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The Medical Minute: Pulling back the curtain on infertility

The old advertising slogan “You’ve come a long way baby” could be used to describe the advances the medical community has made in reducing the social stigma experienced by people who struggle with infertility.

“We’ve come a long way in the last 50 years ― even more so in last 15 to 20 years ― in improving the understanding of infertility as a bona fide medical condition that is more prevalent than people think,” said Dr. Samantha Butts, chief of the Division of Infertility and Reproductive Endocrinology at Penn State Health Milton S. Hershey Medical Center. “We need to take terms like ‘infertility’ out of the margins and bring them into the mainstream. We want to make people comfortable talking about it.”

What is the definition of infertility?

According to the National Institutes of Health, studies suggest that the infertility rate in the United States ranges from 12% to 15% when defined as the number of couples who are unable to conceive after one year of unprotected sex. However, more providers are moving away from that traditional infertility definition, Butts said.

“We want to be as inclusive as possible so people receive the medical attention they need as soon as possible,” she said. According to the American Society of Reproductive Medicine, the definition of infertility includes “the inability to achieve a successful pregnancy based on a patient’s medical, sexual and reproductive history, age, physical findings, diagnostic testing or any combination of those factors.”

“The age of the partner is one of the primary driving forces behind the likelihood of becoming pregnant on her own and in response to treatments we offer; we want to make sure that patients are aware that they can seek consultation sooner than 12 months of trying when they are over the age of 35.

“This is why we are proactive in advocating for patients to pursue care when they can,” she added. “We need to understand what the barriers are to seeking infertility care are so we can craft solutions to improve success.”

What causes infertility?

When someone experiences difficulty getting pregnant, their provider will first want to determine if there is a barrier to fertility in their medical history.

“Have you ever had endometriosis? An ectopic pregnancy? Irregular periods? All of these things are indicators that it could be more difficult for you to become pregnant when you want to,” said Butts, who encourages patients to be reasonably proactive in seeking care, even preconception care. “Female anatomical factors of the reproductive tract, such as scarring of the fallopian tubes due to conditions like endometriosis, pelvic inflammatory disease and scar tissue from prior major surgeries can impair the ability to become pregnant.”

Another common cause is male factor infertility, or issues with sperm, that occur in 30% to 40% of all cases. Adolescents or young adults who have had a cancer diagnosis also can struggle with getting pregnant. Exposure to chemotherapy damages ovaries and leaves female patients with far fewer eggs. In males, it damages the ability to produce sperm.

It is important for a provider to discuss all potential underlying causes when counseling patients to ensure their time is spent wisely and does not cause any further delay. The longer the duration of infertility, Butts said, the more severe the barriers are and the harder it is for treatments to work, making accessing care a priority.

“Which is why we are inclusive and proactive in advocating for patients to pursue care when they can,” she added. “We need to understand what the barriers are to seeking infertility care are so we can craft solutions to improve access.”

How is infertility diagnosed?

The first step to that understanding is a comprehensive workup for every patient. This could include assessments previously completed with a primary care physician or gynecologist.

“Reproductive providers like me are among many specialist types who see patients with fertility needs,” said Butts, who added a whole population of providers interface with women, men and individuals struggling with fertility.

Testing typically begins with ultrasound-based exams and can extend to lab assessments, hormone assessments and general health assessments before moving to fertility treatment.

“We’re talking about evaluating sperm, blood tests, ultrasounds. Very, very low-risk studies,” Butts said. “The knowledge that comes from this testing allows us to understand what a patient is facing and individualize a treatment plan.”

How is infertility treated?

Once armed with your individualized results, your provider will work with you to determine the best course of action, choosing from several broad categories of infertility treatments.

Infertility treatments for women:

  • Changing lifestyle factors (i.e., smoking cessation)
  • Intrauterine insemination
  • Fertility drugs
  • Surgery
  • In vitro fertilization

Infertility treatments for men:

  • Changing lifestyle factors (i.e., smoking cessation)
  • Medications
  • Surgery
  • Sperm retrieval

Where to find support?

Start with people you trust.

“Talk to relatives, colleagues and friends who may have had an experience in this space and have a trusted provider they could refer you to,” said Butts, adding that patients should also talk with their OB-GYN, primary care physician and look to their insurance provider to find in-network physicians who subspecialize. “One part of the conversation has to include what is involved in the treatment and another part has to address the cost of treatments. Patients need to be supported. They need to feel like they have a source of information, guidance and expertise.”

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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