We are inundated with information about getting pregnant.
We hear tragic stories of miscarriages and of pregnancies gone wrong, read about the debate surrounding the politics of egg-freezing, hear the beautiful stories of families formed through alternative methods like surrogacy and adoption — but we very rarely talk about how challenging and difficult getting — and staying — pregnant can be.
Fertility is something many women may not truly think about until they’re already trying to start a family, so here we try to answer your burning questions about what it actually takes to get pregnant, when to start paying attention to what, and how to sort through all the information.
How common is infertility? What makes someone infertile?
According to the CDC’s Division of Reproductive Health, a woman who is unable to conceive after one full year of unprotected sex can be officially deemed “infertile.” Both men and women can be infertile, and infertility can be caused by difficulty with any of the several reproductive processes that must each happen successfully in order for conception to occur. Women or couples who are struggling to get or stay pregnant but who aren’t completely unable to conceive are said to be suffering from “impaired fecundity,” which the American Society for Reproductive Medicine estimates affects almost 11% of the population of females of child-bearing age.
Though the cause of infertility and impaired fecundity is often difficult to pin down, conditions that impact reproductive organs (like the ovaries, fallopian tubes and uterus) often heighten a woman’s likelihood to struggle with infertility. In order to get pregnant, a woman must be ovulating – which is indicated by regular menstruation – and anovulation, or lack of egg production, is one of the leading causes of infertility. Women who suffer from conditions like amenorrhea or polycystic ovary syndrome often deal with anovulation.
What conditions impair fertility and fecundity?
The National Institute of Health cites premature ovarian failure, or POF, as another leading contributor to infertility; POF is a condition similar to premature menopause, in which a woman’s ovaries cease function before she turns 40. Most women with POF cannot conceive naturally even with the help of fertility treatments, though hormone therapy has shown some positive results. Polycystic ovary syndrome (PCOS), endometriosis, and hormone imbalances can stunt or stop ovulation altogether; in fact, RESOLVE: The National Infertility Association calls PCOS the most common cause of infertility amongst women.
What treatments exist for women who are infertile?
Women who don’t ovulate regularly on their own sometimes benefit from induced ovulation or ovarian hyperstimulation, both of which employ medication to chemically jumpstart follicles and try to manufacture ovulation. Many women also use injectable medications called gonadotropins that actually include FSH in them. The efficacy of these drugs varies from woman to woman and differs based on the cause of her infertility.
Beyond these medical interventions, many women seek alternate methods of becoming pregnant themselves before turning to methods like surrogacy and adoption.
What are alternative ways to get pregnant if natural conception won’t work for me?
Intrauterine insemination (often referred to as “IUI” or “artificial insemination”) is a process by which a semen specimen is placed in the cervix or uterus of a woman who has been taking follicle stimulating drugs. The procedure is performed using a speculum and is relatively painless. It’s most effective in women who are under the age of 40 and whose fallopian tubes work properly. IUI can be performed using a partner’s sperm sample or a specimen collected from a sperm bank, and is, therefore, a method that also works well for women who are using a donor’s sperm.
Patients who use in vitro fertilization (IVF) give a sperm and egg sample to be externally combined. The samples are then joined in a dish in a sterile lab, and then an embryo (or a few) are selected to be implanted (in a process called transference) into the woman’s body. IVF is useful for both male and female infertility and can be performed on women whose fallopian tubes are damaged or who have had them removed. After the embryos are implanted, the woman waits to see if any of them takes and becomes a viable pregnancy. Though success rates differ from case to case, the American Pregnancy Association estimates that roughly 36% of women between the ages of 35 to 37 who undergo IVF deliver a healthy baby conceived through the treatment.
Then, for many different reasons, some women may choose to start a family through adoption or surrogacy or fostering. At times, patients also try treatments and means of insemination first, test their efficacy, and then determine whether or not adoption or surrogacy may be better solutions for them.
Who do I see if I have concerns or questions about conception and fertility? What diagnostic tests will they perform to test my fertility?
A reproductive endocrinologist or OB/GYN can help answer questions about your reproductive health. If a doctor wants to look into your likelihood to conceive, he or she will test your ovarian reserves and do a tubal evaluation. Ovarian reserve testing is often done by counting antral follicles, which help indicate how plentiful and viable a woman’s egg supply is. They’re also likely to test your body’s production of follicle-stimulating hormone (FSH), which controls ovulation and menstruation and can indicate whether or not you’ll have trouble conceiving. If a woman is trying to conceive with a partner, his or her fertility will be tested as well. For men, this testing includes semen analysis, by which a doctor determine’s sperm count and viability.
Once your doctor has an understanding of your chances as natural conception, he or she will help you understand your best course of action. If you’re struggling, they’ll begin to discuss Assisted Reproductive Technology (ART), a term which encompasses any and all treatments in which treatment of sperm and eggs occurs outside of a woman’s body.
Struggling to conceive is personal, deeply difficult, and exhausting for many women — though little can be done to prepare for the pain of infertility, so many alternatives exist for women who want to start a family of their own. Until you’re ready to start answering some of the big questions about family planning, having a trusted medical professional you’re comfortable asking questions of will help arm you with knowledge about your reproductive health and make sure you know what to start thinking about and when.
Of course, strong support networks and places to unload the stress of trying to conceive are enormously comforting for many women. Chatrooms, support groups, group therapies, individual counseling, and non-profit organizations all exist to help connect women who are facing similar challenges. Whatever a woman or couple ends up deciding is best for them, there are many roads to becoming a parent — whether biologically or not. Though difficulty conceiving naturally is painful, it’s certainly not the end of the road for women who want to be mothers.