What is Infertility? Symptoms, Causes, & Treatment

Infertility is when a couple can't get pregnant after trying for a year or more with regular, unprotected sex. If you're over 35, doctors typically look into it after six months of trying. This affects about 1 in 8 couples, so you're definitely not alone if you're facing this challenge.

The journey can feel overwhelming and emotionally draining. Many couples assume pregnancy will happen quickly, so when it doesn't, it can bring up feelings of confusion, frustration, and even isolation. Understanding what infertility means and what options are available can help you feel more in control during this difficult time.

What is infertility?

Infertility means your body is having trouble with the process of getting pregnant or staying pregnant. It's a medical condition, not a personal failing or something you've done wrong. About 35% of cases involve female factors, 35% involve male factors, and 30% involve both partners or unknown causes.

There are two main types of infertility. Primary infertility means you've never been pregnant before, while secondary infertility means you've had at least one pregnancy but are now having trouble conceiving again. Both types are equally valid medical conditions that deserve attention and care.

Your reproductive system is complex, involving many steps that need to work together perfectly. From ovulation to fertilization to implantation, any disruption along the way can make pregnancy difficult. The good news is that many of these issues can be identified and treated.

What are the symptoms of infertility?

The main symptom of infertility is simply not getting pregnant after trying for the recommended time period. However, your body might give you other clues that something needs attention. These signs can help you and your doctor understand what might be happening.

For women, symptoms that might indicate fertility challenges include:

• Irregular periods or periods that come less than 21 days apart or more than 35 days apart
• Very painful periods that interfere with daily activities
• No periods at all for several months when you're not pregnant or breastfeeding
• Unusual bleeding between periods or after sex
• Pain during sex that wasn't there before
• Excessive hair growth on your face or body
• Unexplained weight gain or difficulty losing weight

Men might notice fewer obvious symptoms, but some signs can include problems with sexual function, pain or swelling in the testicles, or changes in hair growth patterns. Often though, male fertility issues don't cause noticeable symptoms, which is why testing is so important.

Remember, having one or more of these symptoms doesn't automatically mean you have infertility. Many treatable conditions can cause these issues. The key is talking with your healthcare provider about what you're experiencing so they can help figure out the best next steps for you.

What causes infertility?

Infertility can happen for many different reasons, and sometimes multiple factors are involved. Understanding the possible causes can help you feel more prepared for conversations with your doctor and any tests they might recommend.

The most common female causes include problems with ovulation, where your ovaries don't release eggs regularly or at all. Conditions like polycystic ovary syndrome (PCOS), thyroid disorders, or being significantly over or underweight can affect ovulation. Blocked fallopian tubes, often due to infections or endometriosis, can prevent the egg and sperm from meeting.

Endometriosis, where tissue similar to your uterine lining grows outside the uterus, affects about 10% of women of reproductive age. It can cause inflammation and scarring that interferes with fertility. Fibroids, which are non-cancerous growths in the uterus, can also make it harder to get pregnant depending on their size and location.

For men, the most common issues involve problems with sperm production, movement, or shape. This can happen due to infections, hormone imbalances, genetic conditions, or exposure to certain chemicals or heat. Varicoceles, which are enlarged veins in the scrotum, can affect sperm quality and are found in about 15% of men overall.

Age plays a significant role for both partners, but especially for women. Your egg quality and quantity naturally decline as you get older, with more noticeable changes typically starting in your mid-30s. Men's fertility also decreases with age, though usually more gradually.

Sometimes, despite thorough testing, doctors can't find a specific cause. This is called unexplained infertility, and it accounts for about 10-15% of cases. While this can feel frustrating, many couples with unexplained infertility can still achieve pregnancy with appropriate treatment.

When to see a doctor for infertility?

You should consider seeing a doctor if you're under 35 and have been trying to conceive for 12 months, or if you're 35 or older and have been trying for 6 months. Don't feel like you need to wait if you have concerns earlier than this, especially if you have irregular periods or other symptoms.

Certain situations warrant seeing a doctor sooner rather than later. If you have a history of pelvic inflammatory disease, endometriosis, or previous abdominal surgery, it's worth getting checked earlier. The same goes if you've had cancer treatment, have irregular periods, or if your partner has a history of testicular problems.

Start with your primary care doctor or gynecologist, who can do initial testing and refer you to a fertility specialist if needed. A reproductive endocrinologist is a doctor who specializes specifically in fertility issues and can offer more advanced testing and treatment options.

Remember, seeking help early doesn't mean you're giving up on conceiving naturally. It simply means you're being proactive about understanding your body and exploring all your options. Many couples find that getting answers, even if it's just confirmation that everything looks normal, helps reduce anxiety and stress.

What are the risk factors for infertility?

Several factors can increase your chances of experiencing fertility challenges. Being aware of these risk factors can help you make informed decisions about your reproductive health and when to seek medical advice.

