All About Infertility

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.