All About Infertility

If you or your loved one have been diagnosed with infertility, we want to empower you with the knowledge and information you need on this journey.

FAQs

  • Infertility is the inability to conceive after 12 months or more ( 6 months or more for those over 35) of regular unprotected sexual intercourse. Many factors in both men and women can cause it. Some common causes include:

    • Low sperm count, poor sperm motility, or abnormal sperm shape and function in men. This accounts for about 30-40% of infertility cases.

    • Ovulation disorders, blocked or damaged fallopian tubes, endometriosis, or uterine problems in women. These account for about 40-50% of female infertility cases.

    • Medical conditions like thyroid issues, diabetes, cancers, autoimmune disorders, and STDs.

    • Lifestyle factors like stress, obesity, smoking, alcohol use, and advanced age.

    • Unexplained infertility where no cause is identified in about 10-15% of cases.

    Treatment depends on the cause but may involve medication, surgery, assisted reproductive technologies like IVF, or lifestyle changes. Supporting your partner, staying hopeful, taking care of your health, reducing stress, and exploring all options can help you cope with the challenges of infertility. Seeking medical guidance early is vital, as age affects fertility significantly.

  • Worldwide: The World Health Organization estimates that 8-12% of couples or 1 in 6 experience infertility globally. This amounts to 48.5-74.4 million couples.

    United States: About 6% of married women aged 15-44 years in the US are unable to get pregnant after one year of trying. This is about 1.5 million couples. About 12% of women aged 15-44 have difficulty getting pregnant or carrying a pregnancy to term.

    US Military: A study found that 6.2% of active-duty military women had an infertility diagnosis, which is like the national average. However, there are higher rates among military members who served in the Middle East - up to 16% for women and 10.3% for men. Additionally, an annual survey completed by Blue Star Families noted in their 2021 study that 67% of military-connected people experienced challenges to family building.

    Causes in the military: The higher rates of infertility are associated with exposure to toxic chemicals, radiation, injuries, mental stress, and high rates of STDs. Frequent moves, deployments, and exercises also contribute by causing delays in fertility treatment.

    Seeking treatment: Only about 50% of military members diagnosed with infertility seek treatment due to barriers like costs, stigma, and frequent moves. This is lower than the 60% national average.

    In summary, infertility affects a significant portion of couples globally and in the US. Military members have higher rates due to their exposure and lifestyle challenges. Addressing the barriers to treatment in the military is essential.

    Worldwide infertility rates:

    World Health Organization. Infertility definitions and terminology. https://www.who.int/reproductivehealth/topics/infertility/definitions/en/

    US infertility rates:

    Centers for Disease Control and Prevention. National Public Health Action Plan for the Detection, Prevention, and Management of Infertility. https://www.cdc.gov/reproductivehealth/Infertility/PDF/DRH_NAP_Final_508.pdf

    US military infertility rates:

    Doherty, J., Crane, P., Hammoud, A.O. et al. Reproductive health assessment of active duty military women. J Womens Health (Larchmt). 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203013/

    Causes of infertility in military:

    Lee Robertson, H., Drash, A., Woeller, C.F. et al. Infertility in US Military Veterans. Mil Med. 2020. https://academic.oup.com/milmed/article/185/3-4/e435/5780524

    Treatment seeking rates:

    Tarver, T., Richmond, D.,bunga, G. et al. Military women's genitourinary and reproductive health: findings from the Millennium Cohort Study. J Womens Health (Larchmt). 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102852/

  • Here are some key terms related to infertility that you may come across:

    Anovulation - When a woman does not ovulate or release an egg during her menstrual cycle. This is a common cause of infertility.

    Azospermia - When a man has no sperm in his semen.

    Embryo - The early stage of fetal growth after the egg is fertilized, usually 3-8 weeks after conception.

    Follicle Stimulating Hormone (FSH) - A hormone that stimulates follicle growth and ovulation in women. High levels may indicate diminished ovarian reserve.

    Intrauterine Insemination (IUI) - A procedure where sperm is placed directly into the uterus around the time of ovulation.

    In Vitro Fertilization (IVF) - An assisted reproductive technology where eggs are fertilized by sperm in a lab and the embryo is then transferred to the uterus.

    Oligospermia - When a man has a low sperm count in his semen.

