Infertility is defined as the inability to conceive after one year of unprotected intercourse. It affects an estimated 1 in 6 couples, making it a common reproductive issue.
Key Facts and Statistics
- About 10-15% of couples experience infertility. This equates to 6.7 million women in the U.S. having difficulty getting pregnant or staying pregnant.
- 1 in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy.
- 7.4 million women in the U.S. use infertility services at some point in their lives.
- 1 in 4 women will experience infertility by age 35.
- After trying regularly for 6 months, only 75% of normal healthy couples in their mid 30s will conceive in the following 6 months.
- 30% of infertility issues are due to female factors, 30% are due to male factors, 30% are a combination of both male and female factors, and 10% of infertility cases are unexplained.
These statistics show that while infertility is common, the vast majority of couples are eventually able to conceive, either naturally or with medical assistance. Age is a major factor, as fertility declines significantly for both men and women after age 35.
Causes of Infertility
There are many different causes of infertility in both women and men. Here are some of the most common:
Female Causes
- Ovulation disorders – Issues with ovulation account for 30% of female infertility cases. These include irregular or absent ovulation, which can be caused by polycystic ovary syndrome (PCOS), thyroid problems, excessive exercise or stress.
- Tubal occlusion – Blocked or damaged fallopian tubes prevent eggs from traveling from the ovaries to the uterus. This accounts for 20% of female infertility.
- Uterine or cervical factors – Deformities, tumors or lining issues in the uterus or cervix can disrupt implantation of a fertilized egg. This causes 10-15% of infertility cases.
- Endometriosis – When uterine tissue grows outside of the uterus, it can scar and distort reproductive organs. Endometriosis is responsible for less than 10% of female infertility.
- Primary ovarian insufficiency – Also called premature ovarian failure, this disorder causes menopause before age 40. It affects about 1% of women under 40.
Male Causes
- Varicocele – Dilated veins around a man’s testicle causes increased scrotal temperature, lowering sperm count and quality. A varicocele is found in 40% of infertile men.
- Sperm delivery issues – Impaired transport of sperm or blockages due to infections, physical trauma, prior surgeries or abnormalities affect fertility in some men.
- Low sperm count, abnormal sperm – Low sperm motility, abnormal sperm shape and size, or inadequate semen volume can make it difficult for sperm to fertilize an egg. Up to 90% of male infertility is due to these sperm abnormalities.
- Hormonal disorders – Problems with hormones produced by the pituitary gland can lead to low testosterone and reduced sperm production.
- Chromosomal defects – Men born with a chromosome defect such as Klinefelter’s syndrome are more likely to be infertile.
- Cancer/cancer treatment – Chemotherapy, radiation therapy and cancer surgery can sometimes impair sperm production and fertility.
Unexplained Infertility
For about 10-15% of couples, no specific cause of infertility can be found after diagnostic testing. There are likely complex factors at play that are not yet well understood. Research continues to better understand the intricate nature conception and identify new possible causes.
Risk Factors
Several factors have been associated with increased risk of infertility in men and women:
- Advanced age – For women, fertility starts declining at age 32 and drops rapidly after 37. Male fertility declines gradually after 40.
- Smoking, alcohol use, drug abuse – These harmful habits can disrupt ovulation, hormone production and sperm health.
- Being overweight or underweight – Excess or insufficient body fat disrupts hormone balances.
- Chronic conditions – Health issues like polycystic ovarian syndrome, endometriosis, diabetes, autoimmune disorders and thyroid disease heighten infertility risk.
- Sexually transmitted infections – Chlamydia and gonorrhea can cause pelvic inflammatory disease and damage reproductive organs if untreated.
- Exposure to environmental toxins – Pesticides, industrial chemicals, metals and other toxins may interfere with reproductive functions.
