You may think that infertility is extremely rare, but in fact, recent studies reveal that as many as 15% of couples in the U.S. are considered infertile.
“Poppy Bliss,” by Robert Knight
Infertility is a multifaceted diagnosis that affects more individuals and couples than you might think. One in six couples have trouble getting pregnant or maintaining a pregnancy. From 2015 to 2019, 5.9 million women in the United States between the ages of 25-44 used infertility services. But infertility does not affect women alone. Approximately one-third of infertility is attributed to the female partner, one-third to the male partner, and one-third is caused by a combination of problems in both partners or is unexplained.
During National Infertility Awareness Week, Brindha Bhavan, MD, a reproductive endocrinology and infertility specialist at Stanford Medicine Children’s Health, joined our Instagram ‘Ask Me Anything’ series to share her expertise. The following Q&A is drawn from that session and has been edited for clarity and length.
What are causes of infertility?
When thinking about a patient and their partner, I consider the anatomy that’s involved. It’s kind of a structure for figuring out potential causes. There can be issues with the ovaries, tubes, uterus, and sperm. There could be lower egg quality or egg counts. There could be blocked tubes. There could be some uterine factor, such as adhesions or scar disease or fibroid polyps. There can also be male factor infertility with poor quality or moving sperm. A common cause of infertility is unexplained infertility. In about one-third of cases, we don’t have a clear answer, but now treatments can help. There are many other conditions, like polycystic ovary syndrome and endometriosis that can play a role in fertility.
How common is infertility?
Infertility affects one in six couples. Traditionally, for a heterosexual couple, if the female partner is younger than 35, we consider there to be an issue if they try for 12 months of regular unprotected intercourse without success. If the female partner is older than 35, we consider a six-month timeline. In 2023, the American Society for Reproductive Medicine, encouraged a more inclusive definition of infertility. This definition includes same-sex couples requiring donor gametes, single parents looking to use donor gametes, or anyone who has a medical condition needing immediate help (e.g. individuals who don’t ovulate regularly). All of these individuals warrant care and attention.
What tests are done to diagnose infertility?
To diagnose infertility, we start with a detailed history and physical exam. This is followed by additional work-up that includes bloodwork to understand egg reserve and pre-pregnancy health. We also conduct an ultrasound or special x-ray contrast study to check the patency of the fallopian tubes, conduct 3-D imaging of the uterus to check issues, and do a semen analysis.
What are the treatment options for infertility?
Treatments for infertility vary and are often tied to the cause of the condition. Generally, treatments fall into broad categories like helping people ovulate and timing intercourse. We can assist with intrauterine insemination, directly depositing sperm within the uterus. We can also help with invitro fertilization (IVF), where we manipulate gametes in our lab to make embryos and then transfer them back into the uterus.
What are the success rates for infertility treatment?
Success rates for IVF treatment vary depending on the cause of infertility, unique medical conditions of the patient and their partner, and the patient’s age. Generally, if someone has trouble ovulating and we assist, they usually return to their natural fertility rates based on their age. For intrauterine insemination, ballpark success rates range from 8% to 15%, depending on age. For IVF, success rates can be around 30% per cycle for a live birth.
Are there lifestyle changes that can be made to improve infertility?
We always want people to enter pregnancy in their best health. This includes following a balanced diet, engaging in regular exercise (about 30 minutes five times a week), maintaining a healthy BMI and avoiding substances like tobacco, marijuana, and alcohol. Managing stress and working on activities that bring joy and mindfulness, such as time with family, exercise, therapy, or acupuncture (if it brings wellness), can also be helpful.
What emotional support is available for individuals struggling with infertility?
There is a high incidence of depression and anxiety among infertility patients. Mental health is critical. We have therapists and mental health resources connected with our clinic, as well as psychiatrists focusing on reproductive health. Social media offers many support groups and sharing with family and friends can also provide comfort. If infertility affects one in six couples, it affects someone you know. Support from the community is important.
When should an individual consider fertility preservation?
Fertility preservation has become more popular and accessible. Decisions about fertility preservation are unique and individualized. Factors to consider include family size, timeline partnership goals, and whether someone will pursue career, financial, or educational goals before starting a family. For onco-fertility patients undergoing gonadotoxic cancer treatments, freezing eggs, sperm or embryos is advised. Similarly, individuals preparing for gender-affirming treatments may consider fertility preservation.
What is PGT Testing?
Preimplantation genetic testing (PGT) takes place before we implant the embryo in the uterus. It is typically performed on a Day 5, 6, or sometimes Day 7 embryo from the trophectoderm, which will become the placenta. We can sample cells, freeze the embryo, and send the genetic material to a partner lab that will run genetic tests and provide information.
There are several types of PGT:
- PGT-A (preimplantation genetic testing for aneuploidy): The most commonly used, this checks that the number of chromosomes within an embryo is viable.
- PGT-SR (preimplantation genetic testing for structural rearrangements): For individuals who may have a translocation or inversion that puts them at risk of recurrent pregnancy loss.
- PGT-M (preimplantation genetic testing for monogenic disorders): For those who are known carriers of mutations, such as BRCA1 and BRCA2 (which increase the risk for breast cancer), or Lynch syndrome (which significantly increases the risk for colon cancer). This also includes those who match their partner for cystic fibrosis or another condition identified on a preconception genetic carrier screening panel. We can design special probes, and in collaboration with a genetics company, test embryos ahead of time to determine which are affected and which are not, thereby prioritizing unaffected embryos.
There are different PGT methods in development, and there are many pros and cons, as well as ongoing debates about their use. It is important to have an in-depth conversation with your fertility doctor to determine what is right for you.
What makes Stanford’s Medicine’s approach to care unique?
What makes Stanford so special is that we are an academic center, and we’re able to take on more medically complex cases. We have dedicated, compassionate physicians who specialize in areas like recurrent pregnancy loss, endometrial lining, endometriosis, and onco-fertility preservation. In addition to helping general infertility concerns, we can help people who might have felt that they couldn’t get answers elsewhere.
For individuals or couples like you/yours, Stanford Medicine’s Fertility and Reproductive Health Services is proud to offer one of the most comprehensive and progressive treatment programs in the country.