    Ovulation Induction - Medications are given to stimulate ovulation in women who are not ovulating naturally.

    Progesterone - Hormone essential for fertility, pregnancy, and embryonic development.

    Sperm Motility - The ability of sperm to move towards the egg. Low motility can impact fertility.

    Testosterone - Hormone necessary for sperm production in men. Low levels may require supplements.

    Uterine Lining - The endometrium that thickens to prepare for an embryo to implant. Evaluated in infertility.

    Familiarize yourself with these and other terms you encounter. Don't hesitate to ask your doctor for clarifications. Knowing the terminology can help you better understand the diagnosis and treatment process.

  • AFC - Antral follicle count. Number of follicles seen on ultrasound.

    AIH - Artificial insemination by husband. Using the partner's sperm for insemination.

    AMH - Anti-Müllerian hormone. Used to evaluate ovarian reserve.

    AOV - Advanced ovarian age. Reduced fertility due to older age.

    APS - Antiphospholipid syndrome. An autoimmune disorder causing miscarriages.

    ART - Assisted reproductive technology like IVF and IUI.

    ASRM - American Society for Reproductive Medicine. Professional organization.

    AUB - Abnormal uterine bleeding. This can indicate gynecological issues.

    DHEA - Dehydroepiandrosterone. Supplement for ovarian reserve.

    DIE - Deep infiltrating endometriosis. Severe form of endometriosis.

    DOR - Diminished ovarian reserve. Indicates a low egg supply.

    E2 - Estradiol. Primary estrogen hormone.

    EDD - Estimated due date. Expected date of delivery for pregnancy.

    EMI - Endometrial microbial imbalance. Bacterial overgrowth in the uterus.

    EP - Ectopic pregnancy. Fertilized egg implants outside the uterus.

    ER - Estrogen receptor. Important for reproductive health.

    FET - Frozen embryo transfer. Transferring a previously frozen embryo.

    FSH - Follicle stimulating hormone. Stimulates follicle growth.

    GnRH - Gonadotropin releasing hormone. Triggers FSH and LH release.

    hCG - Human chorionic gonadotropin. Detected in pregnancy tests.

    hMG - Human menopausal gonadotropin. Fertility medication.

    HSG - Hysterosalpingography. Imaging of uterine cavity and fallopian tubes.

    ICSI - Intracytoplasmic sperm injection. Injecting sperm into egg.

    IUI - Intrauterine insemination. Placing sperm in the uterus.

    IVF - In vitro fertilization. Fertilizing egg with sperm in lab.

    LH - Luteinizing hormone. Triggers ovulation.

    PCOS - Polycystic ovary syndrome. A leading cause of infertility.

    SA - Semen analysis. Evaluates the sperm quality and quantity.

    TESA - Testicular sperm aspiration. Obtaining sperm from the testicle.

  • Here are some common diagnoses related to infertility and what they mean:

    Ovulation disorders: Problems with ovulation like polycystic ovary syndrome (PCOS), primary ovarian insufficiency, thyroid issues, etc. This means eggs are not being released properly.

    Diminished ovarian reserve: When the number and quality of eggs in the ovaries is declining. This is often age-related as fertility decreases with age.

    Endometriosis: When tissue similar to the uterine lining is found outside the uterus, often affecting fertility. Can cause inflammation, and scar tissue.

    Uterine fibroids: Noncancerous growths in or on the uterus that can interfere with implantation and pregnancy.

    Pelvic adhesions: Scar tissue bands in the pelvis, often from past infections or surgeries. Can block fallopian tubes, ovaries, and distort pelvic anatomy.

    Male factor infertility: Low sperm count, poor sperm motility, and/or abnormal sperm shape and function. Reduces the chances of conception.

    Unexplained infertility: No identifiable cause was found after evaluation. Accounts for about 15% of infertility cases.

    Recurrent pregnancy loss: Having two or more consecutive miscarriages. This indicates a problem sustaining a pregnancy.

    Understanding any diagnoses you receive is important. Ask your doctor to explain the diagnosis, underlying causes, treatment options, and implications for fertility. Addressing any issues found can help improve your chances of conception.

  • What might be causing my infertility? Are there any apparent factors from my medical history, lifestyle, exams or tests?

    What other tests or evaluations do you recommend for me and my partner to determine the cause?

