Infertility is a common but often treatable condition. For many, the struggle to conceive can be overwhelming, especially when it doesn’t happen as easily as expected. The emotional toll can be significant, and reaching out for help can feel daunting.
Dr. Mark D. Hornstein, a reproductive endocrinologist at Brigham and Women’s Hospital, addresses common questions about infertility, including its causes, symptoms, and available treatments.
What is Infertility?
According to the American Society for Reproductive Medicine (ASRM), infertility is defined as the inability to conceive after one year of unprotected sex for women under 35. For women over 35, the timeframe is reduced to six months. Couples struggling with infertility should seek support from their primary care provider or OB-GYN.
Why is 35 the key age? Dr. Hornstein explains that while fertility gradually declines with age, it becomes noticeable around 35. This age is considered a good cutoff, even though fertility doesn’t suddenly drop at that milestone.
For men, the decline in fertility is slower and occurs at a later age compared to women. Men continue to produce sperm throughout their lives, although sperm production and quality can decrease with age.
What Are the Symptoms of Infertility?
The main sign of infertility is difficulty conceiving after one year of regular, unprotected sex (or six months if you’re over 35). However, some other symptoms may indicate a fertility issue, although they may not necessarily point to infertility.
In women or people AFAB, signs to look out for include:
- Irregular or absent periods
- Chronic pelvic pain
- Severe period pain
- Pain during sex
In men or people AMAB, symptoms may include:
- Erectile dysfunction
- Low semen volume
- Cloudy urine after ejaculation
- Enlarged veins in the scrotum
If you experience any of these symptoms, it’s important to consult with a healthcare provider for further evaluation.
What Causes Infertility?
Infertility can have various causes, including:
- Ovulation disorders, damaged fallopian tubes, or issues with the uterus
- Male reproductive issues like low sperm count or poor sperm quality
- Hormonal imbalances, such as thyroid disease or polycystic ovary syndrome (PCOS)
- Weight issues, smoking, or excessive alcohol use
In some cases, the cause remains unexplained.
What is Secondary Infertility?
Secondary infertility occurs when someone has difficulty conceiving after previously having a successful pregnancy. Dr. Hornstein notes that it’s quite common for people who had no trouble getting pregnant the first time to face challenges when trying for a second child. Age is often a key factor, as reproductive health can change over time, especially after several years between pregnancies.
The Stigma Around Infertility
Infertility was once a taboo subject, with many people struggling in silence due to feelings of shame or guilt. However, this is changing, thanks to increased awareness, especially through social media. Dr. Hornstein highlights that infertility is now recognized as a medical condition and should be treated as such, rather than being seen as a personal failure.
How is Infertility Diagnosed and Treated?
The first step in seeking treatment is consulting with your primary care provider or OB-GYN, who can help assess the situation and recommend the next steps. Stress from trying to conceive can itself affect fertility, so having professional guidance can help reduce anxiety and improve your chances.
At Mass General Brigham, Dr. Hornstein and his team take a personalized approach to treatment, offering both in-person and virtual consultations. It’s important not to wait too long before seeking help. Fertility options tend to decrease with age, so early intervention can improve outcomes.
Treatment Options for Infertility
Infertility treatments vary, and in-vitro fertilization (IVF) is not always the first choice. Dr. Hornstein explains that medications to stimulate ovulation or improve sperm quality are often effective. Surgery may be required to address physical issues like blocked fallopian tubes or fibroids. IVF and intrauterine insemination (IUI) are additional options for some patients.
For individuals facing infertility due to age or other factors, third-party reproduction options, such as sperm or egg donation and surrogacy, may also be available.
What Sets Mass General Brigham Apart?
Dr. Hornstein explains that the Center for Infertility and Reproductive Surgery at Mass General Brigham is unique in its comprehensive approach. In addition to standard fertility treatments, the center specializes in addressing conditions like endometriosis, fibroids, and other complex medical issues. Their team is dedicated to offering tailored solutions, including fertility preservation options for those undergoing cancer treatments or those who want to preserve fertility for future use.
Through their collaborative, multidisciplinary approach, Mass General Brigham provides specialized care for all patients, ensuring that each person receives the best possible treatment based on their individual needs.
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