What you need to know about infertility

Discussing infertility can be difficult, even though it’s an issue that many people experience. National Infertility Awareness Week kicked off on April 25, and physicians are encouraging men and women to discuss fertility issues.

“Many people don’t talk about infertility,” said Dr. Amy Schutt, a clinical fellow in reproductive endocrinology and infertility at Baylor College of Medicine’s Family Fertility Center. “It’s a sensitive subject and for some couples it can feel like an isolating diagnosis, but we see it very commonly. One in eight couples will have difficulty getting pregnant or sustaining a pregnancy, and that is a very high number.”

Age is a factor

One major factor that leads to the decline in fertility is age. For women, fertility starts declining at age 32.

“Women are postponing childbearing to later in life because of higher education, busy careers, or personal circumstances,” Schutt said. “We see these celebrities who have babies in their 40s and 50s, and we think ‘oh we can get pregnant when we’re 49.’ But that just isn’t the case because many of these celebrities are using donor eggs. Women are receiving mixed messages.”

Fertility in women declines more rapidly at age 37, and Schutt warns that for women who wait until their late 30s to begin thinking about starting a family, it might be too late.

“Women lose 1,000 eggs every month, and the ‘ovarian reserve,’ or number of eggs left in the ovaries, can predict future success in attempting pregnancy. We can estimate a woman’s ovarian reserve with a simple ultrasound and blood test that measures the level of anti-Müllerian hormone.”

Important fertility components to consider

When working with couples who have infertility issues, Schutt explains there are four broad categories to consider.

“The four components that need to be functioning properly are the ovary, fallopian tubes, uterus and sperm. There are many things that can affect the quality and quantity of eggs in the ovary, such as age and polycystic ovary syndrome (PCOS), which affects the ability to release an egg.

In order to get pregnant, a woman has to release a healthy egg that is picked up by a fallopian tube and is then fertilized by sperm. The fertilized egg develops into an embryo that is transported to the uterus, where it implants and continues to grow. So there are many elements that have to be working well in order to achieve a healthy pregnancy.”

The male role in managing infertility

Schutt emphasizes that the male partner is important when dealing with infertility. “Up to 50 percent of couples who are dealing with infertility have a male component of infertility.”

Age also plays an important role in men. Dr. Alexander Pastuszak, assistant professor in urology at Baylor, explains the infertility risks men face as they grow older.

“Men who are more than 40 to 45 years old start seeing an increased risk of birth defects and a decreased ability of their sperm to fertilize eggs.  This is likely due to genetic changes in germ cells that can lead to mutations being passed on to the offspring.”

Also important is the link between infertility and hormone levels in men.

“Men’s testosterone levels start to go down as they get older. Starting between 30 and 40 years old, levels steadily decline, and we know there is a link between testosterone levels and sperm production,” said Pastuszak.

He explains that men who are infertile also have an increased risk of getting cancer, having low testosterone levels, skin diseases, endocrine diseases and cardiovascular diseases.

Pastuszak wants couples to know that it is not always women who contribute to infertility – in up to 50 percent of cases it’s either partly or wholly a male factor contributing to the infertility.

“Most people don’t know this, and part of what is happening in the community is that women tend to seek care before men, and their physicians are taking the couple straight to in vitro fertilization (IVF) or other assisted reproductive technology without a full evaluation or treatment of the male.”

Treatment options

Treatments for female infertility may include medication to promote ovulation, ultrasound monitoring, intrauterine insemination (IUI), reproductive surgery and in vitro fertilization (IVF). Other treatments include donor eggs, donor sperm and gestational surrogacy.

For men, there are medical treatments to improve hormone levels, sperm production and sperm health, as well as procedures that can improve sperm production and transport.

Schutt and Pastuszak recommend that both men and women stay proactive and knowledgeable about their general and fertility health, and that both partners are evaluated for fertility.

“Regardless of whether or not you are interested in having children now, it’s important that you think about your future,” Schutt said. “We can do things now that protect the future even if it’s down the road.”

Additional Resources

To schedule an appointment with a Baylor reproductive endocrinology specialist, call 832-826-7500, or request an appointment online.

Top 4 myths about male infertility

Learn more about National Infertility Awareness Week.

-By Jeannette Jimenez