    Based on my age, health, and test results, what are our chances for conception without treatment or with different treatments like medications, IUI, IVF, etc.?

    Will any of my current medications or health conditions impact fertility? Should I make any changes?

    Does my weight or diet need optimization for fertility? Do you have a nutritionist to consult?

    For women - Should I be tracking ovulation with kits, temperature, etc.? How often should we try conceiving?

    For men - Do you recommend a semen analysis or seeing a urologist? Are there any lifestyle changes recommended?

    What options do we have for fertility treatment, and what is the process?

    What are the costs involved for tests, procedures, and medications? Does insurance cover any of this?

    How can we manage stress and keep our relationship healthy while trying to conceive?

    Do you have any counselor or support group you recommend talking to?

    Asking thorough questions will help you understand the potential causes, recommended next steps, treatment options, timelines, and costs. Don't hesitate to ask your doctor to clarify anything you don't understand. It's essential you and your partner understand the journey ahead.

Ovulation Disorders & Conditions

  • Hyperprolactinemia is a condition that can inhibit ovulation and involves the hormone prolactin.

    Overview: Hyperprolactinemia is a condition where prolactin levels are abnormally high. Prolactin is the hormone responsible for breast milk production.

    Causes: A prolactin-secreting pituitary tumor (prolactinoma) is the most common cause, accounting for over 90% of cases. Other causes include medications, thyroid disorders, kidney disease, or chest wall injury.

    Symptoms: In women, it often causes irregular periods, infertility, and milk discharge from the breasts. In men, it may result in low testosterone and erectile dysfunction. Headaches and vision changes may occur if a large tumor is present.

    Diagnosis: Based on symptoms, medical history, blood tests showing high prolactin levels, and MRI scan of the pituitary gland to look for tumors.

    Treatment: Medications like bromocriptine or cabergoline to lower prolactin secretion from tumors. Surgery or radiation to shrink prolactinomas may also be done.

    Effect on fertility: High prolactin inhibits GnRH secretion from the hypothalamus, preventing normal ovulation. Treating the hyperprolactinemia can restore ovulation, menstrual cycles and fertility in most cases.

    Outlook: With treatment, normal prolactin levels can be restored in 90% of cases, restoring fertility. Untreated, it persistently suppresses ovulation leading to infertility. Monitoring and follow-up is needed.

    Hyperprolactinemia data:

    - Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JAH, Giustina A. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf). 2006 Aug;65(2):265-73. doi: 10.1111/j.1365-2265.2006.02562.x. PMID: 16846454.

  • Hypothalamic dysfunction happens when the hypothalamus is not functioning properly. The hypothalamus is responsible for releasing hormones that trigger ovulation. When it's not functioning properly, it can disrupt monthly ovulation. Stress, weight issues, other illnesses can cause this.

    Overview: The hypothalamus is a small structure in the brain that helps regulate hormone production from the pituitary gland, including reproduction-related hormones.

    Causes: Hypothalamic dysfunction can be caused by tumors, inflammation, injury, infections, radiation or medications affecting the hypothalamic-pituitary axis. Stress, weight issues, and endocrine disorders can also impact its functioning.

    Effects: When the hypothalamus malfunctions, it fails to adequately stimulate the pituitary gland. This disrupts the signals for hormones that trigger ovulation (GnRH, FSH, LH) leading to irregular/absent periods.

    Symptoms: Absent or irregular periods are the main sign. Headaches, vision issues, sleep problems may also occur with tumors pressing on the hypothalamus.

    Diagnosis: Based on symptoms, medical history, MRI scans to identify tumors or structural abnormalities, and blood tests to measure hormone levels related to the hypothalamic-pituitary-ovarian axis.

    Treatment: Treating any underlying condition causing it. Fertility medications to induce ovulation. IVF with fertility drugs may be needed in severe cases.

    Outlook: Prognosis depends on the underlying cause. Minor causes may be reversible with treatment and allow normal ovulation/fertility. Severe structural defects can permanently impact fertility.

    Hypothalamic Dysfunction data:

    - Burt Solorzano CM, McCartney CR. Obesity and the pubertal transition in girls and boys. Reproduction. 2010 Sep;140(3):399-410. doi: 10.1530/REP-10-0119. PMID: 20802109; PMCID: PMC2936090.

