Receiving a diagnosis of infertility can be daunting when you're trying to conceive. You might think — were there signs of infertility that I missed? Is there anything I can do to improve my chances of conceiving, or treatment for my infertility? Will I ever be able to have biological children?
It's natural to have these questions and more running through your mind when you are diagnosed with infertility, or even if you suspect fertility issues. In this article, we’ll answer these questions and get to the bottom of everything you need to know about infertility diagnosis.
Infertility is defined as an inability to become or remain pregnant after 12 months of regular unprotected sex (or six months if the female partner is over the age of 35).
Infertility is a “functional diagnosis.” That means it’s not diagnosed by a specific test or metric but, instead, by clinical outcomes. In this case, the outcome that determines a diagnosis is not attaining a pregnancy or experiencing recurrent pregnancy loss.
If you aren’t in a cis, hetero couple — and therefore natural conception isn’t available to you — you might be wondering, where does this definition of infertility leave me?
In recent years, experts in the fertility field have attempted to redefine and broaden the definition of infertility to reflect demographic factors that can influence a person's ability to have children without medical assistance.
Some in the LGBTQ+ community have described their path to parenthood as “social" infertility. Both partners in a same-sex relationship may technically be fertile, but they experience non-medical barriers to pregnancy. Although there are reproductive assistance technologies available for LGBTQ people, the procedures can be expensive — and much of the time, health insurance will not cover these procedures.
There are also people who want to have children but are single. Depending on the sex of the hopeful parent, they may need to purchase donor sperm, find an egg donor, or find a gestational surrogate to carry the pregnancy. Pursuing procedures like insemination, IVF, or surrogacy can be a great financial strain for just one person to bear.
With this in mind, health advocates in the fertility space have pushed for a wider definition of infertility, with hope that this will allow access to healthcare and coverage to expand.
There are several types of infertility, each with different potential causes and different approaches to treatment. In many cases, people with infertility do not experience other symptoms or any warning signs — they only realize there may be an issue once they have trouble trying to conceive.
Although many people see infertility as a “women’s issue,” anyone can be diagnosed with this condition, and male-factor infertility is very common. Of all infertility cases, approximately 40–50% of couples struggle with male-factor infertility, meaning that the fertility of the male partner (and their sperm) is one of the primary drivers of the couple’s difficulty conceiving.
Male-factor infertility could be caused by:
There are a number of factors that can lead to decreased sperm quality, including lifestyle factors such as smoking tobacco or exposure to toxic chemicals. There are also some medical conditions that can affect male fertility, such as a varicocele or an untreated sexually transmitted infection.
Approximately 10% of women in the United States between the ages of 15 and 44 experience infertility. Female-factor infertility is defined as a case in which the female partner and their eggs are at the center of the diagnosis. Female-factor infertility can be caused by any condition or factor that disrupts these three core processes in reproduction:
Ovulation dysfunction can be caused by advanced maternal age (as egg quality and quantity both decline with age), or by hormonal imbalances such as polycystic ovarian syndrome (PCOS). Conditions like pelvic inflammatory disease (PID) or untreated sexually transmitted infections can cause fallopian tube scarring, making fertilization difficult.
Sometimes, it’s a combination of male- and female-factor infertility issues that are causing a couple’s inability to conceive. For example, if the female partner has mild scarring in her fallopian tubes and the male partner has low sperm count, it’s much less likely that the sperm will reach the egg, compared to a couple that’s experiencing only one of these factors. This accounts for about a third of infertility cases.
In most cases, couples struggling with infertility are able to get to the root cause after diagnostic lab tests and examinations. However, around 15% of infertility causes have an unknown or unexplained cause. Lab tests and imaging may find that everything seems normal, and yet the couple still is not able to conceive.
Even if the cause is unknown, there are still infertility treatment methods available. Couples may choose to pursue intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). Making healthy lifestyle choices can also help increase the chances of conceiving, with or without assisted reproductive technologies.
There's a misguided notion that getting pregnant is easy, and you may feel panicked if you don't see a positive pregnancy test after a few months. However, it's completely normal to try for several months before becoming pregnant.
Generally, infertility specialists will work with couples who have not been able to conceive after 12 months of consistently trying. If a partner is older than 35, then it may be beneficial to see an infertility specialist after six months of trying.
If you have a medical condition that is known to affect fertility, such as PCOS or cystic fibrosis, you may want to see an infertility specialist sooner than the recommended 6–12 month range. Similarly, if you’ve had an abnormal test result — such as a semen analysis — you might want to meet with a specialist earlier in the process of trying to conceive.
If you are not in a cis, heterosexual relationship, you may need to meet with a physician as you begin to consider starting a family to explore your options. Same-sex couples may consider surrogacy or use a sperm or egg donor for a procedure like IUI or IVF.
Many couples start by seeing the female partner’s gynecologist. A couple may also seek care from a reproductive endocrinologist, a gynecologist specialist with additional training in fertility. However, couples dealing with male-factor infertility should also consider seeing an andrologist-urologist or male fertility specialist, who can provide more guidance on improving sperm health.
There are several types of male fertility testing options available, some of which you can complete from the comfort of your home. Below are the top three most common and recommended tests for people with testes.
With Legacy's mail-in sperm testing kits, you never even need to leave your home to get comprehensive test results and personalized recommendations from a fertility expert. Learn more about our sperm analysis kits here.
Although the thought of infertility can be scary, there's power in knowledge. The more you know about your body, the better equipped you are to overcome any roadblocks. If you're struggling to conceive or simply planning to start a family soon, getting a clear picture of your sperm health is a great first step.
Some lab and clinical tests can also help identify potential causes for female-factor infertility, including:
A diagnosis of infertility does not mean that having a biological child will be impossible. You may need to make some changes to your lifestyle or your conception attempts, or pursue fertility treatment.
For example, in cases of female-factor infertility, a person might be experiencing ovulation dysfunction, which can be helped with medication. Or if someone is experiencing male-factor infertility, they may receive recommendations to improve sperm health and boost their chances of conceiving. Each case of infertility is unique, so getting to the root cause is an important step in developing a plan of action.
During IUI, thawed and prepared sperm is inserted directly into the uterus, bypassing the vagina and cervix. The procedure happens at the time of ovulation, often timed using ovulation medication. IUI may be helpful for those with anovulation (lack of ovulation) or with mild male-factor infertility. It’s also often the first step for those with unexplained infertility.
IVF is a process in which a patient’s ovaries are stimulated to produce multiple eggs in one cycle. Those eggs are retrieved from the patient’s ovaries surgically, and then combined with partner or donor sperm in the lab to produce embryos. One or more embryos will then be transferred into the patient’s uterus to attempt pregnancy.
IVF is useful for those with moderate male-factor infertility, diminished ovarian function, advanced maternal age, or unexplained infertility that has not been resolved with IUI.
ICSI is an IVF technique in which a single sperm is injected directly into an egg in the lab. It’s most useful in cases of severe male-factor infertility, when sperm motility is low. ICSI may also be helpful when you’re working with frozen sperm and quantities are limited.