Infertility is a common problem throughout the world, affecting 1 in 8 couples in the United States. Globally, it's estimated that between 48 million couples and 186 million individuals experience infertility each year.
Infertility may be due to factors from either partner. For many couples, both partners may be diagnosed with medical conditions that may make it more difficult to conceive. Therefore, it is important that both partners undergo fertility testing simultaneously.
For an individual or couple to conceive, there has to be: healthy sperm and eggs, ovulation (release of a mature egg from the ovaries), successful fertilization of the egg by motile sperm, functioning fallopian tubes, and a healthy uterus in which the embryo can implant and develop normally.
If you've recently been diagnosed with infertility you may be feeling overwhelmed and confused regarding the next steps. In this article, we'll cover how infertility is defined, the ways in which it can impact your emotional well-being, and potential paths to overcoming infertility, including those provided by fertility specialists, Reproductive Endocrinology and Infertility (REI) specialists.
What Qualifies As Infertility?
For those under 35, infertility is defined as not being able to conceive (get pregnant) after at least one year of having unprotected sex. Women who are 35 years or older, should schedule an appointment with a fertility doctor after six months of unprotected intercourse. This is because as women age, it becomes more difficult to conceive and treatment should be initiated sooner.
Some couples may be diagnosed with recurrent pregnancy loss, which is defined as having two or more miscarriages. These women usually do not have trouble with the initial conceiving but unfortunately, experience devastating pregnancy losses.
About 85% of couples with normal fertility will conceive within a year of trying. Experts believe that if a couple doesn’t conceive in the first year of having unprotected intercourse, the chances that they will conceive on their own decrease each month.
Impacts of Infertility On Mental Health
Wanting to start a family is usually an exciting time in someone's life. Infertility can, unfortunately, make the journey to parenthood more challenging and distressing than expected.
A high percentage of people facing infertility report dealing with emotional difficulties including feelings of increased stress, fear, sadness, and frustration. Infertility treatments can also be expensive, depending on the individual's insurance, which can cause a financial burden that further increases stress.
If you're facing infertility and feeling dismayed, even if you haven't officially been diagnosed, know that this is common and very understandable. It might feel like everyone else is getting pregnant and delivering healthy babies, while you're unfairly having a harder time.
To deal with the emotional stress and anxiety that infertility can cause, individuals or couples might choose to visit a fertility counselor or therapist. These providers can include psychologists, social workers, or marriage and family therapists.
Counseling is especially encouraged for those with a history of mental health issues such as anxiety or depression, couples struggling with their sexual relationship while trying to get pregnant, individuals hoping to become single parents, and couples working towards third-party conception with help from an egg or sperm donor or surrogate.
Although doctors and staff at fertility centers offer patients plenty of education on different fertility treatments, infertility counselors can provide additional emotional support.
Speaking with a counselor can be beneficial for patients struggling with the infertility process because counseling can:
- Improve the relationship between patients and healthcare providers.
- Assist in decision-making regarding treatment options.
- Teach patients coping skills to help them better deal with stress.
- Provide grief counseling or short-term crisis counseling following events such as a miscarriage or failed IVF or ICSI trial.
Therapists who help individuals or couples dealing with infertility often recommend focusing on what's within their control, rather than fixating on what isn't.
Another avenue of support for people experiencing infertility is online tools, including infertility support groups and moderated forums. These allow patients to connect with others who are going through similar situations and to have common questions and concerns addressed.
Online support groups are great options for patients who prefer to receive support privately from home, or who are concerned about the cost of paying for counseling.
Possible Paths to Parenthood
For those looking to grow their family, preconception health should be prioritized in order to prepare your body for optimal fertility. For example, making an effort to eat a healthy diet, sleep well, manage stress, and take supplements are all steps someone who is facing infertility can take to improve the odds that they'll be able to conceive.
The first step is to evaluate the patient to determine if there is an identifiable cause of one’s infertility. Fertility specialists or other doctors can use a variety of tests, such as semen analysis, tubal evaluation, and ovarian reserve testing, to collect medical information about an individual or both partners.
Once a cause of infertility is found, it can be decided which treatment options are most likely to be successful. Treatment for infertility always depends on the individual case, as there are many potential pathways to becoming pregnant and delivering a healthy baby.
Some common infertility treatment approaches include:
- Use of medications to encourage egg development and ovulation.
- Intrauterine insemination (IUI) to help with egg fertilization. IUI involves having sperm injected into the uterus around the time of ovulation to increase the number of healthy sperm reaching the fallopian times at the time of the fertile window
- Assisted reproductive technologies, including in vitro fertilization (IVF) is a specialized fertility treatment performed by REI physicians, IVF can help with a variety of infertility causes such as low sperm count or damaged or absent fallopian tubes.
- ART procedures can also be used to help patients conceive using, donor eggs, donor sperm, donated embryos, or a surrogate carrier.
Depending on the factors contributing to infertility, the use of medications and/or IUI may be done before IVF. IVF often has significantly higher success rates than IUI, however, IUI is a less invasive and less expensive approach and therefore usually it's attempted first several times if appropriate.
Where to Find Help
Depending on your circumstances, you might wish to start your fertility journey by speaking with your current OB/GYN or Primary Care Physician (PCP) — who can help with preliminary testing — or with a Reproductive Endocrinology and Infertility Specialist.
When should you seek help for infertility?
A general recommendation is for people younger than 35 with no apparent health issues to try conceiving for at least one year before seeing a healthcare provider for help.
Among women aged 35 years or older, it's recommended to visit a doctor after about six months of trying to get pregnant unsuccessfully.
Because certain pre-existing health issues can contribute to infertility — such as irregular menstrual cycles, PCOS, endometriosis, or a history of cancer treatments — people with these risk factors are encouraged to speak with their health care provider early on in their fertility journey for guidance, rather than delaying.
Consider reaching out to either your OB/GYN, PCP, or an REI if any of these risk factors for infertility apply to you:
- Irregular periods or no menstrual periods
- Pelvic inflammatory disease
- Uterine or tubal disease
- A history of more than one miscarriage
- Diminished ovarian reserve
- History of chemotherapy or radiation
- History of testicular trauma
Many patients struggling with infertility choose to work with a fertility specialist, or an REI because an REI can perform thorough tests prior to any infertility treatments in order to gain more advanced knowledge of a patient's fertility status and obstacles.
Fertility specialists typically have cutting-edge technology and equipment and are capable of uncovering a great deal of information about the quality of one's sperm, eggs, anatomy, menstrual patterns, and so on, which can help increase the chances of getting pregnant.