About Infertility

Understanding Infertility

Creation of a family is a basic human right. If you have concerns about having a baby or about infertility, there is good news! Many of the issues that cause infertility can be treated by your doctor or family planning center health professional, so begin there as a first step. If additional treatment is necessary, your doctor or family planning center can send you to a specialist in infertility.

Ovulation occurs when a woman releases an unfertilized egg from her ovary. Normal ovulation occurs once every 28 days to 35 days. If fertilization has not occurred, a woman will have her regular menstrual period. Signs that a woman is not ovulating include irregular or absent menstrual periods. Hormonal imbalances and conditions such as polycystic ovarian syndrome can also affect a woman’s ability to ovulate regularly. Women who do not have regular monthly menstrual cycles may also wish to seek medical advice sooner. There are treatment options for women.
Male infertility is just as common as female infertility. Decreased numbers of sperm, abnormally shaped sperm, or sperm that are not moving correctly can all negatively impact the likelihood that fertilization will occur. A semen analysis is important for men experiencing infertility. There are treatment options for men.
When a woman ovulates, the egg travels from the ovary to the fallopian tube. The sperm travels through the uterus and into the fallopian tube to meet the egg there, where fertilization occurs. If a problem exists such as a blocked fallopian tube, then egg and sperm cannot meet and the woman will not be able to conceive. There are ways of diagnosing and treating conditions which prevent conception.
After sperm and egg meet in the fallopian tube and conception occurs, the fertilized egg travels down the tube and into the uterus where it should then imbed itself into the uterine wall and start to grow the baby and placenta. This is called implantation. There are some conditions which may prevent successful implantation. For example, if the uterine lining is not the right thickness, or if there is tissue blocking successful implantation, such as endometriosis or fibroids, infertility will result. There are treatment options.

Disparities in access to effective treatment for infertility in the United States

In the United States, many individuals with impaired fertility go untreated or under-treated. Economic, racial, culture, geographic, and other disparities exist in access to effective treatments and in treatment outcomes1.

The National Survey of Family Growth (NSFG) reported that during the period 2006-2010, just 38% of American women who have never given birth with current fertility problems had ever used infertility services, and most commonly those services only included medical advice and testing1. Other methods available for treating infertility include:

  • Assisted reproductive technology (ART)
  • Surgery
  • Medication
  • Intrauterine insemination
Studies have shown that some groups, including minority women, tend to seek medical advice after a longer duration of infertility, potentially contributing to lower pregnancy success rates. The studies suggest a diminished level of access to care when compared to white women 1,2.

A study also conducted by The College of New Jersey for Ferre Institute revealed some interesting trends related to the extent to which individuals of African descent identify with the problem of infertility.

  • Some believed that infertility and sterility are one in the same
  • Many believed that infertility only pertained to women and sterility pertained to men.
  • Men often equate fertility with potency. This myth often contributes to the persistence of the couple’s infertility due to the male’s unwillingness to participate in the diagnostic process.
  • 100% of the respondents indicated that information about infertility is not easily accessible and often is too complex; written in medical jargon that is not easily understood by the lay public.
  • Most respondents were spiritually connected and believed that “God will take care of it”.
Cultural and societal factors can also be a barrier to accessing infertility care. Several studies revealed that African American, Hispanic, Muslim, and Asian populations in the United States with communication or language differences, cultural stigmas (including male and female aversion to being labeled “infertile”), cultural emphasis on privacy, and unfamiliarity or prior bad experiences with the US medical system may choose not to seek treatment1,2.
Economic factors are a chief contributor to disparities in access to effective treatment1.

State mandated insurance coverage has been shown to increase approximately 3-fold the utilization of infertility services; however, mandates apply only to persons who have private insurance, and only to those policies that must comply with the state insurance law. This means that infertility coverage may not be available to people who are uninsured, who obtain health coverage through Medicaid or other government programs, or who obtain health insurance from employers that are either self-insured, too small to be subject to the mandate, or based outside of the mandated state.1

Studies have shown that even in states with comprehensive infertility mandates, infertility care is utilized at a higher rate by non-Hispanic white women of high socioeconomic and educational status.

In addition to being able to afford treatment, the patient must have accessibility to obstetrician-gynecologists and In-vitro Fertilization (IVF) centers as well as be able to take substantial time off from work for office visits when pursuing IVF. Fair access is also impaired by some providers who decline to treat unpartnered individuals and same-sex couples as patients. Thus, geographic unavailability and provider bias may impede many from seeking or obtaining treatment1.
The Centers for Disease Control (CDC) has issued a National Action Plan on the public health implications of infertility.

Visit the CDC website to learn more
Talk to your doctor or family planning center today.
They can help!

Infertility is not just a woman’s problem

It is a myth that most causes of infertility are related to a woman’s reproductive health.

  • 30% of cases are caused by female reproductive problems
  • 30% of cases are caused by male reproductive problems
  • 30% of cases are caused by BOTH male and female problems
  • 10% of cases of infertility are unexplained

Key Statistics on Infertility from the National Survey of Family Growth (NSFG)-Centers for Disease Control and Prevention (CDC)

6.7%

Percent of all married women 15-44 years of age who are infertile (i.e., who are not surgically sterile, have not used contraception in the past 12 months, and have not become pregnant), 2011-2015:

14.2%

Percent of currently married, childless women 15-44 years of age who are infertile.

By current age, 2011-2015:
15-29 years: 8.7%
30-34 years: 11.0%
35-39 years: 23.0%
40-44 years: 26.2%

12.0%

Percent of women 15-44 years of age who have ever received any infertility services, 2011-2015: (7.3 million).
Percent of women 15-44 years of age who have ever received infertility services.By type of service, 2011-2015:

Advice: 6.3%
Medical help to prevent miscarriage: 5.4%
Tests on woman or man: 5.2%
Ovulation drugs: 4.2%
Artificial insemination: 1.4%

6.9%

Percent of childless women 15-44 years of age who have ever received any infertility service.

By current age, 2011-2015:
15-29 years: 3.6%
30-34 years: 13.4%
35-39 years: 21.5%
40-44 years: 23.7%

1 Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Fertil Steril 2015;104(5):1104-10.

2 Huddleston HG, et al. Racial and ethnic disparities in reproductive endocrinology and infertility. Am J Obstet Gynecol 2010;202(5):413-9.