Our longing for children is often a deep primal need, and being unable to conceive or carry a pregnancy to term can be devastating. Many of us feel alone as we struggle to get pregnant, decide the line of treatment, and cope with the sorrow and frustration of our bodies failing us month after month.
With “normal” fecundity or fertility, a woman’s ability to get pregnant is “about 15%-20%” per month with properly timed intercourse. So, it still makes sense, and there is a good chance, that a woman who is fecund/fertile might not get pregnant immediately. Every individual who takes a higher than anticipated time to get pregnant is not necessarily ‘infertile’. It’s an oversight to use ‘infertile’ as a blanket term.
A common definition of sub- and infertility is very important for the appropriate management of infertility. Subfertility generally describes any form of reduced fertility with a prolonged time of non-conception. Infertility, on the other hand, may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. Infertility (clinical definition) is currently defined as 1 year of unwanted non-conception with unprotected intercourse in the fertile phase of menstrual cycles. After six unsuccessful cycles, about 20 percent of couples are considered at least slightly subfertile, but one-half of these couples will go on to conceive naturally or spontaneously in the next six cycles — before the definition of infertility sets in.
Definition and prevalence of subfertility and infertility
|Time||Prevalence/grading||Chances to conceive spontaneously in the future|
|After six unsuccessful cycles||About 20% at least slightly subfertile couples||50% of these couples will conceive spontaneously in the next six cycles, the remaining are moderately subfertile [Equivalent to slightly reduced fertility (Habbema et al., 2004)]|
|After 12 unsuccessful cycles (former clinical definition of infertility)||About 10% at least moderately or seriously subfertile couples||50% of these couples will conceive spontaneously in the next 36 months, the remaining are nearly complete infertile [Equivalent to moderately/seriously reduced fertility, (Habbema et al., 2004)]|
|After 48 months||About 5% of nearly complete infertile couples||Couples with only sporadic spontaneous conceptions [Equivalent to a sterile couple (Habbema et al., 2004)]|
In subfertility, the possibility of conceiving naturally exists, but takes longer than average. It is a substantial gray zone between two absolute extremes of being fertile or infertile.
Various researchers have been organized in this regard and have narrowed down some common factors that impair the chances of pregnancy in subfertile women; age, endometriosis, diabetes, ovarian dysfunction, polycystic ovarian symptom (PCOS), and previous history of infection in the genitourinary tract. While other factors such as previous use of hormonal contraceptives, a previous pregnancy or birth, and history of progesterone therapy at any time have been associated to be advantageous for such women.
Some underlying health conditions, such as some particular types of thyroid or adrenal gland disorders, can contribute to subfertility. Whereas, women with autoimmune diseases like rheumatoid arthritis (RA) or lupus are more likely to have premature ovarian insufficiency (egg loss) that can compromise their chances of getting pregnant.
Many lifestyle factors such as the age at which to get pregnant, nutrition, weight, exercise, psychological stress, environmental and occupational exposure, cigarette smoking, illicit drug use, and alcohol consumption can also have a serious impact on the odds of getting pregnant.
In some women who are overweight or obese and have subfertility, weight loss can improve the odds of getting pregnant significantly. Women at risk of decreased fertility also include those with eating disorders, such as anorexia or bulimia, and those who follow a low-calorie or restrictive diet.
Depending on the underlying health status or other symptoms, doctors usually decide the line of treatment for subfertility. This may also include looking for anatomic factors (such as polyps, fibroids, or endometriosis), laparoscopic surgery, checking the hormone levels, or semen analysis. Once the likely culprit is revealed, a course of action to deal with it and resolve it is mapped out.
If you and your partner are struggling to have a baby, you’re not alone. In the United States, 10% to 15% of couples are infertile.
Conception is a complicated process that depends upon many factors:
- The production of healthy sperm by the man and healthy eggs by the woman
- Unblocked fallopian tubes that allow the sperms to reach the egg
- The sperm’s ability to fertilize the egg when they meet
- The ability of the fertilized egg (embryo) to get implanted in the woman’s uterus
- Sufficient embryo quality
Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman’s hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.
Infertility can rock our very foundation – our sense of control over our futures, our faith in our bodies, and our feeling about womanhood. Studies have found infertile women to be more neurotic, dependent, and anxious than fertile women, experiencing conflict over their femininity and fear associated with reproduction.
How long should couples try to get pregnant before seeing a doctor?
This is majorly dependent on the age of the woman. A woman’s chances of having a baby decrease rapidly every year after the age of 35. Most experts suggest women younger than 35 years and with no underlying health/fertility complications try to conceive for one year before seeing a doctor. This time frame comes down to 6 months for women aged 35 years or older. Couples with a reasonably good prognosis (e.g. unexplained infertility) may be encouraged to wait because even with the treatment they do not have a better chance of conceiving.
Irrespective of their ages, couples with the following signs or symptoms should consult a health care provider when they are trying to get pregnant.
- Irregular or no menstrual periods
- Extremely painful periods
- Multiple miscarriages
- Endometriosis or pelvic inflammatory disease
- Suspected male factor (i.e., history of testicular trauma, chemotherapy, infertility with previous partners, hernia surgery)
- Have undergone treatment for cancer
Is infertility just a woman’s problem?
No, infertility is not always a woman’s problem. It may result from an issue with either of the partners or a combination of factors that prevent pregnancy. Infertility in men can be caused by various factors and is typically evaluated with a semen analysis. Hormonal or genetic disorders could also be responsible for male infertility. Fortunately, many safe and effective therapies significantly improve a couple’s chances of getting pregnant. Most couples will eventually conceive, with or without treatment.
How do doctors treat infertility?
While everyone’s journey to fertility is uniquely their own, there are some common elements that virtually all couples who experience infertility issues encounter. The couple will work closely with their physician to develop a personalized treatment path that addresses their cause of infertility while keeping in mind their medical conditions (if any). Doctors recommend specific treatments for infertility based on:
- The factors contributing to the infertility
- The duration of the infertility
- The age of the female
- The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option
Infertility can be treated with medicine, surgery, intrauterine insemination (IUI), or assisted reproductive technology (ART). IUI is often used to treat mild male factor infertility or couples with unexplained infertility. Often, it is used in combination with medication.
Additional options to consider
These are some of the other options for couples as they decide to grow their family:
- Egg Donation: Recommended when a woman is unable to conceive with her eggs but would like to carry or give birth to a baby.
- Sperm Donation: Considered by women with healthy egg quality when the man has poor sperm quality/sperm count.
- Embryo Donation: Selected by those who are unable to conceive with their sperms and eggs, but would like to carry or give birth to a baby.
- Gestational carrier (Surrogacy): Chosen by those who are unable to carry a baby to term or have a uterine problem which could reduce the chances of success or cause early delivery.
- Adoption: Pursued by those who are unable or chose not to have a biologically related child.