With April 21 through April 27 marking National Infertility Awareness Week, it is an important time to practice understanding, confront stigma, and educate ourselves a bit on the struggles many individuals face. Here, we're explain what is infertility, exactly, as well as the common causes and treatments.
It's so important, especially now, to embrace and share knowledge regarding something so many women and couples face. Brides spoke with Dr. Steven Spandorfer, obstetrician-gynecologist at NewYork-Presbyterian and Weill Cornell Medicine to learn more.
What Is Infertility?
Infertility is a bit of a broad category, defined specifically by age and length of time spent trying unsuccessfully to conceive. Generally speaking, Spandorfer explains the term can be applied to, "Women above the age of 35 years trying for six months, or women 35 years and younger trying for 12 months."
Perhaps surprisingly, conception itself is a bit more difficult than you may have once thought, even amongst healthy, fertile couples. He explains, "After three months of trying, 50% of couples are pregnant. And after six months of trying, 75% of couples have achieved a pregnancy." Farther down the line, after 12 months, the number rises to 85%; while after 24 months of trying, over 90% of couples have achieved a pregnancy on their own.
It's important to clarify, however, "These numbers are age dependent, and for women over 35 and definitely 40 years, these numbers are less."
Infertility can be both male and female related, too. Spandorfer says, "In many couples, there is more than one factor involved. In up to 15 % of couples, no exact etiology can be found."
Some of the most common causes of infertility in women include, "ovulatory issues, tubal factors, endometriosis, and age-related issues."
For men, he says, "It usually involves an issue with his semen analysis—either abnormal counts, abnormal motility, or an abnormal shape for the sperm. Occasionally, for men, it involves an inability to ejaculate during vaginal intercourse."
When to Seek Help
When to seek the help of a fertility specialist depends on your unique situation. In general, Spandorfer recommends that if you are under 35 years old, you should seek help after one year of trying. If you're older, speak to a specialist after six months.
However,"If there are known issues—such as irregular cycles and no ovulation, known history of chemotherapy for either partner, or ejaculatory dysfunction for a man—a woman may seek help sooner," Spandorfer says.
Spandorfer also suggests that couples consider pre-conception counseling before seeking fertility treatment. This would include preconception genetic tests which, "evaluate risks for a variety of genetically inherited conditions."
Spandorfer stresses, "It cannot be emphasized enough how important maternal age is. It accounts for over 80% of fertility success."
If you seek the help of a specialist, your first consultation will generally begin with a detailed history and physical, usually from both partners. "In addition, the doctor will often perform an ultrasound to evaluate the uterus and ovaries to get a sense of a woman’s ovarian reserve," says Spandorfer.
After the evaluation, there will also be blood work to assess your hormonal levels and ovarian reserve. Standard tests you can expect to be ordered include, "semen analysis, Hysterosalpingogram [a test to diagnose blocked fallopian tubes], day-three hormone tests [blood drawn on the third day of your cycle], and AMH (anti-mullerian hormone) levels," Spandorfer explains.
As you may suspect, there is no one-size-fits-all fertility treatment. It largely depends on your test results, history, and goals.
"For women with ovulatory issues, they will often first start with medications to induce ovulation. They may try this initially with timed intercourse," Spandorfer says.
"Ovulation induction involves taking oral medications to stimulate the release of more than the one egg a woman usually produces each month. Often, this is combined with intrauterine insemination [or IUI], which involves placing the husband's washed sperm sample into the uterus." If this doesn't work after several attempts, many women will proceed with IVF (in vitro fertilization).
It's important to note that, "Infertility therapies have evolved as the science has advanced and many women that could not conceive a generation ago are now able to benefit from fertility therapies," says Spandorfer. A hopeful statement for anyone struggling.
"It can’t be emphasized enough that infertility is a couple's issue," Spandorfer says, adding that usually all tests should be obtained before therapy is initiated.
Unfortunately, a significant challenge for couples seeking treatment is that not all insurance plans cover infertility and its treatments. "A couple should know their coverage before they get involved with therapy," he advises."
Overall, it is important to remember (and not just during National Infertility Awareness Week) that Infertility is a disease. It impacts 15% of all couples attempting pregnancy. It is common. It is often treatable.