This informational guide, part of POPSUGAR's Condition Center [1], lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.
Although infertility can feel incredibly isolating, it's not uncommon. The condition, which is defined as not being able to get pregnant after trying for one year, affects about one in eight couples [2]. Even so, there's a lot of shame and stigma associated with infertility, says Betsy Campbell, chief engagement officer at Resolve: The National Infertility Association [3]. "Studies show [4] a diagnosis of infertility is as stressful as a cancer diagnosis," she says. That's why it's important to know as much as you can about the condition, including its causes, its treatments, and, most urgently, where to seek support.
Understanding Infertility
"Infertility affects men and women equally," Campbell says. "About one-third of cases are due to female factors, one-third are due to male factors, and another third is a combination — or unexplained."
In order to get pregnant, a number of things have to take place. One of the ovaries has to release an egg, a sperm has to meet and fertilize the egg, and the fertilized egg has to make its way through a fallopian tube to the uterus, where it must successfully attach to the uterine wall. If something goes wrong anywhere during that process — and so many things can — a pregnancy won't happen.
While fertility does decline with age [5], because the quality and/or quantity of eggs and sperm [6] decline over time, age isn't the only factor. Smoking, excessive alcohol use, exposure to environmental toxins, certain medications, and physical or emotional stress (especially when it causes the loss of menstruation) can all impact fertility as well.
Causes of Infertility
Fertility challenges can stem from a variety of underlying problems, per Mayo Clinic [7].
- Anything that affects ovulation may impact fertility. That includes conditions like polycystic ovary syndrome or early menopause, but also environmental factors like a period of acute stress.
- Blocked fallopian tubes can also lead to infertility. Factors such as a pelvic infection, the STI chlamydia, and endometriosis can all block the fallopian tubes.
- Physical characteristics of the uterus — such as fibroids, adhesions, and endometrial polyps — can also make pregnancy more difficult.
- Sperm production and delivery problems are also a cause of infertility. This can result from genetic conditions, certain infections (e.g., chlamydia, gonorrhea, mumps, or HIV), enlarged testes veins, or premature ejaculation and blockage in the testicles. Frequent heat exposure [8] (think: sitting in a hot tub or putting your laptop in your lap) can have negative consequences on sperm levels, too.
- Environmental factors including excess exposure to lead [9], prolonged [10] and heavy alcohol use [11], and cigarette smoking [12] can affect all genders' fertility as well.
Most Effective Infertility Treatments
While infertility is technically defined as "trying" for 12 months without getting pregnant, if you're over 35, a doctor may treat you after six months of having unprotected sex since fertility tends to decline with age, as does the effectiveness of fertility treatments.
Reproductive endocrinologists use a variety of approaches to treat the underlying causes of infertility, including medications that stimulate ovulation, intrauterine insemination, and assisted reproductive technology (ART), which includes all treatments in which the eggs or embryos are treated outside the body. The most commonly used and effective type of ART is in vitro fertilization, or IVF. In the procedure, mature eggs are retrieved from one person's ovaries and fertilized in a lab with sperm. Then the fertilized eggs are transferred to the uterus. The likelihood of having a baby from the procedure depends on a variety of factors, including the parents' ages, the underlying cause of infertility, and the clinic that delivers the treatment. (The CDC publishes ART success rates at clinics across the US [13].)
But your doctor may not have you jump straight into medications and medical procedures. "A reproductive endocrinologist will also help you address lifestyle issues that may be affecting your fertility, like smoking, stress, and weight," Campbell says.
"The emotional stress of the process can be tremendous," Campbell adds. "Seeking emotional support is as important as seeking medical help." That's especially true given that many doctors agree that stress can interfere with fertility. Resolve: The National Infertility Association [14] has information on peer-led and professional-led support groups, as well as a directory of mental health professionals.