Many of us dream of becoming parents, even when we are children ourselves. Family-building is a common rite of passage into adulthood and most of us never imagine there might be challenges or even barriers that will prevent us from reaching this goal. Infertility — generally defined as difficulty getting or staying pregnant due to medical/health factors — is the most frequent barrier encountered.
Approximately one in eight American women are considered infertile, according to a 2015 survey by the Centers for Disease Control and Prevention. Common causes of female infertility include ovulatory problems, blocked fallopian tubes or structural abnormalities of the uterus or ovaries, or conditions such as polycystic ovarian syndrome and endometriosis.
Infertility is not just a women’s issue, however: While one-third of infertility is due to female factors, one-third of cases are caused by male factors, according to the American Society for Reproductive Medicine. Male infertility often is the result of sperm issues such as low sperm count, caused by environmental or medical factors. The final third of infertility cases are the result of combined or unexplained factors. “Unexplained infertility” may be the most frustrating diagnosis of all — how do you understand or treat a condition when you don’t know what causes it?
In addition to struggling to understand the cause of their infertility, and how to treat it, many people face additional barriers to care. The biggest barrier for most is the financial cost.
Resolve, the National Infertility Association, notes that only 16 states have infertility insurance coverage laws, and only five states have fertility preservation laws for medically-induced infertility (for example, infertility because of health issues such as cancer/cancer treatment). Resolve has designated the theme of 2019’s National Infertility Awareness Week, April 21-27, to be #InfertilityUncovered, which brings to light the significant lack of access to family-building options and emotional support for millions of women and men struggling to build a family. Resolve notes that infertility does not discriminate based on sex, race, religion, age, or socioeconomic status.
Pregnancy and family-building usually are framed by society as joyous and life-changing events. When family-building is unsuccessful, however, the infertile among us are left out in the cold. Like reproductive mental health issues such as postpartum depression or reproductive losses such as miscarriage, infertility can be a difficult topic to discuss and share with others. Silence widens the gulf between those suffering and those who can provide support.
Do you know someone who is struggling with infertility? Show you care by offering a listening ear if they wish to talk about their journey, but don’t press them to share details or offer them unhelpful advice such as “relax and it will happen.”
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Are you coping with infertility? Take care of your physical and mental health by engaging in physical activity (an evidence-based stress-reliever), seeking support (which can be from loved ones, infertility support groups, books/websites/online options, or your therapist), and remembering to focus on additional goals and meaningful aspects of your life. When infertility eclipses the important things in your life, including marriage/partnership, family, friendships, spiritual beliefs and career, it is easy for despair to set in.
Remember that there is hope. There are ways to improve fertility such as by quitting smoking and maintaining a healthy weight. Each day brings new developments in our understanding of the causes of infertility and in the methods of treating it. Infertility may change the course of the journey but it is important to maintain faith that we will eventually reach our desired endpoint: family.
• Stacey Pawlak is the health psychologist for the Center for Advanced Reproductive Care at the University of Iowa Hospitals & Clinics. She is also a clinical assistant professor in the Departments of Psychiatry, Obstetrics/Gynecology, and Psychology/Quantitative Foundations and serves as the Director of the Women’s Wellness & Counseling Service.