Age is the biggest risk factor, especially for women. Your fertility starts to decline gradually in your late 20s and more noticeably after 35. By 40, your chances of getting pregnant naturally each month drop to about 5%. For men, fertility also decreases with age, but the decline is typically more gradual.

Lifestyle factors play a significant role in fertility for both partners. Smoking can damage eggs and sperm, and even secondhand smoke exposure can be harmful. Excessive alcohol consumption, being significantly over or underweight, and high stress levels can all impact your ability to conceive.

Certain medical conditions increase infertility risk. For women, this includes PCOS, endometriosis, thyroid disorders, and autoimmune conditions. Previous pelvic infections or sexually transmitted infections can cause scarring that blocks fallopian tubes. For men, conditions like diabetes, cystic fibrosis, or a history of undescended testicles can affect fertility.

Environmental and occupational exposures can also play a role. Regular exposure to chemicals, radiation, or extreme heat can impact sperm production. Some medications, including certain antidepressants and blood pressure medications, can temporarily affect fertility.

Having one or more risk factors doesn't mean you'll definitely have fertility problems. Many people with multiple risk factors conceive without difficulty, while others with no apparent risk factors may struggle. The key is being aware of these factors so you can discuss them with your healthcare provider.

What are the possible complications of infertility?

While infertility itself isn't dangerous to your physical health, it can lead to emotional and relationship challenges that are important to acknowledge and address. Understanding these potential complications can help you prepare and seek appropriate support.

The emotional impact of infertility can be profound and shouldn't be underestimated. Many people experience grief, depression, anxiety, and feelings of loss of control. The monthly cycle of hope and disappointment can be emotionally exhausting. Some people also struggle with feelings of guilt, shame, or inadequacy, even though infertility is a medical condition, not a personal failure.

Relationships can face strain during fertility challenges. Partners may cope differently with the stress, leading to communication problems or feelings of isolation. The pressure of timed intercourse, medical appointments, and treatment decisions can affect intimacy and spontaneity in your relationship.

Financial stress is another common complication, as fertility treatments can be expensive and aren't always covered by insurance. This financial burden can add another layer of stress to an already challenging situation.

Some fertility treatments themselves can have side effects or complications. Fertility medications can cause mood swings, hot flashes, and other symptoms. More intensive treatments like IVF carry small risks of complications, though serious problems are rare when performed by experienced professionals.

Social complications can also arise, as friends and family members may not understand what you're going through. Well-meaning but insensitive comments can be hurtful, and social gatherings involving pregnancy announcements or baby showers can become difficult to navigate.

The good news is that support is available for all of these challenges. Counseling, support groups, and stress management techniques can be incredibly helpful. Many fertility clinics have social workers or counselors specifically trained to help couples navigate these emotional aspects of treatment.

How is infertility diagnosed?

Diagnosing infertility involves a systematic approach to identify any factors that might be preventing pregnancy. Your doctor will typically start with a detailed medical history and physical exam for both partners, then move on to specific tests based on what they find.

For women, the initial evaluation usually includes blood tests to check hormone levels and determine if you're ovulating regularly. These might include tests for follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, progesterone, and thyroid hormones. Your doctor might also test for conditions like PCOS or check your ovarian reserve, which gives an idea of how many eggs you have left.

An ultrasound can help evaluate your ovaries and uterus, looking for issues like fibroids, polyps, or cysts. A hysterosalpingography (HSG) is a special X-ray test where dye is injected through your cervix to check if your fallopian tubes are open and your uterus is normally shaped.

For men, the main test is a semen analysis, which evaluates sperm count, movement, and shape. This test might be repeated since sperm quality can vary. If abnormalities are found, additional tests might include hormone level checks, genetic testing, or an ultrasound of the reproductive organs.

Sometimes more specialized tests are needed. For women, this might include a laparoscopy, a minimally invasive surgery that allows direct visualization of the reproductive organs. For men, more detailed sperm function tests or a testicular biopsy might be recommended in certain situations.

The diagnostic process can take several weeks to months, which can feel frustrating when you're eager for answers. Remember that thorough testing helps ensure you get the most appropriate treatment for your specific situation.

What is the treatment for infertility?

Treatment for infertility depends on the underlying cause, your age, how long you've been trying to conceive, and your personal preferences. The good news is that about 85-90% of infertility cases can be treated with conventional medical therapies, and only 3% require advanced techniques like IVF.

For women with ovulation problems, fertility medications are often the first line of treatment. Clomiphene citrate (Clomid) is commonly used to stimulate ovulation and is taken as a pill. Injectable fertility drugs called gonadotropins might be used if oral medications don't work. These treatments are often combined with careful monitoring to optimize timing.

