Infertility can be a long, complicated journey. Those who know firsthand the struggles of infertility describe its physical, mental and emotional toll as both heartbreaking and hopeful. According to RESOLVE: The National Infertility Association, one in eight U.S. couples of childbearing age is diagnosed with infertility. However, through new research and technological advancements, couples have more ways to achieve a successful pregnancy.
Dr. Eli Reshef, a reproductive specialist and medical director of INTEGRIS Bennett Fertility Institute, offers the following parameters for when couples may need assistance.
“A fertility specialist – a reproductive endocrinologist, preferably board-certified – should be consulted if the couple has failed to get pregnant after one year of attempts if the female partner is under age 35, or six months if she is 35 or older,” he says.
Reshef adds that a couple may need to see a specialist sooner if the woman has irregular menstrual cycles, blocked tubes (especially from a tubal ligation) or if there is knowledge of severe risk factors for the man, including a vasectomy.
Dr. Stanley Prough, a fellowship-trained reproductive endocrinologist at Tulsa Fertility Center, also recommends that couples seek help early.
“Some people will wait years before they visit a specialist, and during that time they may have lost their window of opportunity,” he says. “See a specialist sooner rather than later, and be open to more aggressive treatments.”
Prough says everyone has a different version of success.
“For some people, success can be adding to their family by having a child, while for others it can be learning what the problem is. In all of these cases, the people didn’t choose the path they are on – it’s been given to them, and it can be an extremely stressful journey,” he says. “There may be treatment options they do or don’t want to use, but they now understand what is going on.”
A couple may experience problems with fertility for many reasons. Infertility is often thought of as a woman’s problem, so many people are surprised to learn about the causes and prevalence of male infertility.
Reshef explains that one-third of infertility is due to male risk factors, one-third to female risk factors and one-third to either a combination of the two or unexplained factors.
“Male factor infertility may be due to infection, genetic causes, external conditions that adversely affect sperm – excess heat, testosterone intake, other anabolic steroids, high level exposure to pesticides, herbicides or paint thinners – or sexual dysfunction, including erectile dysfunction and loss of sex drive,” he says. “Most male factors, however, are unknown.”
Reshef cites the most common causes of female infertility as tubal disease (commonly caused by sexually transmitted diseases, such as chlamydia), endometriosis, ovulation problems, including polycystic ovary syndrome, and cervical mucus abnormalities. Additional causes include genetics, obesity and stress due to excessive exercising, excessive dieting and lifestyle choices. He notes that many female factors, unfortunately, are also unknown.
For both men and women, smoking can contribute to infertility.
As the trend continues for women to wait until their 30s and 40s to have children, age and its role in fertility is an important discussion.
“Age is a key factor in females,” says Reshef. “The number of eggs gradually decreases in women, reaching critically lower levels after age 35. Along with the reduction in eggs comes an increase in genetic abnormalities in the remaining eggs. Therefore, women over age 35 experience greater rates of infertility and more miscarriages and more children with chromosomal abnormalities, such as Down syndrome. In short, women over age 35 who try to conceive face three major hurdles: getting pregnant, staying pregnant and having a healthy child.”
For men, the chances of fathering a child with birth defects slightly increases over age 50.
Still, with many celebrities drawing national attention for having a baby later in life, couples may make the assumption that pregnancy is easily achievable despite the odds.
“If you see a star that is older who has had a baby, you have to consider their circumstances,” says Dr. Shauna McKinney, a fellowship-trained reproductive endocrinologist at Tulsa Fertility Center. “They have either had numerous opportunities due to their financial backing or they have used different methods to become pregnant which they have kept private.”
With such long lists of reasons for why couples may not conceive, it’s clear why many feel discouraged. However, McKinney believes in the possibilities for every couple and speaks from a place of personal understanding.
“The patients we see are often heartbroken. They are afraid that the thing they want most won’t happen,” she says. “At Tulsa Fertility Center, our doctors and staff are open in sharing our own fertility stories. We look at where they have been, what they have been doing and where they are going. It’s about shedding our clinical demeanor and realizing we’re all in this together, and that it’s a human journey.”
Today, through advancements in reproductive medicine, a wide range of fertility treatments and options are available. Some women may benefit from fertility drugs to assist with ovulation or from laparoscopic surgery if endometriosis or tubal disease is a factor. Intrauterine insemination, frequently referred to as artificial insemination, may be suggested if there is a potential problem with the man’s fertility or complications with the woman’s cervix.
The most aggressive procedures – and most expensive – include assisted reproductive technologies, such as the commonly known process of in vitro fertilization – mature eggs are removed from a woman, fertilized with a man’s sperm in a laboratory, and the developing embryos are implanted in the woman’s uterus. Couples may also consider using a donor egg, sperm or embryo. In some cases, a surrogate may be used in which a woman carries and delivers a child for another person or couple.