If you’re struggling with fertility issues, you’re not alone. Millions of people around the world are facing the same challenge.
But there’s hope — advances in reproductive medicine and assisted reproductive technology have enabled individuals and couples to achieve their dream of starting or growing their families.
In this article, we discuss the basics of infertility and briefly overview the different treatment options available.
What is infertility?
Infertility is the inability to get pregnant. If a person or couple has been trying (having regular unprotected sex) for 12 months or longer without success, they may be considered infertile.
Women 35 years or older are considered infertile after six months of trying.
There are two types of infertility: primary infertility and secondary infertility.
- Primary infertility occurs when a person has never been able to get pregnant.
- Secondary infertility occurs when a person who’s had one successful pregnancy has trouble getting pregnant again.
Is infertility a common problem?
Yes, infertility is a common problem that affects millions of people across the globe.
According to a 2023 report published by the World Health Organization (WHO), approximately 17.5% of the adult population (one in six people worldwide) experience some form of infertility in their lifetime.
What causes infertility in women?
Getting pregnant isn’t as easy as they make it out to be in the movies. To get pregnant, a woman needs three things (in addition to a healthy sperm sample): functioning ovaries, fallopian tubes, and a healthy uterus. If a woman has a medical condition or underlying issues that affect any of these organs, she may struggle with infertility.
Some of the most common causes of female infertility include:
- Ovulation disorders: Generally, the menstrual cycle lasts 28 days (give or take; every woman is different). Day 1 is the first day of menstrual bleeding. On average, ovulation occurs 14 days before the start of the next menstrual period. However, people with ovulation disorders may have irregular or absent periods (amenorrhea) due to hormonal imbalances, polycystic ovary syndrome (PCOS), a diminished ovarian reserve (DOR), premature ovarian insufficiency (POI), menopause, or another medical condition that disrupts the “normal” ovulation process.
- Tubal damage: The fallopian tubes play a huge role in female fertility. These organs transport the egg from the ovaries to the uterus. If a woman’s fallopian tubes are damaged, blocked, or missing, it can prevent the sperm from reaching the egg. This can lead to infertility. Some risk factors for tubal damage or blockage include previous pelvic infections, sexually transmitted infections (such as gonorrhea and chlamydia), history of ectopic pregnancy, certain medical conditions (such as endometriosis), or prior abdominal surgery.
- Structural abnormalities: Sometimes, female infertility can result from structural abnormalities in the reproductive organs. These abnormalities include issues with the uterus, such as uterine fibroids (growths or tumors that form in the uterus) or polyps, adenomyosis, or scarring from previous surgeries, infections, or injuries. An unusually shaped uterus can also be a cause of infertility.
What causes infertility in men?
Male factor infertility causes approximately 40% of infertility cases. Issues with sperm production or delivery usually cause it. However, various factors can contribute to male infertility.
Some of the most common causes of male infertility include:
- Sperm disorders: Problems with sperm production or function, such as low sperm count (oligospermia) or a complete lack of sperm (azoospermia), low motility, or abnormal morphology (shape), can contribute to male infertility.
- Varicoceles: Enlarged veins in the scrotum, also known as varicoceles, can interfere with sperm production and function. About 15% of men have varicoceles, but only about 35% of those men have fertility problems. This means that not all men with varicoceles will experience infertility.
- Testicular damage: The testicles produce and store sperm, so any damage to these organs, whether from injury, infection, or other conditions such as testicular cancer, can impact fertility.
- Ejaculation disorders: Ejaculation disorders, such as retrograde ejaculation (semen flows backward into the bladder instead of out of the penis) or premature ejaculation, can also contribute to male infertility.
Risk Factors for Infertility
Some of the most common risk factors for infertility include:
- Age: A woman’s fertility declines with age. According to the American College of Obstetricians and Gynecologists (ACOG), only one in 10 women 40 or older will get pregnant per menstrual cycle without fertility treatments. Men’s fertility declines with age, but not as dramatically as women’s. After age 40, the quality and quantity of sperm may decrease, making it more difficult to conceive. Additionally, men 45 or older increase the risk of miscarriage in their partners.
- Medical conditions: Some medical conditions can affect fertility in men and women. Autoimmune disorders, such as lupus, Hashimoto’s (and other thyroid disorders), and rheumatoid arthritis, can damage the reproductive organs and make it difficult to conceive.
- Genetic disorders: Genetic disorders such as Turner syndrome (when the female partner is missing one X chromosome) and Klinefelter syndrome (when the male partner has an extra X chromosome) can cause infertility.
- Lifestyle factors: Smoking, excessive alcohol, and drug use can all damage sperm and eggs. Obesity can also affect fertility in both men and women.
Who should consider seeking fertility treatment?
Fertility treatment can help individuals and couples struggling with infertility fulfill their dreams of starting or building a family.
