Infertility is a common and often treatable condition, but for many, it can be a shocking and emotional experience. The journey of trying to conceive often brings high expectations, and repeated negative pregnancy tests can feel disheartening. For some, seeking help may seem intimidating, but understanding infertility is the first step toward addressing it.
Dr. Mark D. Hornstein, a reproductive endocrinologist at Brigham and Women’s Hospital, answers key questions about infertility, its causes, signs, 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 intercourse for women under 35, or after six months for women 35 and older. In these cases, couples are encouraged to consult their primary care provider or OB-GYN for guidance.
Age plays a significant role in fertility. Dr. Hornstein explains that while fertility does not sharply decline exactly at age 35, studies show that this is when a noticeable decrease begins. For individuals assigned male at birth (AMAB), fertility declines more gradually, with sperm production decreasing over time.
What are the Symptoms of Infertility?
The main indicator of infertility is the inability to conceive after one year of regular, unprotected sex (or six months for women over 35). There are other signs, but these may indicate other health issues and should be discussed with a healthcare provider.
For Women or People Assigned Female at Birth (AFAB):
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Irregular or absent periods
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Chronic pelvic pain
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Severe menstrual cramps
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Pain during sex
For Men or People Assigned Male at Birth (AMAB):
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Erectile dysfunction
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Reduced semen volume
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Cloudy urine after ejaculation
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Enlarged veins in the scrotum (varicoceles)
Common Causes of Infertility
Infertility can stem from a variety of factors, including but not limited to:
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Ovulation or ovarian disorders
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Blocked or damaged fallopian tubes
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Hormonal imbalances like thyroid disease or polycystic ovary syndrome (PCOS)
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Diminished ovarian function
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Scarring from conditions like endometriosis or fibroids
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Lifestyle factors such as obesity, smoking, and alcohol use
Secondary Infertility
Secondary infertility refers to difficulty conceiving after a successful first pregnancy. Dr. Hornstein explains that this is more common than many realize. Various factors, including previous pregnancies or age, may affect a person’s ability to conceive a second time.
For example, cesarean sections or infections during labor can sometimes affect fertility. Age is another key factor, as fertility naturally declines over time. A gap of just a few years can significantly impact reproductive health.
Breaking the Silence on Infertility
Historically, infertility was a taboo topic, often causing feelings of guilt and isolation. However, the rise of social media has made it easier for people to share their experiences, helping reduce stigma. Dr. Hornstein notes that infertility is now recognized as a medical condition, defined as such by the Americans with Disabilities Act.
How is Infertility Diagnosed and Treated?
If you are struggling with infertility, your first step should be speaking with a primary care provider or OB-GYN. They can help assess your situation and direct you to the appropriate specialist if necessary. Early intervention is crucial, as options may be more limited the longer you wait.
At Mass General Brigham, Dr. Hornstein and his team conduct comprehensive evaluations to diagnose and treat infertility. Virtual appointments are also available to make treatment more accessible.
Treatment Options for Infertility
Infertility treatment is not limited to in-vitro fertilization (IVF). While IVF is a common option, many treatments exist depending on the individual’s needs.
Medications:
These can help stimulate ovulation in women or address fertility issues in men.
Surgery:
In some cases, surgical procedures may be necessary to repair reproductive organs or remove blockages.
IVF:
This involves harvesting eggs and fertilizing them outside the body, then implanting them in the uterus.
Intrauterine Insemination (IUI):
Sperm is directly placed into the uterus to enhance fertilization chances.
Third-Party Reproduction:
Egg or sperm donation, or surrogacy, may be an option for some couples, including LGBTQ+ families.
What Sets Mass General Brigham Apart?
Dr. Hornstein highlights the comprehensive care provided at the Center for Infertility and Reproductive Surgery at Mass General Brigham. The center’s multidisciplinary approach goes beyond just treating infertility; it also addresses related conditions like endometriosis and fibroids. Their team is known for its strong communication and collaborative care, ensuring patients receive the most effective treatment for their unique situations.
Additionally, the center offers specialized services for individuals with complex health conditions, including those with extreme body weight or cancer patients seeking fertility preservation.
Conclusion
Infertility can be an overwhelming and emotional challenge, but it’s important to know that help is available. Early diagnosis and treatment can significantly improve the chances of a successful pregnancy. If you or someone you know is struggling, reach out to a healthcare provider for support and guidance.
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