So you and your partner have decided you’re ready to have a baby. You’re tracking your cycle; you’re having unprotected sex during your ovulation window. And months are going by, and still, you’re not pregnant.
If a year passes in this way, you might be dealing with infertility.1 The word may feel heavy or scary, but infertility is quite common—and it is not “unfixable.” It’s so common, in fact, that according to the NHS about 1 in 7 couples have trouble conceiving.1
While there is a tendency for women to blame themselves for infertility, perhaps because we are the ones who actually get pregnant, it’s important to remember that the male factor substantially contributes to about 50% of all cases of infertility.2
If you two have been trying for a year with no luck, it may be time for some fertility tests to determine the underlying cause. You’ll be more informed when it comes to reviewing fertility treatment options, if that’s something you want to—and can—do.
Before you undergo any (potentially expensive) infertility testing, we hope your doctor asks you a few questions about you and your partner’s lifestyles and current health. If your fertility issue can be helped without fertility treatment—which can be expensive and invasive—lifestyle changes are a good place to start.
Common Causes for Female Infertility
- Certain medications: Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, can reduce fertility in females. So can neuroleptic, antipsychotic, and chemotherapy medications.3
- Obesity: Research shows that females who are obese can have trouble conceiving.4
- Over-exercising: Excessive physical activity or being underweight can affect fertility.4
- Substance use: Tobacco use, heavy drinking, heroin, cocaine, and even regular use of cannabis can impact fertility in both sexes.4
- Polycystic Ovary Syndrome (PCOS) can make it harder to conceive as it can cause an irregular menstrual cycle, a lower egg count, and potential hormonal imbalances.3
- Fibroids: Non-cancerous growths called fibroids in and around the womb can make becoming pregnant more difficult. These can be surgically removed.3
- Endometriosis: With endometriosis tissue similar to the lining of the womb grows in other places outside of the womb. If this damages the ovaries or fallopian tubes, it can cause fertility problems.3
- Certain STIs: STIs like chlamydia and gonorrhea can impact infertility in females.5
- Working the nightshift: No, really—your sleep schedule can impact infertility. Working overnight can mess up your circadian rhythm and ultimately, your reproductive hormones. This can make it more difficult to conceive.5
- Stress: Chronic or intense stress can reduce fertility in both females and males.3
It’s also important to note that fertility decreases in both sexes as we age; however, the impact of age on fertility is much greater in females. In fact, if you get pregnant after the age of 35 it is considered a “geriatric pregnancy.” (Any doctors reading this, please retire this term from your vocabulary and maybe choose something else. Thanks.)
Common Causes for Male Infertility
- Certain medications: Certain arthritis medications, chemotherapy medications, and some herbal remedies can decrease sperm production.3 So can bodybuilding medications like androgens.4
- Substance use: Tobacco use, heavy drinking, heroin, cocaine, and even regular use of weed can reduce fertility in both sexes.4
- Obesity: Obesity is linked to a lower sperm count and quality in men.4
- Testicular cancer: Or injury to the testicles.3
- Ejaculation disorders: These can affect fertility. 3
- Strenuous physical labor: Intense physical activity can reduce male sperm count4
- High blood pressure: This can change the shape of sperm, reducing fertility.4
- Stress: As mentioned above, chronic stress can reduce fertility in both males and females.3
- Certain STIs: It’s estimated that certain STIs, like HPV and chlamydia, may cause about 15 percent of male infertility.6
A common myth is that tight underwear can impact sperm count. Research shows this one’s not true.4
Fertility Treatment Options
If you’ve addressed any lifestyle changes that your doctor has recommended—like diet, exercise, medication, sleep, drug or alcohol use, or exercise changes—fertility testing may be your next step. It’s important that you and your partner both get tested, so your doctor can determine next steps, because treatment will be different depending on which one of you is (as Charlotte from SATC would say) “reproductively challenged.”
Oftentimes, the issue is with both partners. In fact, egg and sperm health each contribute 50 percent of conception challenges. To make sure both sides are well covered, you might try adding in PREGGO Conception and PREGGO Sperm Health before undergoing costly treatments—but check in with your doctor before adding any supplements into your routine.
