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How Infertility Can Affect the Path to Parenthood

When we imagine our future families, we have a lot of plans. We think about how many kids we want to have, where we want to raise them, and the values we want to instill in them as they grow. 

One thing none of us plan for is infertility.

Fertility issues can make all of our plans and dreams feel out of reach, but it’s important to take heart in the fact that building a family can look different for everyone. Infertility Awareness Week is an annual event that takes place in the second week of April. The event was started in 1989 by Resolve: The National Infertility Association to help bring awareness to the issue of infertility. One of the goals of Infertility Awareness Week is to help educate women about their fertility and their options for building a family.

During this week—and 365 days a year—Nanit is committed to removing the stigmas and barriers that stand in the way of parents building the families of their dreams. We’re partnering with Dr. Temeka Zore to offer our community an opportunity to ask questions about infertility, along with sharing her insights in the blog post below.

How common is infertility?

Infertility can feel incredibly isolating at times, especially as you scroll through your Facebook or Instagram feeds, and it seems everyone you know is either pregnant or sharing infant milestone photos. According to Dr. Temeka Zore, a reproductive endocrinologist and infertility specialist, patients often tell her one of the hardest parts about going through infertility is wondering what they did to cause it or what they could do differently. “I always tell patients infertility is a medical disease and treatment may be essential. There is no shame in infertility and there is nothing you did, or said to cause infertility.” 

The truth is, you’re not alone. According to the CDC, among heterosexual women aged 15 to 49 with no prior births, about 1 in 5 is unable to get pregnant after one year of trying to conceive, and about 1 in 4 has difficulty getting pregnant or carrying a pregnancy to term. One in 8 couples in the United States struggles with infertility, and between 48 million couples and 186 million individuals live with infertility globally.

Infertility is defined as being unable to conceive after a year or more of unprotected appropriately timed intercourse. While infertility is a topic that is often left unspoken, it’s something that affects many of us, and it can be both emotionally and financially draining. By starting the conversation, we can help people who are struggling with infertility feel less alone and more supported by their communities.

What factors can affect fertility?

For women, age is a major factor in fertility. A woman’s fertility starts to decline in her mid 30s and continues to decrease as she gets older due to a decline in egg quantity and quality. Many women struggle to balance their desire to build a family with the desire to pursue their education, their careers or their other passions. “I find that, in general, there is a lack of understanding regarding the age-related decline in a female’s reproductive biology. In school we are mostly taught to avoid sex to avoid getting pregnant, but what many women do not learn is how their own fertility may change with time and the options that exist that may allow them to preserve fertility such as egg or embryo freezing if they are choosing to delay childbearing,” says Dr. Zore. 

Various physical conditions can impact ovarian function and fertility, including polycystic ovary syndrome (PCOS), hypothalamic amenorrhea, thyroid/prolactin disorders and uterine or tubal factors such as endometrial polyps, fibroids or endometriosis. Other factors that can affect a woman’s fertility include her weight, smoking habits, and exposure to environmental toxins. 

For men, age may also be a factor in ability to conceive, albeit it is less of a factor than in women. The reason for this is that men generate new sperm on a daily basis whereas women are born with all of the eggs they will ever have and continuously lose eggs monthly until menopause. . A man’s sperm count begins to decline after the age of 45, which can make it more difficult to father a child. Additionally, men who are overweight, smoke, use alcohol or drugs, or are exposed to environmental toxins may have reduced sperm counts and motility. . There are a number of physical issues that can impair testicular or ejaculatory function such as varicoceles or low testosterone that can also impact male fertility. A semen analysis is typically the first step to identifying a possible male factor. 

Understanding secondary infertility

Secondary infertility is the inability to conceive after previously giving birth to one or more children. According to the Cleveland Clinic, secondary infertility is as common as primary infertility.

While the causes of secondary infertility are often the same as those for primary infertility, including age, overall health, uterine fibroids, endometriosis, and PCOS, complications from a previous pregnancy or surgery can also contribute. One example of this is Asherman’s syndrome, which can cause adhesions in the uterus after a C-section or dilation and curettage procedure.

Like primary infertility, secondary infertility can be isolating. Women who experience secondary infertility often feel guilty sharing their experiences and feelings because, unlike women with primary infertility, they already have one or more children. Per Dr. Zore, “Secondary infertility is as common as primary infertility, but often times is less frequently talked about as patient’s feel similar isolation and confusion regarding the diagnosis.”

How can I learn more about my fertility or my partner’s fertility?

If you’re trying to conceive, you can talk to your doctor about fertility testing and treatment options. 

According to Dr. Zore, the fertility consult is typically a 30-60 minute appointment that will involve a medical, family and reproductive history for you and your partner, a transvaginal ultrasound and blood work. Additional evaluation to complete the infertility work-up may include a semen analysis if the partner has sperm and a fallopian tube evaluation with a diagnostic test known as a hysterosalpingogram (HSG). Once all your testing returns your doctor will discuss with you possible diagnoses regarding your infertility and treatment options based on your age and family goals. There are many books and websites that can provide helpful information on increasing your chances of becoming pregnant, but your primary care doctor, OB-GYN, or urologist is always your best resource. They may help you determine the next steps on your journey to parenthood or refer you to a reproductive endocrinologist or another specialist.

If you’re concerned about your partner’s fertility, you can encourage them to talk to their doctor or do some research together. Learning about fertility can be an emotional process, but it can be empowering to arm yourself with knowledge about this important topic.

What treatment options do I have if I want to conceive?

There are several different treatment options available if you are having difficulty conceiving. If you are under the age of 35 and have been trying to conceive for more than a year or over age 35 and have been trying to conceive for more than 6 months without success, it is recommended that you consult with a fertility specialist. Additionally, Dr. Zore notes that if you have a known factor that may impact your fertility, such as a known male factor, endometriosis, PCOS, irregular periods that you don’t need to wait 6-12 months to see a specialist. Depending on the underlying cause of your infertility, female age and desired family size, treatment may involve medication, surgery, intrauterine insemination, assisted reproductive technologies (ART), or other fertility treatments. Some of these treatments may be utilized in tandem. For example, it’s common for medication and intrauterine insemination to be used at the same time.

While some couples may conceive after just a few months of treatment, others may need to undergo multiple rounds of treatment before they are successful. The good news is that there are many effective treatment options available, and the majority of couples who seek fertility treatment will eventually conceive.

Where can I go for more information?

Use The National Infertility Association’s personal risk assessment tool to understand your risk for fertility issues. Additional science-based resources for infertility include:

Learn more about Infertility Awareness Week

Want to learn more? Join us at this week’s Ask Me Anything about Infertility with Dr. Temeka Zore or start a discussion about parenthood in our Me Time community.

About Temeka Zore, MD

Temeka Zore, MD, is a reproductive endocrinologist and infertility specialist and board-certified obstetrician and gynecologist currently practicing at Spring Fertility in San Francisco. She enjoys taking care of a wide range of reproductive and fertility issues but has a special passion for fertility preservation and educating and empowering women regarding their reproductive health. Follow her on Instagram @temekazoremd and read her previous contributions to our blog: 10 Questions to Ask at Your First Prenatal Visit and An OB-GYN on Her Journey as a Black Woman in Medicine.

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