Estimated reading time: 7 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
Infertility is a deeply personal and often challenging experience that affects millions of women and couples worldwide. In fact, in the United States, infertility affects approximately 12.7% of women of reproductive age each year. Beyond a medical condition, it is an emotionally complex experience that affects many aspects of life stemming from emotions and relationships. For those struggling on the path to parenthood, processing an infertility diagnosis and weighing the available treatments and options can feel overwhelming.
Infertility does not discriminate. LGBTQIA+2S individuals and couples experience infertility challenges. In later blogs, we will be addressing the unique obstacles faced by this community, such as navigating a heteronormative healthcare system, fertility preservation, and family planning options like adoption and surrogacy.
Over the next 6 weeks we will be covering topics of infertility from the daily emotional toll and what to expect at doctor visits to treatment options like IVF and egg freezing. We will also cover lifestyle factors, the impact of sexual health, and the medications commonly prescribed.
Whether you are starting to think about family planning and explore your fertility or are deep in the process, PatientsLikeMe is here to help you feel informed and supported, no matter your circumstance.
Different Types of Infertility: Primary and Secondary Infertility
Infertility is defined as the inability to conceive after 12 months or more of regular, unprotected sex. It affects both men and women, with a variety of causes ranging from hormonal imbalances to structural issues with reproductive organs.
Infertility is categorized as primary or secondary.
- Primary infertility is when a pregnancy has never been achieved.
- Secondary infertility is when there’s been at least one prior pregnancy, but the couple is now unable to conceive again.
Primary infertility can be particularly distressing because couples may feel they’ve never had the opportunity to be pregnant. It may feel unfair or like a punishment and it deeply affects their self-worth. On the other hand, secondary infertility can carry its own emotional complexities. There is an added layer of confusion and frustration because they already have a child or children and didn’t expect to face these difficulties.
Potential Causes of Infertility
The causes of primary and secondary infertility can include many factors and it's important that you and your partner discuss these potential causes with your doctors if they apply.
Advanced maternal age (age 35 and older)
Fertility gradually starts to decrease around the age of 35 and more rapidly around 37. At the time of birth, people with a uterus are born with all the eggs they will ever have and as you age, both the quality and quantity of eggs decreases. By the age of 45, pregnancy is highly unlikely but still possible (with risks) until menopause begins.
Impaired sperm production
Low sperm count, also known as oligospermia, is when a man’s semen contains lower than normal sperm. Azoospermia is the total absence of sperm. These are caused by other medical conditions, medication, environmental exposures such as chemicals or radiation, and past surgeries.
Damaged fallopian tubes
One form of fallopian tube damage is hydrosalpinx, where fluid builds up in one or both fallopian tubes, creating a blockage. A blocked fallopian tube prevents sperm from reaching an egg. If sperm does make it to fertilize an egg, the blockage can prevent the embryo from reaching the uterus. Hydrosalpinx is present in 10% - 20% of infertility cases related to fallopian tubes. Other forms of damage include pelvic inflammatory disease, STIs, or past ectopic pregnancies.
Endometriosis
Endometriosis, or sometimes known as endo, happens when tissue similar to the lining of the uterus grows outside of the uterus and on other places it does not belong such as the ovaries, fallopian tubes, and the tissues that hold the uterus in place. The American Society for Reproductive Medicine found that 24% to 50% of women with infertility have endometriosis.
Uterine conditions
These are conditions that begin in the uterus or are caused by hormones or other factors outside of the uterus. These include; uterine fibroids, polyps, scar tissue, radiation damage, or injuries to your uterus. Uterine factor infertility affects approximately 3% of people with a uterus that haven’t experienced menopause.
Polycystic Ovary Syndrome (PCOS)
PCOS is a leading cause of infertility. This condition affects your hormones and causes irregular menstrual periods, excess hair growth, acne and infertility. The etiology of PCOS is multifactorial, involving a combination of genetic, hormonal, and environmental factors. The two leading causes are hyperandrogenism and insulin resistance.
Excessive weight or underweight (in both men and women)
Weight can be a factor contributed to infertility. In women being overweight or underweight can affect their menstrual cycles and ovulation. But obese and underweight women can also get pregnant without issues. Check with your healthcare provider for other conditions such as thyroid disease, insulin resistance, and diabetes which may be affecting your ovulation. In overweight men, they experience low sperm counts and reduced sperm motility compared to those with normal weight.
Lifestyle factors such as smoking and heavy alcohol use
In men, a study showed there is a correlation between a high intake of tobacco and alcohol and azoospermia, the total absence of sperm.
Certain medications
Some medications and recreational drugs may affect ovulation or the body’s receptiveness to pregnancy. It is important that you discuss medication changes with your doctor if you have fertility concerns. Here are some medications or drugs to look for:
- prescription NSAIDs
- risperdal (a psychiatric medication)
- spironolactone
- tobacco
- cannabis
- chemotherapy
LGBTQIA+2S Representation in the Data
According to WHO, infertility affects 15% of heterosexual couples in the United States. WHO data does not account for LGBTQIA+2S couples or single people who want to have a child. LGBTQIA+2S individuals and couples experience different challenges from heterosexual couples such as needing donor sperm or eggs, finding a surrogate, or utilizing fertility preservation options.
Finding Support and Community
Understanding infertility means acknowledging both the medical complexities and the emotional tolls. For our transgender and non-binary friends, fertility preservation before hormone therapy or surgery adds another layer to this process– we will be covering this process in greater detail later. The road to parenthood can be exhausting, requiring medical interventions, emotional resilience, and perhaps a reevaluation of what family means to each person. As we continue, we will explore these aspects in greater depth.
PatientsLikeMe puts you in control of your health by providing you the tools and community support you need to manage your fertility journey. Join others who share their experiences with infertility and insights, offering advice and encouragement. Track your symptoms, treatments, and outcomes with ease, making it easier to see the full picture of your health and communicate better with your healthcare team. You can also evaluate the effectiveness of treatments based on comprehensive patients' data. Join for free today.
Resources
Weigel, G., Ranji, U., Long, M., & Salganicoff, A. (2020, September 15). Coverage and use of fertility services in the U.S. | KFF. KFF. https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/view/footnotes/
Advanced maternal age. (2024, April 22). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/advanced-maternal-age
Hawkins, D. (2023, August 8). As infertility rates rise, data shows much of the US lives in a ‘fertility desert.’ WWNO. https://www.wwno.org/public-health/2023-08-08/as-infertility-rates-rise-data-shows-much-of-the-us-lives-in-a-fertility-desert
Low sperm count - Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/low-sperm-count/symptoms-causes/syc-20374585
Hydrosalpinx. (2024, May 1). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/24437-hydrosalpinx
Endometriosis | Office on Women’s Health. (n.d.). OASH | Office on Women’s Health. https://www.womenshealth.gov/a-z-topics/endometriosis
Endometriosis. (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
Uterine factor infertility. (2024, May 1). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17738-uterine-factor-infertility
World Health Organization: WHO & World Health Organization: WHO. (2023, June 28). Polycystic ovary syndrome. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
Weight and fertility patient education fact sheet. (n.d.). ReproductiveFacts.org. https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/weight-and-fertility/
Basic M, Mitic D, Krstic M, Cvetkovic J. Tobacco and alcohol as factors for male infertility-a public health approach. J Public Health (Oxf). 2023 Jun 14;45(2):e241-e249. doi: 10.1093/pubmed/fdac042. PMID: 35485418; PMCID: PMC10273357.
Geng, C. (2024, July 25). Which drugs can affect fertility in females? https://www.medicalnewstoday.com/articles/drugs-that-cause-infertility-in-females