Infertility Awareness Week

According to the World Health Organization (WHO), ‘infertility is a disease of the reproductive system, defined by the failure to achieve a clinical pregnancy after 12 months or more of regular, unprotected sexual intercourse’1. Worldwide, the number of people affected by infertility is over 48.5 million people2. 1 in 8 couples in the US and 1 in 7 couples in the UK face infertility3,4. In developing countries, infertility rate is even higher, with 1 in 4 couples being affected5.

A couple with a normal functioning reproductive system has a 20-25% chance of conceiving at any given month6. After 6 months of trying, 60% of those couples will conceive without medical assistance6. Causes of infertility can vary, and a personal, thorough clinical examination and family history must be taken by a specialist. Reasons for infertility can be genetic due to a translocation (incorrect rearrangement of chromosomes) in one of the partners, or due to hormonal levels, like ovulatory disorders, poor response to fertility treatments, premature ovarian failure or polycystic ovarian syndrome. Also, structural problems of the uterus, cervical factors or issues with the sperm production or transportation to the egg, immunologic disorders, and environmental factors can affect fertility. Secondary infertility, the inability to get pregnant naturally after having a baby without difficulty, is also seen. Lastly, infertility could be unexplained.

Infertility affects both men and women equally. Approximately 30% of infertility is due to female factor and 30% due to male factor. The remaining cases are from problems in both partners, or due to unexplained etiology7. The most important contributing factor for infertility is maternal age. Paternal age plays a role, but not as central. As women are born with all their eggs, their quantity and quality decreases overtime. Consequently, it is conceivably harder for women who are older to conceive and carry a pregnancy to term. In general, guidelines recommend seeing a fertility specialist after 12 months of unsuccessful trying, women over the age of 35 are advised to consult a specialist after 6 months – and not wait for a year.

Couples or people who know they might be affected by infertility, if they have experienced multiple miscarriages or have known risk factors for infertility, like endometriosis, may also consult their doctor and seek an expert’s opinion as early as they wish. Couples have a right to advocate for themselves, seek treatment, explore their options – fertility treatments, surrogacy, adoption – and take their own decisions for their families, even if these decisions are taking no actions at all.

The perceived stigma surrounding infertility often prevents people from talking about, or admitting of their fertility challenges. The desire to have children and the inability to accept infertility as a disease of the reproductive system doesn’t only feel like a biological fail, but a personal one. Infertility is unlike other medical conditions with defined pathways and mechanisms of action. Treatment might need to be emotional as well as physical, and above all, personal. As friends, family or society, all we can do is to provide emotional support, promote discussion and understanding in a way that enables better policies and more affordable and accessible fertility treatments on this global public health issue.

This year, the US National Infertility Awareness Week (NIAW), founded in 1989 by Resolve, celebrates 30 years. Resolve’s aims are to enhance public understanding on infertility, ensure couples wishing to start a family know the guidelines, and educate lawmakers on the impact of infertility policies. These empower Resolve’s purpose, which is to eliminate the barriers and the stigmas that stand in the way of building families.

For information on support groups, please visit: https://fertilitynetworkuk.org/how-we-can-help/support-groups/, https://infertilityawareness.org/, or https://resolve.org/.

References:
     1. Zegers-Hochschild F. et al. (2009) ‘International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009

  1. Mascarenhas M. et al. (2012) ‘National, regional and global trends in Infertility prevalence since 1990: A systematic analysis of 277 health surveys’. PLoS Medicine; 9:e1001356.
  2. 2006-2010 National Survey of Family Growth, CDC (2017) https://www.cdc.gov/nchs/nsfg/key_statistics/i.htm#infertility
  3. National Institute for Health and Clinical Excellence, Manchester (2013) Fertility: Assessment and Treatment for People with Fertility Problems. NICE Clinical Guideline.
  4. World Health Organization, Sexual and Reproductive Health (2019), https://www.who.int/reproductivehealth/topics/infertility/burden/en/
  5. Resolve (2019), https://resolve.org/infertility-101/what-is-infertility/fast-facts/
  6. American Society for Reproductive Medicine, Reproductive Facts, (2019), https://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/