5 Things to Know About Infertility

National Infertility Awareness Week highlights that infertility, affecting about 1 in 6 individuals globally, impacts both men and women, is more prevalent among Black and Hispanic/Latina women, is not caused by contraceptives, and becomes more challenging to address with time, emphasizing the need for equitable access to fertility care. | Image Credit: tashatuvango - stock.adobe.com

National Infertility Awareness Week is April 21 to April 27 to advocate and educate others about infertility.¹ There are often common myths surrounding infertility which lead to greater misunderstandings. To combat these myths, here are 5 things to know about infertility.

1. A Shared Challenge: Both Men and Women are Impacted

Couples who fail to achieve clinical pregnancy after 12 months of regular unprotected sexual intercourse define infertility.² Infertility affects both men and women, yet the burden frequently falls on women. Women with infertility experience greater psychological stress and stigma for being infertile and childless than infertile men. While some infertility causes remain unexplained, identifiable factors affect both male and female reproductive systems.³

Blockages in the ejaculatory ducts and seminal vesicles, often from injuries or infections, cause male infertility. Hormonal disorders, such as those where testosterone fails to regulate sperm production, also induce abnormalities. Pituitary or testicular cancers create hormonal imbalances that lead to infertility, varicoceles, and chemotherapy treatments impact sperm production, and conditions that alter sperm shape or movement, particularly anabolic steroid use, negatively affect fertility.

Untreated sexually transmitted infections, unsafe abortions, postpartum sepsis, or abdominal/pelvic surgery block fallopian tubes, causing female infertility. Endometriosis, septate uterus, or fibroids disrupt the uterus, contributing to infertility. Polycystic ovarian syndrome and other follicular disorders affect the ovaries, leading to infertility. Endocrine system disorders that imbalance reproductive hormones also induce female infertility.

Lifestyle factors, including smoking, excessive alcohol intake, and obesity, affect men's and women's fertility. Environmental pollutants and toxins directly decrease egg and sperm count and quality. Men cause infertility in a third of infertile couples, women in another third, and the remaining third involves unidentified factors or both partners.⁴

2. The Widespread Reality of Infertility

Approximately 17.5% of the adult population experiences infertility, a condition more common than many people realize.⁵ Roughly, 1 in 6 individuals worldwide experience infertility, based on a report from the World Health Organization. Comparable prevalence rates across high, middle, and low-income countries demonstrate infertility's status as a widespread global health challenge.

High-income countries show a lifetime infertility prevalence of 17.8%, while low and middle-income countries show 16.5%.⁶ Data indicates that after 1 year of unprotected sex, 12% to 15% of couples do not conceive, and after 2 years, 10% of couples trying to become pregnant remain unable to.⁷

Age-related decline impacts fertility in both men and women, with a significantly greater impact on women. Women experience approximately half the fertility in their thirties compared with their early twenties. After age 35, a woman's chance of conception declines significantly. Male fertility also declines with age but at a more gradual rate.

3. Statistical Differences and Historical Influences Within Racial Groups

Studies show non-Hispanic Black women experience infertility challenges 1.8 times more often than Hispanic or non-Hispanic White women.⁸ Black women also seek help for infertility half as frequently as White women. A Society for Assisted Reproductive Technology database review of 80,390 cycles revealed African American women accounted for 4.6% of cycles, while Caucasian women accounted for 85.4%.⁹ Historically, chattel slavery and the racist notion that Black women reproduce easily influenced perceptions of Black women's fertility.¹⁰ This belief perpetuates reproductive discrimination, which falsely suggests infertility primarily affects White people.

In the early 1900s, 32 states passed laws that allowed governments to sterilize people with disabilities, people of color, and others, believing they could improve humans through selective breeding and by preventing “undesirable” people from having children. Government-funded programs forcibly sterilized Black, Indigenous, and Latina women, continuing into the 1970s. These programs often told the women the procedures were reversible.

Black women often lack clarity on when to seek infertility help and frequently possess medical conditions that impede pregnancy or full-term birth. However, doctors sometimes fail to inform Black women about potential conception barriers. Furthermore, Black women develop fibroids 3 times more often than White women, which frequently causes miscarriages and infertility.

4. Contraceptives Are Not the Cause

Hormonal birth control delays fertility and prevents pregnancy temporarily, but once contraceptives are halted, fertility levels eventually return to previous levels.¹¹ It is possible for some to experience a delay in fertility even after the birth control hormones have left their body, but it usually returns in a few months to a year. Patients often blame contraceptives for pre-existing irregularities and conditions like polycystic ovary syndrome that had masked symptoms through contraceptives that are now revealing themselves.

Some methods of contraceptives have more fertility delays than others. Users of injectable contraceptives had the longest delay in return of normal fertility (5-8 cycles), followed by users of patch contraceptives (4 cycles), based on a study published in BMJ.¹² Patients who used the oral and ring contraceptives experienced normal fertility after 3 cycles, while users of hormonal and copper intrauterine devices and implant contraceptives had 2 cycles before returning to normal. Health care professionals have suggested other forms of contraceptives from the shot because it can take up to a year for usual fertility levels to return and would not be beneficial for people who want to conceive soon.