Here are some people who may want to consider fertility treatment:
- Couples (female partner age <35) who’ve been trying to conceive for at least 12 months without success. This is the most common reason for seeking fertility treatment.
- People or couples with a family history of infertility or reproductive issues. These individuals may be at an increased risk of experiencing infertility.
- People or couples with a medical condition that affects fertility. Some medical conditions, such as endometriosis, can make it difficult to get pregnant.
- People or couples who have undergone cancer treatment that may have affected their fertility. Cancer treatment can sometimes damage the reproductive organs, making it difficult to conceive.
- People or couples who are 35 or older and have been trying to conceive for six months without success. Fertility declines with age, so women over the age of 35 and men over the age of 40 may be more likely to need fertility treatment.
- People or couples who have failed multiple cycles of fertility treatments. Those who’ve tried other fertility treatments without success may want to consider more advanced treatments, such as in vitro fertilization (IVF).
Infertility Treatment Option #1: Ovulation Induction
Ovulation induction (OI) uses medication to stimulate the ovaries to produce eggs and ovulate in a predictable way. This fertility treatment option can be helpful for people who have irregular ovulation or ovarian dysfunction and are not ovulating regularly on their own.
OI is often combined with other fertility treatment options, such as IUI, to increase the chances of pregnancy.
Here’s how OI works:
- Baseline fertility testing: Before OI begins, the person receiving treatment undergoes a series of tests to assess their fertility. This includes a blood test to check hormone levels and an ultrasound to examine the ovaries.
- Medication: The person takes fertility medications under the guidance of their fertility specialist. The dosage and type of medication (e.g., clomiphene citrate or Clomid, Letrozole or Femara, etc.) depends on the individual’s needs and fertility goals.
- Monitoring: Their progress is monitored closely through blood tests and ultrasounds. This helps the doctor determine when they’re ovulating and ready for IUI.
- Timed intercourse or IUI: If everything looks promising, the person may proceed with timed intercourse or IUI.
Infertility Treatment Option #2: Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is a noninvasive fertility treatment that involves injecting sperm into the uterus using a thin catheter. The procedure is similar to getting a Pap smear.
IUI or artificial insemination is often recommended as a first line of treatment for couples with unexplained infertility, mild male factor infertility, or same-sex couples interested in growing their family.
Here’s a quick overview of the steps involved in IUI:
- Semen collection: The male partner or donor provides a semen sample. This can be done at the fertility clinic on the same day of the IUI procedure.
- Sperm preparation: A laboratory technician prepares the semen sample to ensure it’s high quality. This may involve washing the sperm to remove impurities and concentrating the sperm.
- Insemination: Once the sperm is prepared, a fertility specialist injects it into the woman’s uterus using a thin catheter.
Infertility Treatment Option #3: In Vitro Fertilization (IVF)
In vitro fertilization (IVF) is a fertility treatment in which eggs are fertilized (with a partner’s or donor sperm) outside the body. The fertilized eggs (embryos) are then transferred to the woman’s uterus, where they can implant and develop into a fetus.
Here’s a breakdown of the steps involved in IVF:
- Ovarian stimulation: The first step in IVF is ovarian stimulation. During this step, the person receiving treatment takes hormonal medications to stimulate their ovaries to produce multiple eggs. This process typically lasts for eight to 12 days.
- Egg retrieval: Exactly 36 hours after the person administers the IVF “trigger shot,” the eggs are retrieved through a minor surgical procedure.
- Embryo culture: After egg retrieval, an embryologist fertilizes the eggs (with a partner or donor sperm) in a laboratory. Development can take anywhere from five to seven days.
- Embryo selection: Once the embryos are ready, an embryologist assesses their quality and development to choose the most viable ones for transfer.
- PGT: Some couples may opt to do pre-implantation genetic testing (PGT) on their embryos to determine which embryos have a normal number of chromosomes. This is another method that aids in selecting the best embryos for transfer.
- Frozen embryo transfer: The selected embryos are then frozen (after reaching the blastocyst stage) to preserve them for future use. Frozen embryo transfer (FET) is the standard of care for all IVF patients at RMA.
Infertility Treatment Option #4: Third-Party Reproduction
Third-party reproduction is a fertility treatment option that uses donated eggs, sperm, or embryos to help people achieve their dream of parenthood. This option is available to single parents, same-sex couples, and individuals who cannot conceive and carry a child independently.
There are three main types of third-party reproduction:
Donor Eggs & Embryos
Donor eggs or embryos can be a life-changing option for people and couples who cannot produce viable eggs of their own.
Donor eggs can be a helpful treatment option for people who have:
- a diminished ovarian reserve
- premature ovarian insufficiency
- a history of poor or abnormal fertilization or arrested embryo development
- a genetic condition
- no ovaries due to a surgical procedure or congenital condition
- a history of failed IVF attempts
Donor eggs and embryos are also an option for LGBTQ individuals, people undergoing chemotherapy or radiation therapy, or women of advanced maternal age.
