Physicians define infertility as the inability to get pregnant after a year or more of well-timed, unprotected vaginal intercourse or sperm insemination. Women are also considered infertile if we are unable to carry a pregnancy to term. Overall, about 10 percent of Americans of reproductive age experience some kind of infertility. An average woman experiences peak fertility in her twenties with a 20 to 30 percent chance of conceiving each menstrual cycle. Fertility begins to drop slowly in the early thirties, and more steeply in the late thirties. By age forty, a woman’s chance of getting pregnant without medical assistance is approximately 5 percent each cycle. Women over forty who undergo assisted reproduction using our own eggs have pregnancy rates from 5 to 15 percent per cycle depending on the type of technology used.
Infertility may be a temporary or a permanent condition; this depends on the cause, the available treatments, and the fertility of the partner at any particular point in time. About 15 percent of women in the childbearing years have received some kind of infertility service, with the proportions much greater among high- than low-income women. Many insurers do not cover advanced infertility treatments, or they offer only a limited benefit, making infertility treatments too expensive for the average person.
Infertility is often considered “the woman’s problem” but that is just not so. Both the man and the woman should be evaluated, and treated if necessary, to improve the couple’s chances of conceiving a child together. In straight couples who underwent an infertility evaluation in 2001, female factors contributed to nearly 50 percent of cases, and male factors were involved in 34 percent; in the remaining 16 percent, infertility was either unexplained or due to other factors.
Approximately 50 percent of couples who are treated for infertility become pregnant. Even after giving up fertility treatments, many couples may still become pregnant, sometimes even years after treatment ends.
The use of birth control pills does not kill a woman’s eggs, nor has it caused an infertility epidemic. But it may give women an illusion of control over fertility, whereas birth control is really only some measure of control over unplanned pregnancy. There are concerns that increasing numbers and kinds of chemicals and toxins in the environment may be interfering with men’s and women’s fertility.
Even though age-specific infertility rates in the United States do not seem to be changing markedly, the number of infertility visits has skyrocketed due to women delaying childbearing for economic, professional, or personal reasons, as well as the broader social acceptance of infertility treatments and the increasing number of technologies available.