5. Access, Equity, and the Diverse Landscape of Treatment

A wide variety of populations seek infertility management and fertility care services, including heterosexual couples, same-sex partners, older couples, individuals who are not in sexual relationships, and those with certain medical conditions.³ Disparities in access to care adversely impacts lower income, unmarried, unemployed, and uneducated individuals.

Awareness surrounding assisted reproductive therapies (ART) among Black women is growing but these populations often do not know when to seek help for infertility or that they should seek help in the first place.¹⁰ Significant financial barriers have been created to access ART, typically catering to White, wealthy couples and average cycles costing between $15,000 to $20,000.

Since September 2023, 21 states plus DC have passed fertility insurance coverage laws, 15 of those laws include IVF coverage, and 17 cover fertility preservation for medically induced infertility. The American Society for Reproductive Medicine issued a new definition of “infertility” that specifies, “the need for medical intervention, including but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner”. The push to include donor eggs and sperm could lead to better insurance coverage for LGBTQ couples and single women.

Fertility is a social justice issue regarding reproductive justice because it is currently inaccessible to certain aspects of the population based on their state, insurance, and the exclusion of individuals, especially people of color, from having babies that they want.

Treatments for men to become fertile can range between lifestyle changes, medications, surgeries, and sperm retrieval procedures.¹³ Treatment for women to become pregnant include fertility medications, intrauterine insemination, and surgery to restore fertility. Other techniques include intracytoplasmic sperm injection, assisted hatching, donor eggs or sperm, gestational carrier, and genetic testing.

It is important to highlight that infertility challenges impact individuals differently, and it can be a very emotional hardship to navigate. To support someone with infertility, it is helpful to validate their feelings and say things like, “What can I do during this time to help?”¹⁴ Additionally, avoid minimizing the condition and comparing others because everyone’s infertility journey is different.

From understanding the shared biological causes and the temporary effects of contraceptives to addressing the stark racial disparities and the financial barriers that limit access to treatment, it's clear that infertility is a complex issue requiring both medical and societal attention.

References

1. Tvenge R. #InfertilityUncovered- April 21-27 Is National Infertility Awareness Week. Center for Reproductive Medicine. April 21, 2019. Accessed March 31, 2025. https://www.ivfmn.com/infertilityuncovered/

2. Taebi M, Kariman N, Montazeri A, Alavi Majd H. Infertility stigma: a qualitative study on feelings and experiences of infertile women. Int J Fertil Steril. 2021;15(3):189-196. doi:10.22074/IJFS.2021.139093.1039

3. Infertility. World Health Organization. May 22, 2024. Accessed March 31, 2025. https://www.who.int/news-room/fact-sheets/detail/infertility

4. Walsh M. See the most recent fertility stats. The Checkup. November 17, 2020. Accessed March 31, 2025. https://www.singlecare.com/blog/news/infertility-statistics/

5. 1 in 6 People Globally Affected by Infertility. World Health Organization. April 4, 2023. Accessed March 31, 2025. https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility

6. Infertility prevalence estimates, 1990-2021. World Health Organization. 2023. Accessed March 31, 2025. https://iris.who.int/bitstream/handle/10665/366700/9789240068315-eng.pdf?sequence=1

7. How common is infertility? National Institutes of Health. February 8, 2018. Accessed March 31, 2025. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/common

8. Chandra A, Copen C, Stephen E. Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth. National Health Statistics Report. August 14, 2013. Accessed March 31, 2025. https://www.cdc.gov/nchs/data/nhsr/nhsr067.pdf

9. Armstrong A, Plowden TC. Ethnicity and assisted reproductive technologies. Clin Pract (Lond). 2012;9(6):651-658. doi:10.2217/cpr.12.65

10. Armstrong L. Black women are more likely to experience infertility than white women, they’re less likely to get help, too. The Guardian. December 10, 2023. Accessed March 31, 2025. https://www.theguardian.com/us-news/2023/dec/10/black-women-infertility-causes-treatment-inequity-healthcare

11. Sharkey L. Reversible birth control can’t cause infertility or affect future pregnancy. Healthline. June 14, 2021. Accessed April 1, 2025. https://www.healthline.com/health/birth-control/can-birth-control-cause-infertility#delay-by-method

12. Yland JJ, Bresnick KA, Hatch EE, et al. Pregravid contraceptive use and fecundability: prospective cohort study. BMJ. 2020;371. doi:10.1136/bmj.m3966

13. Infertility - diagnosis and treatment. Mayo Clinic. September 1, 2021. Accessed April 1, 2025. https://www.mayoclinic.org/diseases-conditions/infertility/diagnosis-treatment/drc-20354322

14. How to support someone experiencing infertility. Northwestern Medicine. April 2022. Accessed April 1, 2025. https://www.nm.org/healthbeat/healthy-tips/emotional-health/How-to-Support-Someone-Experiencing-Infertility