Fertility Treatments for Females
If you and your doctor have determined fertility treatments are the best option for you, these are probably the options you’re going to discuss:
- Medical treatment for lack of regular ovulation
- Surgery to treat endometriosis, remove fibroids, repair fallopian tubes, or remove scarring
- Assisted conception like Intrauterine Insemination (IUI) or In-vitro Fertilization (IVF)
IUI vs. IVF
TL;DR: With IUI, sperm is injected directly into the uterus. With IVF, it’s a multi-step process that involves egg stimulation, egg retrieval, lab fertilization, and then transfer back into the womb.7
What is IUI?
IUI reduces the distance sperm has to travel by placing it right here into your uterus. This gives the sperm a better chance of reaching your eggs. It is a relatively simple in-office procedure done the day after you ovulate. Your doctor will use what’s called a “speculum” to locate your cervix, and then insert a tube into your uterus, using it to inject the sperm sample.
Sometimes IUI is combined with ovulation induction– where you take medication to stimulate ovulation. This can further increase the likelihood of conception for some.7
Now let’s be real here, having a tube inserted into your cervix won’t exactly be comfortable. Most medical websites say that it is “completely painless,” but most of those writers probably haven’t actually done it. According to some women who’ve actually experienced IUI, it can be painful, or just uncomfortable, but overall the discomfort doesn’t last long.
What is IVF?
IVF is a more complicated process. Normally your ovaries produce one follicle each month, but with IVF you’ll be injecting a high dose of hormones each month in order to produce more follicles.
Once those eggs mature, your doctor will retrieve them through your vagina during a 10-minute outpatient surgery called “oocyte retrieval.” These little eggs will then go to the lab to be combined with your partner—or a donor’s—sperm. Those that result in an embryo are then transferred into your uterus or frozen for a rainy day.7
Now oocyte retrieval is painful, and is usually performed under sedation and analgesia (numbing agents and pain relievers.)8
Cost of IUI vs. IVF
Generally, IUI is the less expensive option here, costing about $300 to $1,000 without insurance.9 IVF, on the other hand, can be pretty expensive since it includes medication, procedures, anesthesia, ultrasounds, blood tests, lab work, and embryo storage. The exact cost can be $15,000 or more for a single IVF cycle.9
Fertility Treatments for Males
If you and your doctor have determined fertility treatments are the best option for your male partner, these are probably the options on the table:
Medication
If a hormone imbalance is the root cause, hormone therapy can help regulate that. Your doctor may also recommend stopping certain medications like steroids, certain antidepressants, or calcium channel blockers.10
Surgery
Surgical options for male infertility include vasectomy reversals (for obvious reasons); vasoepididymostomy—which can remove a blockage preventing sperm from entering the semen; sperm retrieval—which removes sperm directly from the testicals; and varicocelectomy—which can help correct varicose veins in the testicals.
Assisted Reproductive Technology
Just like IUI and IVF can help with female reproductive issues, Intracytoplasmic Sperm Injection (ICSI) and IVF help with male fertility issues as well.
During ICSI, your doctor will physically inject a single sperm into an egg.
IVF, we’ve already discussed. The guy’s part in both of these procedures is pretty limited; he’ll need to ejaculate into a sterile container, usually at a fertility clinic, and provide emotional support for his partner during this process.
Gestational Surrogacy and Adoption
If you’ve tried fertility treatments to no avail, or all of this simply isn’t for you but you still want to have a baby, gestational surrogacy and adoption are some other options.
Gestational surrogacy is when a person carries and gives birth to a baby for somebody else. This is usually done through IVF, using someone else’s egg and someone else’s sperm, so the person carrying the baby doesn’t actually have any genetic relation to the baby.
(This is different from “traditional surrogacy” where the person carrying the baby is genetically related, because their eggs are used to create the pregnancy.)
Because gestational surrogacy involves IVF (an expensive procedure on its own), plus basically renting somebody else’s womb and all of the legal fees that would go along with that, it can be quite expensive. You can expect to spend at least $50,000 to $150,000 or more.11
If you’re interested in adopting a child, there are many steps in the adoption process and knowing where to even start can be a little confusing. We recommend reading over this Adoption Process Overview to get an idea of how it all works.
A note on sex and gender: Sex and gender exists on spectrums, and this article uses terms like “male” or “female” to refer to sex assigned at birth. Learn more.