Diagnosis
A fertility evaluation begins with a medical history, physical exam and consultation with both partners. Further testing may include:
- Tracking ovulation and menstrual cycles
- Hormone level tests
- Sperm analysis (sperm count, motility and morphology)
- Hysterosalpingography – An X-ray with dye to examine the uterus and fallopian tubes
- Hysteroscopy – Inserting a camera into the uterus to inspect the lining
- Laparoscopy – A tiny incision to insert a camera for viewing the pelvic region
- Genetic tests
- Postcoital test – Checking cervical mucus after intercourse
This thorough diagnostic process helps identify contributing factors for each partner to pinpoint appropriate treatment options.
Treatments
Treatment depends on the cause of infertility and the couple’s preferences. Some options include:
Medications
- Fertility drugs – Clomiphene and gonadotropins stimulate ovulation in women. Hormones like HCG and testosterone support sperm production in men.
- Intrauterine insemination (IUI) – Sperm is washed, concentrated and inserted directly into the uterus around ovulation.
Surgery
- Laparoscopic/hysteroscopic surgery – To remove uterine fibroids, scar tissue, endometriosis or blockages in fallopian tubes.
- Varicocele repair – To normalize sperm parameters in men with varicocele.
Assisted Reproductive Technology (ART)
- In vitro fertilization (IVF) – Eggs are collected and fertilized by sperm in a lab, then transferred to the uterus.
- Intracytoplasmic sperm injection (ICSI) – A single sperm is injected directly into an egg, used with IVF when sperm parameters are very poor.
- Donor eggs or sperm – Eggs or sperm from a donor are used to achieve pregnancy.
- Gestational carrier – When the uterus is unable to sustain a pregnancy, another woman carries the pregnancy to term.
The most effective treatment is determined after testing reveals the underlying cause. Multiple treatments may be used together for those with unexplained infertility or several factors contributing to their difficulty conceiving.
Prevention
Some tips for reducing the risk of infertility include:
- Avoid smoking and recreational drugs
- Limit alcohol intake
- Maintain a healthy BMI
- Exercise moderately
- Avoid excessive stress
- Get sexually transmitted infections diagnosed and treated
- For women – Get regular gynecological care. Speak to your doctor before trying to get pregnant if you have irregular cycles, painful periods, abnormal bleeding or other issues. Consider freezing eggs if planning to delay pregnancy past age 35.
Making healthy lifestyle choices optimizes fertility for both women and men. Tracking menstrual cycles and being aware of changes over time can also help women identify potential issues early. Speaking to your doctor promptly about any concerns supports timely diagnosis and treatment.
Outlook
Infertility can be a frustrating and emotionally painful condition for those trying unsuccessfully to have a baby. However, there are many medical resources available to evaluate and address fertility issues for the majority of couples today. After a thorough diagnosis, treatments tailored to the cause provide most couples struggling with infertility the chance to welcome a long hoped-for baby into their lives.
| Cause | Percentage of Infertility Cases |
|---|---|
| Ovulation Disorders | 25% |
| Tubal Factors | 20% |
| Uterine or Cervical Factors | 10-15% |
| Endometriosis | Less than 10% |
| Primary Ovarian Insufficiency | 1% in women under 40 |
| Varicocele | 40% of infertile men |
| Sperm Delivery Issues | Varies |
| Low Sperm Count/Motility/Morphology | Up to 90% of male infertility |
| Hormonal Disorders | Varies |
| Chromosomal Defects | Varies |
| Cancer/Cancer Treatment Effects | Varies |
| Unexplained | 10-15% |
Conclusion
Infertility is a condition that affects millions of couples hoping to start a family. While the numbers may seem daunting, it’s important to remember that most cases can be treated successfully. Key facts to keep in mind:
- About 15% of couples are affected by infertility – this equates to millions in the U.S. alone.
- 1 in 4 women have difficulty getting pregnant or sustaining a pregnancy by age 35.
- Female and male factors each account for about a third of infertility cases. In 10-15%, no cause is found.
- Advanced age, lifestyle factors and health conditions heighten infertility risk.
- After evaluation, most couples conceive either naturally or with medical assistance.
Despite the prevalence of infertility, there are more diagnostic and treatment options available now than ever before. Today’s technologies offer new hope and high success rates for the millions challenged by fertility issues. With quality medical guidance and support, most couples facing infertility are able to build the family they’ve been longing for.