According to the current clinical definition, if, after having unprotected sex, a woman is unable to conceive or carry a baby to term, and the condition remains unchanged for at least a year, she may be infertile. In the United States, about 12 percent of women between ages 15 and 44 fit this label. After a year of trying to conceive, couples should consider infertility as a possible reason and seek professional help.
Women who are actively trying to get pregnant may wish to consult a doctor if they are over the age of 40, have irregular or painful periods, have a history of miscarriages, have been diagnosed with pelvic inflammatory disease or endometriosis, or have been treated for cancer.
Women are not always the source of a couple's infertility—in approximately one-third of cases, men may have difficulty with conception. In another third of cases, men are a contributing factor, along with female infertility and other problems. Men should be evaluated by a physician if there is a family history of infertility, if they have undergone cancer treatment, if they have small testicles, a swollen scrotum, or a low sperm count, or if they have any other testicular, prostate, or sexual problems.
If a physician believes infertility is a concern, a number of tests will be administered. For women, these may include ovulation testing, ovarian reserve testing, hormone testing, and hysterosalpingography (X-rays of the fallopian tubes) or other imaging tests. Assessing male infertility involves semen analysis, which examines the number of sperm, as well as their motility and shape, also known as morphology. Other tests for men may include hormonal and genetic testing, testicular biopsy, and additional imaging.
Every woman is born with a set number of eggs, which declines as she ages. To get pregnant, an egg released from a woman’s ovaries must be fertilized by sperm, travel down the fallopian tube, and attach to the side of her uterus. At any stage along the way, a problem may occur, resulting in a case of infertility.
Couples experiencing infertility have a range of treatment options. However, infertility treatment can come with many obstacles, including high costs, time burden, physical pain, shame and embarrassment, and social stigma. Talking to a trusted family member, friend, or therapist can often help men and women process the mix of complex emotions.
For women, the most common causes of infertility are primary ovarian insufficiency (early menopause), ovulation disorders affecting egg release, uterine or cervical abnormalities, endometriosis (where tissue grows outside of the uterus), fallopian tube blockage or damage, polycystic ovary syndrome, and various hormonal imbalances. Certain cancers and their treatments can also negatively impact a woman’s fertility.
Male infertility may be caused by trouble with sperm delivery due to structural difficulties like testicle blockage or damage to the reproductive organs, sexual function concerns such as premature ejaculation, or genetic conditions including cystic fibrosis. Another root of male infertility may be abnormal sperm function or production, often due to genetic defects or health problems including diabetes or certain sexually transmitted diseases. Other risk factors include overexposure to certain environmental factors, such as alcohol, cigarette or marijuana smoke, chemicals, and pesticides, as well as frequent exposure to high temperatures (hot tubs and saunas). Specific cancers and their treatments can also be harmful to male fertility.
Women can take fertility drugs to stimulate ovulation, or undergo certain surgeries and procedures, like intrauterine insemination, which carefully places healthy sperm in the uterus right before an egg is released to increase the chances of fertilization. Men can also take fertility medication or undergo surgery to increase the chances of conception.
Assisted reproductive technology (ART) includes any treatments that handle both eggs and embryos outside the body. The most common type of assisted reproductive technology is in vitro fertilization (IVF). Other techniques may include special injections or using a donor's eggs or sperm. Complications can sometimes occur, the most common being bleeding or infection, ovarian hyperstimulation syndrome, in which the ovaries become swollen and painful, and multiple pregnancies.
Alternative therapies are often used in conjunction with conventional treatments. Certain lifestyle changes can help improve the odds of conception: adequate sleep, maintaining a healthy weight, eat well, quit smoking, cut back on alcohol and caffeine, and get regular, moderate exercise. Many people tout the benefits of yoga, meditation, and mindfulness. Specific vitamins can boost the reproductive system, including vitamins A, B6, B12, C, and E, folic acid, zinc, and essential fatty acids. Be sure to run any supplements by your doctor before starting a new regimen.
Infertility can have a profound impact on one’s mental health. When men and women find out that they can’t conceive, they may experience the same painful emotions as anyone coping with grief or profound loss. Common reactions include shock, frustration, grief, anger, decreased self-esteem, anxiety, and depression, but feelings about infertility can vary greatly depending on the source of the problems. Men, in particular, find it far easier to deal with a partner’s infertility than with their own.
Along with being physically demanding, fertility treatments can also spark a roller-coaster of emotions each month, including hope, anger, disappointment, sadness, and guilt. Just the sight of a pregnant woman can evoke strong negative and stressful feelings. During this time, those struggling with infertility may pull away from friends and family who remind them of their difficulty with reproduction; some of their closest relationships may suffer.
Couples might also find that their sex life suffers from the high expectations and routines of fertility treatment, as they may experience dips in self-esteem, desire, and performance. Sex, which was once a source of joy and emotional connection, can become a source of frustration and failure. Sharing complicated feelings and separating lovemaking from babymaking can help couples stay sexually connected during infertility treatment.
It’s normal to feel jealousy and other negative emotions when other couples seem to have no trouble conceiving. Managing pregnancy jealousy can be tricky. Instead of giving in to guilt, acknowledge your difficult emotions. Focus on what you can control—feel free to pass on other people’s baby showers, keep active in hobbies, join a support group, or talk to a therapist.
No, but dealing with infertility can often lead to stress, depression, anxiety, and even, in some cases, PTSD. If you notice that you (or someone you care about) are suddenly experiencing difficulty making decisions, severe disorganization, or dependency issues, it’s time to take stock of your mental health.