National Infertility Awareness Week 2021

For one in eight couples in the United States infertility is one of the most challenging experiences of their relationship. Anyone can have difficulty conceiving, regardless of age, gender, or access to quality health care. Conception is a process with many steps leading to pregnancy, and if a health condition affects any of these steps, fertility can be impaired. Infertility can cause serious emotional strain for a couple, and awareness of fertility issues helps to remove the stigmas and shame that often surround them.

The Facts About Infertility

Infertility is thought of as a women's health issue, but male conditions can be a factor as well:

• 6 percent of married women aged 15 to 44 in the United States are unable to get pregnant after a year or more of trying.
• 12 percent of women are have difficulty getting pregnant or carrying a pregnancy to term, a condition known as impaired fecundity.
• In 35 percent of couples with infertility, there is both a male and female factor.
• One-third of couples with a woman older than 35 years have a fertility problem.
• 8 percent of couples with infertility have only a male cause.

Causes for Women

A woman's reproductive system requires ovaries, fallopian tubes, and a uterus for pregnancy, and conditions in any of these organs can be a factor in infertility.

Disruption of ovarian function -- anovulation (lack of ovulation) can be caused by a number of conditions:

• Polycystic ovary syndrome (PCOS).
• Diminished ovarian reserve: women are born with all of their eggs, and over time their egg count decreases.
• Functional hypothalamic amenorrhea (FHA): sometimes associated with anorexia, and caused by excessive stress, exercise, or low body weight.
• Hormonal disorders: Conditions that affect the proper functioning of the hypothalamus or pituitary glands, which produce the hormones that maintain ovarian function.
• Menopause.
• Premature ovarian insufficiency (POI): ovarian failure before a woman is 40 years of age.

Fallopian tube obstruction: tubal occlusion, or blocked fallopian tubes, can occur because of a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, endometriosis, or a history of abdominal surgery.

Abnormal uterine contour: the presence of fibroids (benign tumors) or other abnormalities in the shape of the uterus.

Causes for Men

Infertility is a complicated condition and can spring from many different factors in men as well as women. In men, these can include:

Disruption of testicular or ejaculatory function -- Conditions that affect the function of the testes or the amount and condition of sperm present within them, as well as a man's ability to transfer them:

• Varicoceles: enlarged, overheated testicles affecting the number and shape of sperm.
• Physical trauma to the testes.
• Unhealthy habits: heavy alcohol use, smoking, illicit drug use, anabolic steroid use.
• Certain medications or supplements.
• Cancer treatments, especially testicular removal.
• Medical conditions: diabetes, cystic fibrosis, certain autoimmune disorders, and certain infections.

Hormonal disorders: Conditions that affect the proper functioning of the hypothalamus or pituitary glands, which produce the hormones that maintain testicular function. These can include tumors, exposure to excessive estrogen or testosterone, congenital adrenal hyperplasia, Cushing’s syndrome, and chronic use of glucocorticoids

Genetic disorders: These can include Klinefelter’s syndrome, Y-chromosome microdeletion, myotonic dystrophy, or other disorders that reduce sperm count.

Risk Factors

Many different factors can increase a person or couple's risk of fertility complications, and these factors can result from both lifestyle behaviors and genetics. Some of these risk factors affect both genders:

• Age: increased age also leads to increased risk of infertility.
• Smoking.
• Excessive alcohol use.

Risk factors for women include:

• Extreme weight gain or loss.
• Amenorrhea: absent periods stemming from extreme physical or emotional stress.

Risk factors for men include:

• Obesity or being overweight.
• Regular exposure of the testes to high temperatures, such as frequent wheelchair use, or regular use of hot tubs and sauna.
• Drug use, particularly marijuana.
• Exposure to testosterone: from legitimate medications or for illegal medications to increase muscle mass.
• Radiation exposure.
• Exposure to environmental toxins such as pesticides, lead, cadmium, or mercury.

Treatments

Treatments for infertility are available. When making recommendations, doctors take into account the contributing factors, duration of infertility, and the age of the woman. Couples who undergo counseling about treatment options often have preferences, as well. These treatment options include:

• Medications: often ones that stimulate ovulation or increase the amount of mature eggs produced.
• Surgery.
• Intrauterine insemination: artificial insemination, in which specially prepared sperm are inserted into the uterus.
• Assisted reproductive technology (ART): all treatments that involve handling eggs and embryos outside of the woman's body, typically combining the eggs and sperm in a laboratory and returning the embryos to the body. In vitro fertilization (IVF) is the most common option.