Hello, “class!” Welcome to Infertility 101. In this series of posts I’m going to teach you the basics of what you need to know about a disease that affects 1 in 8 couples: infertility. My husband & I have struggled with infertility for 3 years, and we’ve learned a lot along the way. The more I open up and share about our infertility problems, the more I notice that most people aren’t educated about infertility at all. Whatever the reason for this lack of education, it needs to change. Much of the hurt and isolation that infertile couples deal with is caused by the lack of education and basic understanding of their condition among their family members and friends. My goal in this series is simply to spread knowledge about infertility to those who don’t know very much about the disease. Knowledge is power, and the knowledge you gain will give you the power to have more empathy and understanding for the 1 in 8 people you know who (sometimes silently) struggle with infertility. Being among those 1 in 8, I can tell you that your simple effort to learn about infertility means the world to those of us whose arms ache for children. Thank you for showing your love for us by spending a little time learning about what we’re going through and how you can help.
Disclaimer: I am not a doctor and do not pretend to offer medical advice in this series of posts. Instead I will explain my understanding of infertility and its medical implications in language that is easy for anyone to understand. I hope that this series will educate and inform you about a topic that is often confusing and overwhelming. If you think you may be struggling with infertility or have any specific health questions, please consult a doctor you trust.
PART 1: THE BASICS
Everyone knows that to make a baby, a sperm and an egg need to come together. And then, poof! A baby is born. Babies are born all the time all over the place, so this process must be simple and foolproof, right? Wrong! There are many little factors influencing conception that have to align just right at the right time in exactly the right way for pregnancy to happen. These are the main factors:
FACTORS THAT AFFECT CONCEPTION:
- Egg Quantity & Quality
- Sperm Quantity, Quality, & Motility
- Successful Ovulation
- Fallopian Tube Functionality
- Timing of Intercourse
- Successful Fertilization
- Successful Implantation
- Hormone Balances
Each of those factors has several detailed steps and risk factors and variations that can happen that can determine whether or not conception occurs. In fact, the more I’ve learned about it, the more I’m convinced it’s a miracle anyone gets pregnant at all! We’ll go over the details of each of those factors in upcoming posts in this series, but for now let’s talk about what infertility really is.
INFERTILITY: The inability to conceive or carry a pregnancy to term after 12 months of trying to conceive.
Most couples who are having unprotected intercourse (and trying to control at least one of the above factors) usually become pregnant within one year. It’s considered normal if a couple gets pregnant at 3 months or 12 months after their starting time. Let’s go through a few scenarios that will help explain what infertility is and isn’t.
Scenario 1: A woman has unprotected intercourse for a month or two and–surprise–finds out she’s pregnant. If she and her husband weren’t timing intercourse or attempting to influence any of the other factors that affect conception, then they weren’t technically “trying” to conceive. The UK phrase for getting pregnant makes a lot of sense in this scenario–the woman “fell pregnant.” All the factors that affect conception happened to line up just right and so pregnancy happened to this couple when they were open to the idea of being pregnant. Clearly this couple doesn’t currently meet the definition of infertility. Pregnancy might always come easy to this couple, or it might have been a one-time stars-aligning situation and they might be surprised when they’re ready to have another child and pregnancy doesn’t “just happen.”
Scenario 2: A couple has been having unprotected intercourse for over a year and has been actively “trying” to conceive–using ovulation prediction kits, timing intercourse, eating healthy to promote egg & sperm quality, or by other means attempting to influence the factors that affect conception. In that time period, nothing works and they never get a positive pregnancy test result. This couple fits the definition of struggling with infertility, and it’s recommended that they meet with an OB-GYN or an RE (reproductive endocrinologist) to have testing done to help them understand what factors could be preventing their conception and discuss treatment options. Age plays an important role in several of the factors that affect conception, so couples over age 35 are encouraged to consult with a doctor after 6 months of trying rather than waiting a year.
Scenario 3: A couple conceived within a year (maybe it took 3 months of trying, or maybe it took 11 months) and gave birth to a child. A couple years later, they decide they’re ready to add another child to their family and start trying to conceive again. This time, a year or more passes and they are unable to conceive even though they’ve been trying to influence the factors that affect conception. The phrase for this couple’s struggle is secondary infertility. It applies to couples who didn’t have problems conceiving their first (or in some cases even second or third) child, but for reasons unforeseen are struggling to conceive another child. (Please note that the crazy stories you hear in the news about women who had no problems conceiving children when they were younger but then decided at age 50+ that they wanted one more so they did IVF are not representative of a struggle with secondary infertility. Remember that age impacts many of the factors that affect conception, and a woman’s fertility dramatically declines when she is over age 40.) Couples in this situation would benefit from consulting with a reproductive endocrinologist who can help them solve the problem of why they were able to conceive before, but not now.
Scenario 4: A couple tries to conceive and becomes pregnant within a year, maybe after just a couple months of trying, but a miscarriage occurs. They try again, become pregnant again, and miscarry again. For some couples the pattern of pregnancy loss (whether due to miscarriage or stillbirth) repeats over and over and over. This couple fits the definition of struggling with infertility, because while they are able to conceive within a year, for some reason they haven’t been able to carry a pregnancy to term. While as many as 25% of recognized pregnancies end in miscarriage, recurrent pregnancy loss is not normal. There are several factors that could prevent a pregnancy from being carried to term, so it’s important that a couple in this situation consult with specialists who can help them figure out what specific factors could be causing the recurrent pregnancy losses and can help them achieve a healthy, full-term pregnancy.
These are just a few scenarios that help illustrate what infertility does and doesn’t look like, and give you an idea of the variety of ways the disease of infertility can manifest itself in couples. Keep in mind that there are infinitely more scenarios than I mentioned, and many unique and complex situations out there. In the next post, I’ll start getting into the details of the factors that affect a couple’s ability to conceive, but for now I’ll leave you with a takeaway tip that will help you be more tactful toward all couples who are struggling with any form of infertility–whether you know they’re struggling or not.
I know–everyone means well. I get that. And not everybody gets offended by those questions. But most people who struggle with infertility absolutely dread the teasing “So, when are you two going to get a move on?” questions. When you’ve been doing everything in your power to grow your family for years, those questions feel like a knife in the heart. And honestly, it’s nobody else’s business but the couple’s. If you’re wondering if a friend or relative is struggling with infertility, just wonder in your brain please. If they are struggling with infertility and they feel comfortable confiding in you about it, they will open up to you when they’re ready. And if someone confides in you that they’re struggling with infertility, please don’t gossip about it to other friends or family members. The choice of who a couple shares such a personal struggle with belongs to them. Knowing that you care about and respect them enough to keep things confidential will mean a lot to any loved ones who share a private struggle like infertility with you.
Do you have any questions or comments about this basic overview of infertility? Please let me know what you think in the comments!
More facts, statistics, and helpful information can be found via these resources: