Infertility: What you need to know

Nov 3, 2019

Infertility affects about 10% of women ages 15-44 in the United States, according to the Centers for Disease Control and Prevention (CDC). That's 6.1 million people. With infertiliy affecting so many, it’s important to understand what it is and how it’s treated.

Dr. Zaraq Khan is a gynecologist at the Mayo Clinic. He joined us on “Take Care” to discuss the basics of infertility and what that means for couples going through it.

Classically, infertility is defined as a couple attempting to achieve pregnancy and not having success for about 12 months for women who are 35 years or less, Khan said. And for women 35 and older, it’s after six months of trying. Waiting even six months, though, can be tortuous for many couples, so Khan recommends checking with an infertility clinic after two to three months of no success.

Khan said that, thankfully, the dogma around infertility is changing: the World Health Organization now classifies it as a disease, and it can be treated.

“More and more, we’re talking about infertility as being a disease and a disease that impacts quality of life,” he said. “And in my opinion, I think a couple needs to seek fertility evaluation anytime they feel like they’re not getting to their goals.”

Khan said what is often overlooked is the couple perspective of infertility.

“I feel like we should be talking about couples and not women,” he said. “We tend to forget about the men in the equation quite a bit.”

Khan said that about 20% of infertility cases he sees are a result of male infertility, but social norms still place the blame on the woman.

“Infertility is a couple’s medical problem, though it becomes a woman’s social burden to bear,” he said.

With both parties factored in, Khan said about 15% of couples will have some sort of trouble in achieving a pregnancy. But that number is also influenced by age.

"We need to start talking about the importance of infertility because we're not only creating awareness; we're actually helping these couples that feel like they're on an isolated island."

Age largely determines a woman’s ovarian reserve, meaning the number of eggs in her body at the time of birth. That is a finite number, so that does present a bit of a time clock for optimal fertility conditions, Khan said.

“We have this limited amount of time that we can then utilize to our advantage, but that decline in ovarian age, unfortunately, doesn’t go hand in hand with advancement of chronologic age,” he said.

That doesn’t mean that nothing can be done about it, Khan said.

“We cannot change parameters of ovarian reserve, but we definitely want to check for them to make sure that the person has an adequate amount of egg supply,” Khan said.

Age 35 is that “line in the sand,” Khan said, that is generally seen as the average age at which women are affected by ovarian age. This increases by 38 and “excessively after the age of 40,” Khan said.

Over the past few decades, the rate of infertility has remained largely unchanged, at around 10 to 15% worldwide, Khan said. And in those cases, there are some typical causes, like low ovarian reserve and issues with sperm and semen.

Ovarian reserve issues are typically genetic, as many infertility causes are, Khan said. This is why it’s important to look into family history and discuss it with medical professionals.

“Genetic history and a family history is exceedingly important from a couple that we see at their first intake,” Khan said. “There are definitely certain genetic diseases that can predispose a person or an individual to infertility.”

Some of the common genetic diseases that impact infertility are chromosomal abnormalities, Khan said.

“Getting a holistic family history as well as an infertility history of the family is very important, and then, based on a case-by-case basis, we can make those decisions of whether that couple would warrant or benefit by seeing a geneticist,” he said.

There are other tell-tale things to look for, Khan said, which is why he and others like making sure the uterus is anatomically normal and doesn’t have any abnormalities and that the female has patent fallopian tubes to carry the egg.

Khan is sensitive to the fact that these conversations aren’t common in families, so he knows it can be a hard topic to discuss.

“The area of medicine that we work in not necessarily is a common speaking point amongst friends or social circles, so I do agree that are dealing with subjects that are very, very personal, and I think that’s why having a very honest conversation and a good report with your patients is going to help,” Khan said.

Unfortunately, these issues are not often talked about, which Khan said is leading to ignorance, misinformation and a lack of understanding all around.

“If they don’t hear that other people have been through something impactful or life-altering like infertility treatment, that feeling of isolation kicks in, and I feel like that in itself is a big blow for the morale with couples that are dealing with infertility,” Khan said.

The solution? We need to discuss infertility more often, Khan said.

“We need to start talking more about these issues,” he said. “We need to start talking about pregnancy loss. We need to start talking about the importance of infertility because we’re not only creating awareness; we’re actually helping these couples that feel like they’re on an isolated island.”

Though Khan encourages struggling couples visit an infertility clinic when they’re not finding success, he cautions that there might not always be a clear explanation.

“We would love to say that we can answer all questions, but, unfortunately, we -- meaning medical science -- hasn’t advanced enough where we are able to specifically answer each question,” he said.

About 1 in 5  patients that Khan and others see in his clinic don’t have any obvious reason for infertility, which he calls “unexplained infertility.” However, even if the reason is unclear, the infertility is still treatable, Khan assured.

And fortunately for couples going through fertility, there are advancements that will help make that treatment easier coming in just a couple decades, Khan estimated. He said he’s excited mostly about advancements to methods used to select embryos for transfer.

Most of that selection is currently done by grading embryos based on visual observation, but that may soon change.

“What I think we’re going to start seeing in the next decade or two decades is the use of artificial intelligence that will be able to tell us which embryo would be the best one to transfer,” Khan said.

Khan and other researchers are studying how embryos are divided, and Khan said that soon, bioinformatic software and articial intelligence can take that data and decide algorithms and devise different ways of deciding on its own which embryos will be destined for a pregnancy.

“I think that’s something very, very exciting that is going to be upcoming,” he said.

Khan said he also projects future research that will help decrease false positives in genetic testing of embryos.