If you’ve been trying to get pregnant for a few months without results, you might wonder if the issue is infertility. But before you jump to any conclusions, you should know that it takes more than a few months to determine such a condition. According to the Mayo Clinic, infertility is the failure to become pregnant despite having frequent unprotected sex for at least a year in most cases and in six months in certain circumstances. About ten to 15 percent of couples in the U.S. receive this diagnosis.

Falling birth rates

According to the CDC, the fertility rate—that is, the number of births per 1,000 women between ages 15 and 44—in the U.S. has been falling since 2007. Does that mean that U.S. women are becoming less able to get pregnant? Not exactly. It turns out that the falling birth rate is more the result of societal choices, such as delaying the first pregnancy.

“Women are having their first child at a later age, and they’re having fewer children,” says Dr. Lisa Hansard of Texas Fertility Center. “So if you start your family in your mid- to late-30s, then you’re not going to have enough time to have as many children. It’s not necessarily that infertility is a bigger component of the lower birth rates.”

Factors causing infertility When a woman puts off pregnancy until her mid-30s, it can be harder for her to become pregnant. “The most common issue we see [in infertility] is advanced ovarian age,” says Dr. Hansard. “The average age of a patient that we see is 36. We know that fertility starts to decline around 34 or 35, and there’s a steady decline until 40 and a dramatic decline after 40.”

But other factors can also contribute to infertility.

According to the Mayo Clinic, in about a third of infertility cases, the cause involves only the man. In another third, the cause lies with the woman. And in the remaining cases, the cause either involves both the man and the woman, or the cause cannot be identified.

For men, the Mayo Clinic cites problems with sperm production or function, which can be caused by a variety of problems ranging from diabetes to prior infections, such as mumps, or problems with the delivery of sperm. Other causes include prior cancer treatment, which can severely impair the production of sperm, and overexposure to toxins and chemicals, such as pesticides, tobacco smoke and alcohol.

“For women,” says Dr. Hansard, “it’s often ovulation disorders, including the ovarian reserve—the quantity and quality of the woman’s eggs. Women are born with all of the eggs they are going to have. That amount reduces over time and cannot be increased.” Dr. Hansard says other problems for women include abnormalities in the uterus and obstruction of one or both fallopian tubes. “The last thing for women would be a process in the pelvis—like endometriosis—or pelvic adhesions, fibroid tumors—things that interfere with the egg/sperm interaction.”

Treatment options

For those couples who have received a diagnosis of infertility, there are options. According to the National Institutes of Health (NIH), treatment depends on the determined cause, but may include education and counseling, fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF) or medication to treat infections and clotting disorders or help the growth and release of eggs from the ovaries. Another option is to skip treatment. As many as 1 in 5 couples diagnosed with infertility eventually become pregnant without it, according to the NIH.


Sara Rider is a native Austinite who has worked with physicians and hospitals throughout Texas. She frequently writes freelance articles on health topics for newspapers and magazines.



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