Donor Sperm
Donor sperm is a fertility treatment option for people or couples dealing with male-factor infertility.
Donor sperm can be a helpful treatment option for people who have:
- low or no sperm count
- impaired sperm motility
- genetic factors affecting sperm health
- a history of failed attempts at fertilization
Donor sperm is also an option for same-sex couples or single individuals without a male partner.
Gestational Carrier
A gestational carrier is a woman who carries a pregnancy for someone else. She’s not genetically related to the child; the intended parents or donors provide the eggs or embryos used in gestational surrogacy.
The process of gestational surrogacy can be complex and expensive. It typically involves IVF, embryo transfer, and prenatal care. It also involves legal work, as the gestational carrier and intended parents will need a contract that outlines the agreements and responsibilities of each party involved.
Additional Service #1: Single Embryo Transfer (SET)
Single embryo transfer (SET) involves transferring one high-quality embryo into the woman’s uterus during an IVF cycle. SET reduces the woman’s risk of having multiple pregnancies (carrying twins or triplets), which can have higher risks and complications.
SET is the standard of care for all patients at RMA. Transferring more than one embryo is no longer recommended due to the higher risks of pregnancy complications.
Additional Service #2: Frozen Embryo Transfer (FET)
Frozen embryo transfer (FET) is a fertility treatment option that accompanies an IVF cycle.
Studies have demonstrated that using Frozen Embryo Transfer (FET) can enhance the chances of successful implantation and lead to better outcomes during pregnancy. This method is often regarded as a more beneficial approach for implantation because it fosters a stronger bond between the mother and the placenta. When comparing frozen cycles with fresh transfers, it’s observed that babies from the former often have a greater birth weight and a decreased probability of being born prematurely.
Moreover, FET provides flexibility in timing, offering a more harmonious transfer experience. This is because the embryo can be stored in a cryopreserved state, awaiting a time when the woman’s hormone levels have adjusted to an ideal state for implantation, typically during her subsequent cycle.
Additional Service #3: Preimplantation Genetic Testing (PGT)
Preimplantation genetic testing (PGT) is an additional step that can be included in an IVF cycle to increase the chances of a successful pregnancy. PGT involves testing embryos for genetic defects before they’re transferred to the uterus.
PGT is a helpful option for individuals or couples with a history of recurrent pregnancy loss or a known genetic condition that could be passed on to their child. PGT can also be used for women over 35, as they’re at an increased risk of having embryos with genetic defects.
There are three types of PGT:
- PGT-A (Preimplantation genetic testing for aneuploidy): PGT-A tests for whole chromosomal abnormalities, such as Down syndrome. Every patient is eligible for this type of general chromosome screening.
- PGT-M (Preimplantation genetic testing for monogenic/single gene defects): PGT-M tests for specific genetic conditions, such as cystic fibrosis. Patients who are known carriers of specific diseases may consider this option.
- PGT-SR (Preimplantation genetic testing for structural chromosomal rearrangements): PGT-SR tests for structural chromosomal rearrangements, such as translocations.
Additional Service #4: Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic Sperm Injection (ICSI) involves injecting a single sperm directly into an egg. ICSI is done during an IVF cycle.
This technique is recommended for couples with male-factor infertility, such as low sperm count or motility, or for men who have sperm that are unable to penetrate the egg on their own. ICSI is also used for couples with unexplained infertility or failed IVF cycles.
It’s a relatively straightforward procedure. The doctor or embryologist injects a single sperm into the egg’s center. The embryos are cultured, and the best ones are transferred back into the uterus.
ICSI is often successful in achieving a healthy pregnancy, even for men with severe fertility problems. However, ICSI is a more expensive procedure than IVF with conventional fertilization.
Additional Fertility Option for Women: Egg Freezing
Egg freezing gives women the opportunity to preserve their eggs for future use. The process starts with blood work and a vaginal ultrasound to determine a woman’s ovarian reserve. The doctor then creates a treatment plan, including specific medications, doses, and a timeline.
The woman will begin treatment with oral and/or injectable fertility drugs when ready. These shots stimulate the woman’s ovaries to grow multiple eggs. The woman will take these medications for about ten days until her eggs are ready to be retrieved.
On the day of her egg retrieval, the doctor aspirates the eggs (inside follicles) from her ovaries under light anesthesia. This procedure takes about 15 minutes. The mature eggs are frozen that same day.
A note from RMA Network
We know that infertility can be a difficult and emotional journey. You may feel frustrated, isolated, and even hopeless. But you’re not alone. We understand what you’re going through and are here to help.
If you’re struggling with infertility, we encourage you to contact us today. We’ll listen to your story and create a personalized treatment plan that’s right for you.
We believe that everyone deserves the opportunity to experience the joy of parenthood. At RMA, we’re here to help you realize that dream.
