s womb midway through pregnancy. From the time of birth onwards, a woman is continuously losing eggs. Her egg supply cannot be replenished.

The “window of opportunity” begins to narrow as a woman approaches her mid-20s. It is wise for women who are 35 years old to seek an evaluation if they have not conceived within six months of stopping a method to prevent pregnancy. 

By age 40, the decline in a woman’s fertility accelerates; therefore, she should begin her fertility testing if she is unsuccessful after three months.

Men may also see a decline in the quantity and quality of their sperm as they age.

Figure 1.2 The effect of a woman's age on estimated monthly pregnancy rates.

Smoking

Most people understand that smoking increases the risk for heart, vascular, and lung disease. Many do not realize that smoking can also lead to problems with fertility in both men and women. Erectile dysfunction and pregnancy complication rates also increase with smoking.

Weight

Menstrual dysfunction and problems with ovulation occur more commonly in women who are overweight or obese. These women have a higher risk for reproductive health issues including subfertility, infertility, miscarriage, and pregnancy complications. 

Women who are underweight, with a BMI less than 18.5, may also struggle with infertility. These women may experience hormone imbalances that affect ovulation. Additionally, they may have a higher risk for pregnancy complications such as preterm birth and low birth weight for the baby. 

Obesity may adversely impact hormone levels in the male and reduce male fertility.

Sexual history

Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected intercourse with multiple partners increases the risk of a sexually transmitted infection that may cause fertility problems later.

Alcohol

Drinking alcohol may cause problems with menstruation and ovulation, which can then impact fertility. For men, drinking alcohol can lower testosterone levels, cause erectile dysfunction, and decrease sperm production. Consume no more than one alcoholic drink per day.

Emotional stress

Stress in and of itself does not cause infertility. In other words, a woman doesn’t make herself infertile because she feels stressed.

Causes of infertility 

Common causes of fertility problems in women include: 

• Hormonal problems or lack of ovulation. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods. If a woman is not ovulating, an egg is not available to be fertilized by the sperm.

• Blocked fallopian tubes. A history of past pelvic infection (PID) such as chlamydia, gonorrhea, prior ectopic pregnancy, or tubal surgery may indicate a problem with the fallopian tubes.

• Problems with the uterus. Problems such as fibroids, endometrial polyps, or scar tissue inside the womb may impede the ability for pregnancy to occur.

• Endometriosis. Moderate or severe endometriosis increases the risk for infertility.