What is Infertility Anyway?

Reprinted with permission from Protect Your Fertility, sponsored by ASRM Infertility is a disease that affects the reproductive organs of both men and women. It impairs one of the body’s most basic functions: the ability to have children. Infertility affects about 6.1 million people in the United States alone; ten percent of the reproductive-age population-both men and women. However, just like lung cancer and HIV/AIDS, infertility can often be prevented. But only if people are aware of risk factors such as smoking, sexually transmitted infections, age, unhealthy body weight, using steroids, etc., well in advance of trying to conceive. Decisions and choices that you make in your teens and twenties can affect your fertility for years to come. What am I doing that can cause infertility?Female Risk Factors Infertility is a disease that affects the reproductive organs of both men and women, impairing one of the body’s most basic functions-the ability to have children. And just like diseases like lung cancer or HIV/AIDS, infertility can often be prevented. Far too many people are not aware of this last point. Actions people take long before they may be ready to have children can impact their ability to eventually conceive. What Can I Do? Smoking Body Weight Safe Sex Aging Visit Your Doctor Smoking If you smoke, you are most likely aware of the health risks involved. But you probably don’t know that smoking also can affect your ability to have children. Former U.S. Surgeon General C. Everett Koop, MD, clearly stated in his warning about smoking that women who smoke have decreased fertility. In fact, a study in Great Britain showed that up to 13 percent of female infertility is caused by cigarette smoking. Menopause (ovarian failure) occurs about two years earlier in women who smoke. Quitting smoking will not only benefit your health and lengthen your life; it will also help protect your fertility. For more information about smoking, visit the American Lung Association’s website at http://www.lungusa.org. ASRM’s Paper on Smoking and Infertility (Microsoft Word document) ASRM’s Public Service Announcement on Smoking and Infertility (Adobe Acrobat document) Weight Twelve percent of all infertility cases are a result of a woman either weighing too little or too much. As a culture obsessed with body image, the American paradox is that we are both starving ourselves and gaining more weight by the minute. Both excess and deficiency of body fat can lead to infertility. To protect your chances of conceiving, maintain a healthy weight through proper nutrition and exercise. (Your Body Mass Index should be between 18-24 kg/M².) For more information about nutrition, visit the American Dietetic Association’s website at http://www.eatright.org. ASRM’s Paper on Body Weight and Infertility (Microsoft Word document) ASRM’s Public Service Announcement on Body Weight and Infertility (Adobe Acrobat document) ASRM’s Patient Fact Sheet on Exercise, Weight and Fertility Sexually Transmitted Infections Everyone knows that if you don’t practice safe sex, you might get pregnant. However, most people don’t know that if you don’t use a condom now, you may never get pregnant in the future. Sexually transmitted infections (STIs) such as chlamydia and gonorrhea are a leading cause of infertility, often have no symptoms, and can be prevented by regular use of condoms. If you want to improve your chances of having a baby in the future, practice safe sex now. For more information about STIs, visit the Center for Disease Control’s website section on STI prevention at http://www.cdc.org. ASRM’s Paper on STIs and Infertility (Adobe Acrobat document) ASRM’s Public Service Announcement on STIs and Infertility (Adobe Acrobat document) Age It is a biological fact that there is a decrease in fertility with advancing age. As many women delay childbearing, there has come to be an unrealistic expectation that medical science can undo the effects of aging. While women and their partners must be the ones to decide the best time when (and if) to have children, women in their twenties and early thirties are most likely to conceive. ASRM’s Paper on Aging and Infertility (Microsoft Word document) ASRM’s Fact Sheet on Prediction of Fertility Potential in Older Female Patients (Adobe Acrobat document) ASRM’s Patient Guide on Age and Fertility (Adobe Acrobat document) ASRM’s Public Service Announcement on Aging and Infertility (Adobe Acrobat document) Fertility and Age Statistics from the Centers for Disease Control Protect Your Fertility and Visit Your Doctor Visit your ob-gyn once per year. In addition to cancer prevention, you can also protect your fertility. Pay attention to your medical procedures, and work with your doctor to prevent inappropriate medical treatment (e.g., surgery done prematurely that could later affect your fertility). Listen to your body-if you have irregular or painful menstrual cycles, your body may be trying to tell you something. See your doctor. For more information, also see ASRM’s Fact Sheets on Stress and Infertility (Adobe Acrobat document) Unexplained Infertility (Adobe Acrobat document) Additional InformationFrequently Asked QuestionsStats and FactsGlossary of Common Terms What is Infertility? Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality. 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. What Causes Infertility? 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 female factors. 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 azospermia (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, a genetic disease such as cystic fibrosis or a chromosomal abnormality causes infertility in men. 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 can be associated with repeated miscarriages. How is Infertility Diagnosed? Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will ask many questions and 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 ovulation, x-ray of the fallopian tubes and uterus, and perhaps a laparoscopy. For men, the initial test is a semen analysis. How is Infertility Treated? Most infertility cases -- 85 to 90 percent -- are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. In a recent government survey, it was reported that only five percent of infertility was treated with in vitro fertilization. Do Insurance Plans Cover Infertility Treatment? The degree of services covered depends on where you live and the type of insurance plan you have. Twelve states currently have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New York, Ohio, Rhode Island and Texas. However, the laws vary greatly in their scope of what is and is not required to be covered. For more information about the specific laws for each of those states, please refer to the State Infertility Insurance Laws page of the ASRM Web Site. ASRM believes the desire to have children and be parents is one of the most fundamental aspects of being human. People should not be denied insurance coverage for medically appropriate treatment to fulfill this goal. What impact does infertility have on psychological well-being? 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. Stats and Facts Infertility affects 6.1 million American women and men, about 10 percent of the reproductive age population. 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% -- can be treated with conventional medical therapies such as medication or surgery. While vital for some patients, in vitro fertilization and similar treatments account for less than 5% of infertility services, and only three hundredths of one percent (.003%) of U.S. health care costs. Twelve percent of all infertility cases are a result of the woman either weighing too little or too much. Women who are infertile as the result of body weight disorders can conceive spontaneously if their weight disorder is corrected. Men and Women who smoke have decreased fertility. The risk of spontaneous abortion 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.