April 24–30 is National Infertility Awareness Week, established in 1989 to increase public knowledge about infertility—a mission we can get behind. This year’s theme? #StartAsking, which hopes to promote discussion about fertility as a way to reduce misunderstanding and stigma, help those with infertility learn how to seek treatment, and help those at risk for infertility learn how to prevent it.
With that in mind, here are 5 frequently asked fertility questions, answered.
1. What is infertility, anyway?
Infertility is a disease of the reproductive system. Physicians define infertility as the inability to get pregnant after 12 months of regular, unprotected sex. Being diagnosed as infertile doesn’t mean you can’t get pregnant ever. It just means something is preventing your body from getting pregnant on its own, and you may need to learn more about your cycle (such as when you’re ovulating) or get help from a fertility doctor, known as a reproductive endocrinologist, to understand and overcome the problem.
2. Is infertility common?
It’s probably more common than you think—experts estimate that 1 in 8 women (or 12.5%) experience infertility. However, it’s important to note that infertility rates increase with a woman’s age, with the steepest drop-off of fertility happening after age 35—which is why you’ll see that age thrown around a lot in conversations about fertility. According to the Office on Women’s Health at the U.S. Department of Health and Human Services, about one-third of women over age 35 experience infertility. That’s why, for women over 35, experts recommend seeing a doctor if they’re not pregnant after just 6 months of regular, unprotected sex. Even a half-year can make a difference.
3. Okay, so what causes it?
For women, the most common cause of infertility is age. We’ve talked about this before, but let’s do a quick overview: women are born with all the eggs they’ll ever have, and as they age, both the quantity and the quality of those eggs declines. Egg quality refers to the number of eggs that are genetically “normal,” or free from chromosomal defects that could cause infertility, miscarriage, or congenital disorders. Both the decline in quantity, known as “diminished ovarian reserve,” and the decline in quality can affect a woman’s ability to get pregnant and give birth to a healthy baby.
No, age isn’t the only factor—certain disorders and imbalances can also cause infertility, even in young women, and worsen fertility rates for older women. One example is endometriosis, a disorder of the endometrium (or uterine lining) that causes endometrial tissue to grow on other surfaces in the reproductive system, potentially causing cysts, blockages, or other barriers to normal reproductive function. Other possible causes include polycystic ovarian syndrome, or PCOS, smoking, and untreated sexually transmitted infections. (Learn more.) But it’s really important that we make it clear that the top cause of infertility is age-related ovarian disorder. We’re not saying this to freak you out—we just want to make sure you have the facts!
4. But is it only a problem for women?
Absolutely not, although for centuries women have taken the brunt of the blame for fertility problems. (Typical!) According to ASRM, infertility affects men and women equally; potential causes for male factor infertility include varicocele, or a swelling of veins in the testicles; hormone imbalances; or problems with erection, ejaculation, or the tubes that carry sperm from the testicles to the penis. Like the female reproductive system, the male reproductive system has lots of moving parts, and they all have to work correctly for a pregnancy to happen.
Age is also a factor for men, but it’s not quite the same as it is for women. Age-related fertility decline starts a little later for men—around age 40—and the decline is just a few percentage points. However, if both partners are over 35, that decline can compound the woman’s declining fertility. Additionally, like we see in women’s eggs, chromosomal abnormalities are more likely to be present in sperm from men over 35 or 40.
5. Why are we talking about infertility? You’re an egg freezing company!
Good question! You’re right—while the “bread and butter” of many practices is assisted reproductive technology like in vitro fertilization (IVF), here at Extend Fertility we focus on helping women preserve their fertility before it’s a problem. But this conversation is a really important one, even for us, because many women don’t fully understand their own fertility—and therefore aren’t equipped to make the best possible decisions for themselves and their bodies. Just one example: many women think that they’ll be fertile and able to get pregnant until menopause, which we know isn’t true; for most women, fertility starts to decline pretty rapidly over a decade before menopause hits.
We know that for women who want to delay childbearing (or those who are at risk of infertility due to another cause, like endometriosis or cancer treatment), preserving their fertility through egg freezing is one of the smartest decisions they can make. Plus, studies have demonstrated that using eggs frozen when a woman was under 35 to conceive later increases the chance of a successful pregnancy and decreases the chance that she’ll need in vitro fertilization at that time. That’s why we like to think of egg freezing as preventative medicine for infertility.
Wait, one last thing—how can I #StartAsking?
If you want to have kids (or you might want to have kids), we recommend you start a conversation with your doctor or complete some preliminary testing to learn more about your fertility. It’s never too early! And if you’re pretty sure you want to delay having kids until later (because you’re busy in school, working on your career, travelling, waiting for the right partner, or any other reason!), schedule a consultation with a reproductive endocrinologist to talk about fertility preservation.
More awareness + more information + more options = better decisions and a happier, healthier you.