  • PCOS is a hormonal disorder where women develop multiple small cysts on the ovaries and have irregular or prolonged menstrual cycles. It results in irregular/absent ovulation due to hormone imbalances. It can be treated with medications to regulate cycles and induce ovulation.

    Overview: PCOS is a common hormonal disorder affecting up to 10% of women of reproductive age. It causes infrequent, irregular, or prolonged menstrual periods and excess androgen levels.

    Symptoms: In addition to menstrual irregularities, symptoms may include excess facial and body hair growth, acne, thinning scalp hair, weight gain, darkening skin patches, pelvic pain, and difficulties getting pregnant.

    Causes: The exact cause is unknown but is related to hormone imbalances, including elevated testosterone, insulin resistance, inflammation, and genetics.

    Diagnosis: PCOS is diagnosed based on Rotterdam criteria - having two of the following three: irregular periods, excess androgens, and polycystic ovaries on ultrasound. Blood tests help rule out other conditions.

    Treatment: Lifestyle changes like weight loss, diet, and exercise can help manage PCOS. Birth control pills can regulate menstrual cycles. Fertility medications like clomiphene may be used to induce ovulation. Metformin may be prescribed for insulin resistance.

    Fertility Impact: PCOS makes ovulation less frequent or absent, leading to infertility. Treatment can improve ovulation and chances of conception. Some may need advanced treatments like IVF.

    Long Term Risks: PCOS increases risks for type 2 diabetes, heart disease, endometrial cancer if not properly managed. Monitoring health and follow-up with doctors is important.

    Polycystic Ovary Syndrome (PCOS) data:

    - Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018 Sep 1;33(9):1602-1618. doi: 10.1093/humrep/dey256. PMID: 30060021.

  • Primary Ovarian Insufficiency, also known as premature ovarian failure is when the ovaries stop functioning normally before age 40. It causes low estrogen levels, irregular periods, and reduced egg numbers. Usually requires donor eggs to achieve pregnancy.

    Overview: POI, also known as premature ovarian failure, is when a woman's ovaries stop functioning normally before the age of 40. It results in infertility and early menopause.

    Causes: Genetics play a major role, such as chromosomal defects or autoimmune disorders. Other causes include previous surgery, chemotherapy/radiation, or infections damaging the ovaries. In about 25% of cases, no cause is identified.

    Symptoms: Irregular periods, hot flashes, night sweats, vaginal dryness, mood changes, difficulty conceiving. Periods become infrequent and eventually stop.

    Diagnosis: Based on abnormal hormone levels - high FSH, low Estradiol levels - before age 40. Antral follicle count shows very few follicles remaining. Karyotype testing checks chromosomes.

    Treatment: Hormone replacement therapy helps with symptoms but won't restore fertility. Donor eggs are usually required to achieve pregnancy. Adoption or childfree living are options.

    Outlook: Spontaneous conception is very unlikely with POI. With donor eggs, success rates are comparable to other women in that age group. Early menopause risks (osteoporosis, heart disease) need to be monitored.

    Support: POI diagnosis can be emotionally difficult. Counseling, connecting with support groups, and relying on family can help cope with the effects on relationships, self-esteem, and grief over fertility loss.

    Primary Ovarian Insufficiency data:

    - Jameson JL, De Groot LJ, de Kretser DM, Giudice LC, Grossman AB, Melmed S, Potts JT Jr (eds.): Endocrinology: Adult and Pediatric. Saunders Elsevier, Philadelphia, PA, 2016, pp 2200-2205.

Thyroid Disorders & Conditions

  • Both hyperthyroidism and hypothyroidism can lead to irregular ovulation and menstrual cycles, resulting in difficulty getting pregnant. Thyroid hormones directly impact reproductive health.

    Overview: The thyroid gland produces hormones like thyroxine and triiodothyronine that regulate metabolism. Both hypothyroidism and hyperthyroidism can disrupt normal menstrual cycles and ovulation.

  • Overview: Hyperthyroidism is an overactive thyroid leads to excess thyroid hormone levels. This can cause irregular, light, or absent periods. Ovulation may still occur but at an increased rate less favorable for conception. It is associated with decreased fertility.