If blocked fallopian tubes are the issue, surgery might be recommended to remove blockages or repair damage. Laparoscopic surgery can also treat endometriosis by removing scar tissue and abnormal tissue growth. For fibroids, treatment depends on their size and location, ranging from medication to surgical removal.

Male fertility issues might be treated with hormone therapy, antibiotics for infections, or surgery to correct varicoceles or blockages. Lifestyle changes like improving diet, exercising regularly, and avoiding smoking and excessive alcohol can also help improve sperm quality.

Assisted reproductive technologies (ART) are available when other treatments haven't worked. Intrauterine insemination (IUI) involves placing prepared sperm directly into the uterus around ovulation time. In vitro fertilization (IVF) involves retrieving eggs, fertilizing them with sperm in a laboratory, and transferring the resulting embryo back into the uterus.

For severe male factor infertility, intracytoplasmic sperm injection (ICSI) can be combined with IVF. This technique involves injecting a single sperm directly into an egg. These advanced techniques have helped millions of couples worldwide achieve pregnancy.

Third-party reproduction options include using donor eggs, donor sperm, or gestational surrogacy. These options can be life-changing for couples who can't conceive with their own eggs or sperm, or when carrying a pregnancy isn't possible or safe.

How to manage infertility at home?

While medical treatment is often necessary for infertility, there are many things you can do at home to support your overall reproductive health and emotional well-being. These strategies work best when combined with appropriate medical care.

Maintaining a healthy lifestyle can significantly impact your fertility. Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Consider taking a prenatal vitamin with folic acid, even while you're trying to conceive. Regular moderate exercise is beneficial, but avoid extreme exercise that might interfere with ovulation.

Stress management is crucial during this journey. While stress doesn't directly cause infertility, managing it can improve your overall well-being and help you cope better with treatment. Try relaxation techniques like deep breathing, meditation, or yoga. Many people find journaling helpful for processing their emotions.

Track your menstrual cycle and ovulation signs to optimize your timing. This might include monitoring your basal body temperature, cervical mucus changes, or using ovulation predictor kits. However, don't let this become a source of additional stress if it feels overwhelming.

Create a supportive environment at home by communicating openly with your partner about your feelings and concerns. Consider setting boundaries around discussions about your fertility journey, especially with well-meaning friends and family members who might ask intrusive questions.

Limit alcohol consumption and avoid smoking completely, as both can negatively impact fertility for both partners. Men should also avoid hot tubs, saunas, and tight clothing that might raise testicular temperature and affect sperm production.

Consider joining online or in-person support groups where you can connect with others going through similar experiences. Sometimes talking with people who truly understand what you're going through can be more helpful than advice from well-meaning friends who haven't faced infertility.

How should you prepare for your doctor appointment?

Preparing for your fertility appointment can help you make the most of your time with your healthcare provider and ensure you get all the information you need. A little preparation can also help you feel more confident and less overwhelmed during the visit.

Start by gathering your medical history information. Write down details about your menstrual cycles, including when they started, how long they typically last, and whether they're regular. Note any previous pregnancies, miscarriages, or fertility treatments you've tried. Include information about any medications you're taking, including supplements.

Keep a fertility calendar for at least two to three months before your appointment if possible. Track your periods, ovulation signs, and when you have intercourse. This information can help your doctor understand your patterns and identify potential issues.

Prepare a list of questions to ask your doctor. You might want to know about specific tests they recommend, treatment options, success rates, costs, and timelines. Don't hesitate to ask about anything you don't understand, including medical terms or procedures.

Consider bringing your partner to the appointment, even if they're not being examined that day. Infertility affects both partners, and having support during medical discussions can be helpful. Two people can also remember more information and ask different questions.

Gather information about your insurance coverage for fertility testing and treatments. Many plans have specific requirements or limitations, and understanding these upfront can help you make informed decisions about your care.

Be prepared to discuss sensitive topics openly and honestly. Your doctor needs complete information to help you effectively, so share details about your sexual health, lifestyle habits, and any concerns you might have.

What's the key takeaway about infertility?

Infertility is a common medical condition that affects millions of couples, and experiencing it doesn't mean you've done anything wrong or that pregnancy is impossible. With today's medical advances, most people who seek treatment for infertility can eventually achieve their goal of having a family.

The most important thing to remember is that you're not alone in this journey. Support is available in many forms, from medical professionals who specialize in fertility to counselors who understand the emotional aspects of infertility. Don't hesitate to reach out for help when you need it.

Every person's fertility journey is unique, so try not to compare your experience to others. What works for one couple might not work for another, and timelines can vary significantly. Focus on taking care of yourself physically and emotionally while working with your healthcare team to find the best approach for your situation.

While the process can be challenging and emotionally draining, many couples find that it ultimately strengthens their relationship and gives them a deeper appreciation for the family they're working to build. Remember that seeking help for infertility is a sign of strength, not weakness, and taking proactive steps toward your goals is something to be proud of.