Don’t put your life on hold. Continue to focus attention and energy on activities that you enjoy and on goals where you have a degree of control.
Don’t put your life on hold. Continue to focus attention and energy on activities that you enjoy and on goals where you have a degree of control.
- What is Infertility?
- What causes infertility?
- How is infertility diagnosed?
- About treatment options
- Quick Facts About Infertility
In general, infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex. Women with infertility should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility. Reproductive endocrinologists may also be able to help women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.
Pregnancy is the result of a process that has many steps.
To get pregnant
- A woman’s body must release an egg from one of her ovaries (ovulation).
- A man’s sperm must join with the egg along the way (fertilize).
- The fertilized egg must go through a fallopian tube toward the uterus (womb).
- The fertilized egg must attach to the inside of the uterus (implantation).
Infertility may result from a problem with any or several of these steps.
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.
No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.
The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.
The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.
Rates of infertility and miscarriage increase with age. A woman’s fertility peaks in her late 20s. It gradually begins to decline in her early 30s. A more pronounced drop in fertility and increase in miscarriage risk begins around her mid-30s. This is primarily due to the aging egg supply. Male fertility also decreases with age. But it is a more gradual decline than in women.
It’s crucial that men get tested for fertility as well as women. Yes, it can be embarrassing, but discovering male fertility problems early can mean earlier treatment and a successful pregnancy. Male infertility testing can also spare women unnecessary discomfort and expense.
Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception.
If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.
Many couples who have problems getting pregnant arrive at a common point: They must decide whether they want to try assisted reproductive technology (ART).
- In vitro fertilization (IVF) is the most common type of ART. In this treatment, a fertilized egg or eggs are placed in the woman’s uterus through the cervix.
- Intracytoplasmic sperm injection, or ICSI (say “ICK-see”). In a lab, your doctor injects one sperm into one egg. If fertilization occurs, the doctor puts the embryo into the woman’s uterus.
Treatment for the woman
Treatment for fertility problems in women depend on what maybe keeping the woman from getting pregnant. Sometimes the cause is not known.
- Problems with ovulating. Treatment may include taking medicine, such as:
- Clomiphene. It stimulates your ovaries to release eggs.
- Unexplained infertility. If your doctor can’t find out why you and your partner haven’t been able to get pregnant, treatment may include:
- Hormone injections.
- Blocked or damaged tubes. If your fallopian tubes are blocked, treatment may include tubal surgery.
- Endometriosis. If mild to moderate endometriosis seems to be the main reason for your infertility, treatment may include laparoscopic surgery to remove endometrial tissue growth. This treatment may not be an option if you have severe endometriosis. For more information, see the topic Endometriosis.
Treatment for the man
Your doctor might recommend that you try insemination first. The sperm are collected and then concentrated to increase the number of healthy sperm for insemination.
- Infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body’s ability to perform the basic function of reproduction.
- Impaired fecundity (the inability have a child) affects 6.7 million women in the U.S. — about 11% of the reproductive-age population (Source: National Survey of Family Growth, Centers for Disease Control and Prevention [CDC] 2006-2010).
- In a survey of married women, the CDC found that 1.5 million women in the US (6%) are infertile (Source: National Survey of Family Growth, Centers for Disease Control and Prevention [CDC] 2006-2010).
- Infertility affects men and women equally.
- Twenty-five percent of infertile couples have more than one factor that contributes to their infertility.
- In approximately 40 percent of infertile couples, the male partner is either the sole cause or a contributing cause of infertility.
- Irregular or abnormal ovulation accounts for approximately 25 percent of all female infertility problems.
- Most infertility cases — 85% to 90% — are treated with conventional medical therapies such as medication or surgery.
- Twelve percent of all infertility cases are a result of the woman either weighing too little or too much.
- It is possible for women with body weight disorders to reverse their infertility by attaining and maintaining a healthy weight.
- Men and Women who smoke have decreased fertility.
- The risk of miscarriage is higher for pregnant women who smoke.
- Up to 13 percent of female infertility is caused by cigarette smoking.
- Chlamydia causes about 4 to 5 million infections annually in the United States. If left untreated, chlamydia can cause infertility
About the psychological component
Infertility often creates one of the most distressing life crises that a couple has ever experienced together. The long term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. If you find yourself feeling anxious, depressed, out of control, or isolated, you are not alone.
One of the most challenging aspects of the infertility experience is dealing with the emotional ups and downs relating to medical treatment, the uncertainty about outcomes, and the challenge of having to make important decisions such as when ‘enough is enough.’ It is important to learn how to take care of yourself, make sure that you get the support you need, and to manage your emotions so that your self-esteem and outlook on life remains as positive as possible.
What does a couple who has just been diagnosed with a fertility problem have in common with a couple who just had their fourth miscarriage? The level of anguish may not be the same, but these two couples do have a lot in common: a sense of loss and disappointment, and the feeling of emotions and events being out of control. For both couples a basic assumption—that by being decent people who try hard in life, your wishes will be fulfilled—has been shattered.