    Diagnosis: Thyroid disorders are diagnosed by blood tests measuring TSH, T4, and T3 levels. Anti-thyroid antibodies may also be tested to check for autoimmune causes like Hashimoto's or Grave's disease.

    Treatment: Hyperthyroidism is treated with anti-thyroid medications, radioiodine, or surgery.

    Fertility Impact: With proper thyroid treatment and hormone levels normalized, fertility can improve and women can conceive and have healthy pregnancies. Doctors monitor thyroid levels closely.

  • Overview: Hypothyroidism When the thyroid is underactive and thyroid hormone levels are low. This causes irregular periods, anovulation, increased prolactin levels - all contributing to infertility. It also raises the risk of miscarriage and birth defects if pregnant.

    Diagnosis: Thyroid disorders are diagnosed by blood tests measuring TSH, T4, and T3 levels. Anti-thyroid antibodies may also be tested to check for autoimmune causes like Hashimoto's or Grave's disease.

    Treatment: Hypothyroidism is treated with levothyroxine supplements to restore thyroid hormone levels.

    Fertility Impact: With proper thyroid treatment and hormone levels normalized, fertility can improve and women can conceive and have healthy pregnancies. Doctors monitor thyroid levels closely.

    Thyroid Disorders data:

    - Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010 Oct;31(5):702-55. doi: 10.1210/er.2009-0041. Epub 2010 Jun 22. PMID: 20573783.

Other Disorders & Conditions

  • Overview: Diminished ovarian reserve (DOR) is when the ovaries have a reduced number and quality of eggs available compared to normal reproductive-aged women. It indicates declining fertility.

    Causes: The most common cause is advanced maternal age. The natural aging process depletes eggs over time. Other causes can include genetics, prior ovarian surgery, pelvic infections, endometriosis, smoking, and chemotherapy.

    Symptoms: Irregular periods, infertility, and early menopause can occur, but sometimes there are no obvious symptoms. Many only discover when trying to conceive.

    Diagnosis: DOR is diagnosed through blood tests for FSH and AMH levels and antral follicle count via ultrasound. Abnormal results indicate DOR.

    Risks: DOR lowers the chances of conception with natural or assisted reproduction. It may indicate early menopause as well. There is also an increased risk of miscarriage. Donor eggs improve success.

    Treatment: Options include IVF with maximal fertility drugs to harvest any remaining eggs, donor eggs, embryo adoption, or child-free living. Supportive care is recommended.

    Outlook: With DOR, chances of conception and live birth using a woman's own eggs is lower. Donor eggs can greatly improve success rates. Early detection and intervention is optimal.

    Diminished Ovarian Reserve data:

    - Committee on Gynecologic Practice. Committee opinion no. 618: Ovarian reserve testing. Obstet Gynecol. 2015 Jan;125(1):268-73. doi: 10.1097/01.AOG.0000459864.68372.ec. PMID: 25560136.

  • As women near menopause, cycles become irregular and ovulation is unpredictable. Egg quality also declines. This starts several years before menopause.

    Overview: Perimenopause refers to the transition period leading up to menopause, when reproductive hormones start to decline. It usually begins 4-5 years before menopause.

    Causes: The ovaries start producing less estrogen and progesterone as a woman's egg supply declines. Follicle stimulating hormone (FSH) levels also start to rise.

    Symptoms: Irregular periods are the main sign. Other symptoms include hot flashes, night sweats, vaginal dryness, mood changes, trouble sleeping, decreased libido. Periods become increasingly irregular.

    Diagnosis: Based on symptoms and hormone tests showing elevated FSH and low anti-mullerian hormone (AMH) levels for the woman's age.

    Fertility Impact: Ovulation becomes more unpredictable and fertility declines significantly. The remaining eggs are lower in quality, increasing chances of chromosome abnormalities.

    Treatment: No treatment can stop perimenopause progression. For symptoms, hormone therapy, birth control pills, or fertility drugs may provide temporary relief. Use of donor eggs improves IVF success.

    Outlook: Pregnancy is still possible in perimenopause but chances are lower with each passing year. Freezing eggs or embryos earlier on for future use is an option. The average age of menopause is 51.

    Perimenopause data:

    - Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ; STRAW+10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012 Apr;19(4):387-95. doi: 10.1097/gme.0b013e31824d8f40. PMID: 22343518; PMCID: PMC3340904.