Infertility, defined as the inability to conceive after one year of regular, unprotected intercourse, affects many couples worldwide. The World Health Organization (WHO) estimates that between 48 million couples and 186 million individuals live with infertility globally. Experiencing infertility can feel devastating, especially for those who want to be parents more than anything. This can be a truly emotional time and we want to help by explaining infertility and bringing awareness of the options available that can provide hope and direction.
Understanding Infertility – The Causes
Infertility can result from a variety of factors, which may involve one or both partners. Causes in women may include ovulatory disorders, fallopian tube damage, endometriosis, and uterine or cervical abnormalities. In men, infertility may be due to low sperm count, sperm motility issues, or anatomical problems. Additionally, lifestyle factors such as smoking, excessive alcohol consumption, obesity, and stress can impact fertility in both sexes. Studies suggest that obesity is linked to reduced sperm quality in men and ovulatory disorders in women.
It's estimated that in about one-third of infertility cases, the issue is with the male partner.
Another one-third of fertility issues are due to the female partner, and the remaining cases involve problems with both partners or are unexplained.
Diagnosing Infertility
The first step towards addressing infertility is a thorough evaluation, but when should you begin testing for infertility?
- For most couples after 12 months of trying, the general recommendation is for couples to seek fertility testing if they have not achieved pregnancy after one year of regular, unprotected intercourse. This time frame provides a basis for most couples under the age of 35.
- Women over 35, after 6 months of trying to conceive, should consider seeking fertility evaluation. As fertility can decline more rapidly with age, earlier testing can help identify any issues sooner, which means appropriate measures to help improve fertility can also be taken sooner.
- For known medical conditions or risk factors, couples should immediately consider seeking advice and possible testing before attempting to conceive. This includes women with irregular menstrual cycles, endometriosis, a history of pelvic inflammatory disease, miscarriages, or if either partner has a known genetic condition or history of cancer treatment.
- Men should also consider evaluation if there is a known or suspected risk factor that could affect fertility, such as a history of testicular, prostate, or sexual problems, surgery in the genital area, or if there’s a known low sperm count.
- For couples at any age, a review of health and lifestyle factors with a healthcare provider can be beneficial. This review can address issues like weight, smoking, alcohol use, or exposure to environmental toxins, which can all impact fertility.
Testing for Infertility
When deciding to seek fertility testing, the first step is usually a consultation with your primary healthcare provider or an OB/GYN. They can provide initial assessments (including an exam, lab testing, and possibly imaging) and refer you to a fertility specialist if needed. Fertility testing, for women, may involve blood tests to check hormone levels, ultrasound examinations to assess the uterus and ovaries, and specialized tests to evaluate the fallopian tubes. For men, semen analysis is the primary diagnostic test. Based on these evaluations, we can identify specific issues and tailor a treatment plan.
Treatment Options
Treatment depends on the underlying cause of infertility. Options may include:
- Medications: Fertility drugs can stimulate ovulation in women and improve sperm production in men.
- Surgical Interventions: Procedures like laparoscopy can address endometriosis, remove fibroids, or unblock fallopian tubes. For men, surgery may correct varicoceles or other obstructions.
- Assisted Reproductive Technologies (ART): These include In Vitro Fertilization (IVF), where eggs are fertilized outside the body and the embryo is transferred to the uterus; IVF may also incorporate Intracytoplasmic Sperm Injection (ICSI), which is particularly useful for severe male infertility; and other techniques like gamete or zygote intrafallopian transfer (GIFT or ZIFT). Embryo, egg or sperm donation, along with surrogacy can also be helpful to address certain reproductive challenges.
- Modifying lifestyle factors can significantly impact fertility. Maintaining a healthy weight, quitting smoking and reducing alcohol intake, managing stress, and adopting a balanced diet can all enhance fertility for both partners.
Emotional Support and Counseling
The journey through infertility can be emotionally taxing. Counseling and support groups can offer much-needed emotional support and resources. It's important to communicate openly with your partner and seek support together. Remember you are not alone and talking with others who are experiencing the same hardships can be very helpful.
Alternative and Complementary Therapies
Some couples find complementary therapies like acupuncture, yoga, and meditation helpful in managing stress and potentially, indirectly, improving fertility outcomes. While evidence is mixed, these therapies can offer comfort and relaxation during what can be a stressful time.
Deciding When to Explore Other Options
For some, the journey may lead to considering other paths to parenthood, such as adoption or fostering. These options can fulfill the desire to parent and provide a loving home to a child in need.
Moving Forward
Each couple's fertility journey is unique. It's important to maintain hope, seek support, and explore all options available to you. Your family doctor is a great place to start. Remember, many couples who face infertility go on to have children, whether biologically or through alternative paths to parenthood.
Understanding your fertility and the options available is the first step towards making informed decisions on your journey to parenthood. If you're facing infertility, know that you're not alone, and there are many paths forward. Talk to your doctor today.