Even if your mind isn’t consciously thinking about loss, your unconscious mind and your body may be responding to feelings of grief. Do you recognize any of the following symptoms that either appeared or worsened during your infertility experience:
lack of energy (especially when you have an unsuccessful cycle, on medical appointment days or when you will see a pregnant friend)
irritability (snapping at people or making mountains out of molehills)
inability to concentrate
The best way to get back to “business as usual” is to take care of the emotional business at hand. And there’s nothing wimpy about healthy grief work – it calls on all of your courage and resourcefulness. A Zen proverb says, “The way to control a bull is to give it a big pasture.” Paying attention to grief ends its power over you. Give grief its due and you’ll find the energy and concentration to get on with your life. See a mental health professional if you feel that infertility is making it hard to cope day in and day out.
Denial, Shock and Numbness
After several months of unsuccessful attempts to get pregnant or stay pregnant, feelings of shock or numbness may result. Feelings of “this can’t be happening to us” or “I know next month we will be successful” begin to change over to anger and guilt.
Anger usually results from feeling vulnerable or helpless or both. Helpless feelings result from the lack of control that you may feel over your life plan, your body, and your future. This may be a new experience; previously, when you worked hard at something, you probably achieved your goal. Now you are working hard and doing everything you can to conceive, but without reaching your desired goal. A sense of vulnerability evolves from feeling “jinxed,” or feeling that life isn’t fair. You may feel as if you can no longer count on anything good happening in your life.
Anger can consume you, coloring your everyday thoughts and experiences. You may feel emotionally guarded, pulled between tears and sadness or anger and rage. The next time you feel angry, irritable, or frustrated, take an inventory of your body and identify how different parts of your body respond to the angry feelings. Do your legs feel weak? Does your heart beat faster? Do you feel flushed or shaky? Does your breathing change? Become familiar with how you react physically to these intense emotions.
Remember that anger is a normal response to infertility. You may find it helpful to try some of these techniques to manage angry feelings. There is no “right” way to do this; don’t force it, and don’t expect a specific response. Tears and feelings of sadness often mingle with anger.
- Take a blank sheet of paper and list all of the things in your life that you are angry with
- Get active physically
- Express your anger but use “I feel” statements rather than attacking a family member or friend.
- Talk about your anger with a counselor or therapist who can help you process and deal with your emotions
Guilt and Shame
Shame is a searing, painful feeling associated with faltering self-esteem, and a sense of inadequacy, defectiveness and helplessness. As repeated attempts to get pregnant come to naught, there is a realization that this intensely strived-for goal has not been, and may never be, attained. As this failure becomes more and more evident, one’s self-image is assaulted. It is easy to move from procedures that have failed to the feeling that “I am a failure.” Anguish, self-doubt, and chronic sadness converge as couples come to think of themselves as failing, not only in realizing their own dream to reproduce and nurture, but failing their spouse, parents, and siblings as well. Because shame embodies the painful sense of self-defect, it is often hidden and disguised, even from oneself. The tragic story of chronic infertility is that, over a period of time, the sense of failure gradually and imperceptibly spreads like a shadow over a person’s experience, while simultaneously the sense of other competencies gradually becomes obscured.
Ultimately what heals is the acceptance of the self with all of its weaknesses and failures. The goal, then, is to reach a point where you can accept what you see as failure and no longer have to conceal these feelings of shame. The process of coming to terms with infertility is long and gradual, but it is possible to transform the sense of failure into an empathy with yourself, an affirmation of your strength, an acceptance of your limits, a pride in your endurance, and maybe most of all, an empathy with others who, as partners in the human condition, also face defeats. In time, the shadow cast upon your life can fade and the light can shine through again.
How do I know if I could benefit from psychological counselling?
Everyone has feelings and emotional ups and downs as they pursue infertility treatment. Feeling overwhelmed at times is a perfectly normal response.
However, if you experience any of the following symptoms over a prolonged period of time, you may benefit a great deal from working with a mental health professional:
- loss of interest in usual activities
- depression that doesn’t lift
- strained interpersonal relationships (with partner, family, friends and/or colleagues)
- difficulty thinking of anything other than your infertility
- high levels of anxiety
- diminished ability to accomplish tasks
- difficulty with concentration
- change in your sleep patterns (difficulty falling asleep or staying asleep, early morning awakening, sleeping more than usual for you)
- change in your appetite or weight (increase or decrease)
- increased use of drugs or alcohol
- thoughts about death or suicide
- social isolation
- persistent feelings of pessimism, guilt, or worthlessness
- persistent feelings of bitterness or anger
In addition, there are certain points during infertility treatment when discussion with a mental health professional of various options and exploration of your feelings about these options can help facilitate clarification of your thinking and help with your decision making. For example, consultation with a mental health professional may be helpful to you and your partner if you are:
- at a treatment crossroad
- deciding between alternative treatment possibilities
- exploring other family building options
- considering third party assistance (gamete donation, surrogacy)
- having difficulty communicating or if you have different ideas about what direction to take
How can I find a mental health professional experienced in working with infertility?
Make sure you choose a mental health professional who is familiar with the emotional experience of infertility.
It is recommended that they have:
a graduate degree in a mental health profession
a license to practice
clinical training in the psychological aspects of infertility
experience in the medical and psychological aspects of reproductive medicine
Interview more than one person. Ask them for their credentials as well as their experience with infertility issues and treatments.
To find a mental health professional, ask your fertility specialist for names of people that he/she would recommend.