Infertility: Get the Facts

Hadassah is committed to empowering women and men with the knowledge to make critical health decisions for themselves and their families. Health education is also fundamental to helping our communities converse openly, improve sensitives to others, and prepare advocates and elected officials to fight for policy change. Get the facts and learn more about how Hadassah’s reConceiving Infertility initiative is raising awareness and helping our communities expand the definitions of what it means when we talk about family.

What is infertility?
How common is infertility? Does infertility affect women and men equally?
Is infertility a Jewish problem?
What are the causes of infertility?
Who may need fertility treatments?
What does infertility treatment entail?
What about other pathways toward parenthood?

What is infertility?
Clinical infertility is the inability to achieve or sustain pregnancy while trying for one year to conceive through intercourse, or after six months of trying if the woman is 35 or older.

How common is infertility? Does infertility affect women and men equally?
Infertility affects both women and men. In the United States, about 13 percent of women, or roughly 9.5 million women age 15-49, and 9 percent of men are affected by infertility1. The National Survey of Family Growth found that over 12 percent of women aged 15-49 had used infertility services2.

Male-factor infertility accounts for or contributes to 40 percent of infertility cases3. About a third of all infertility is due to unknown or a combination of factors between both partners4.

Is infertility a Jewish problem?
One in eight couples in the United States report having trouble getting pregnant or sustaining a pregnancy5. Rates are even higher in the Jewish community, according to the Jewish Fertility Foundation, with infertility affecting as many as one in six Jewish couples.6

In the United States, Jews outside the Orthodox community are more likely than the general population to start trying to have children at a later age, which is a risk factor for infertility. Religious (Halachic) infertility can be an issue for Jews who strictly observe religious laws of ritual purity. For those with a short ovulation cycle, that could mean being required to abstain from sex around peak ovulation, leading to difficulty getting pregnant.

Some conditions that cause infertility – like polycystic ovarian syndrome (PCOS), cystic fibrosis and Fanconi anemia C – are more prevalent in the Jewish community7. A higher incidence of genetic mutations, such as Tay-Sachs8 and BRCA, also increase the Jewish community’s need for in vitro fertilization with preimplantation genetic testing treatment. With 1 in 40 Ashkenazi Jewish women carrying the BRCA mutation9 that increases risk for breast and ovarian cancer – especially at a young age – there is also an increased need for fertility preservation services.

What are the causes of infertility?
There are many causes of infertility, which can occur independently or in combination. For 5 to 10 percent of couples, infertility is unexplained.10

Age and Gamete Health: Infertility increases with age, due to the decreased number and quality of reproductive cells (gametes). As women age, their egg count (ovarian reserve) goes down and more eggs are likely to contain genetic abnormalities. For men, sperm count, shape or movement (motility) can all be affected. Problems with reproductive cells are more common as people get older, though patients of any age can be affected due to hormonal or genetic conditions, lifestyle and other factors.

Ovulation Disorders and Poor Sperm Delivery: Ovulation disorders can impact about 1 in 4 infertile couples11. As many as 5 million women in the US have polycystic ovarian syndrome (PCOS) a metabolic condition that affects hormone levels and the release of eggs, in addition to increasing risk for diabetes, obesity and heart disease12, erectile dysfunction and other sexual issues that inhibit sperm delivery can also decrease the likelihood of conception.

Obstructions and Structural Problems: Physiological issues affecting fertility may be caused by other underlying conditions -- or not. Blockages can prevent the delivery of eggs and sperm, and conditions like endometriosis and uterine fibroids create growths and scar tissue that may impede implantation on the uterine wall. For people missing reproductive organs – either since birth or due to injury or removal – natural conception may never be an option.

Genetics: Chromosomal abnormalities can affect the quality of reproductive cells, as well as the other reproductive functions described above. Reproductive cells with abnormalities may result in lower embryo stability and increase the likelihood of pregnancy loss. Studies have found that chromosomal abnormalities account for over 50 percent of early pregnancy loss13, and recurrent pregnancy loss (three consecutive miscarriages) affects 1 to 2 percent of the population.14

Lifestyle and the Environment: Extreme weight gain or loss, obesity and excessive physical or emotional stress may impact fertility – especially for women. Heavy alcohol use, smoking, and the use of anabolic steroids or illicit drugs, as well as certain prescription medications, can also be factors. Exposure to radiation – through medical treatment or otherwise – can also increase risk for infertility.

For additional information, refer the Centers for Disease Control and the U.S. Department of Health and Human Services Office of Women’s Health.

Who may need fertility treatments?

What does infertility treatment entail?
When seeking treatment for infertility, people may start with their ob-gyn or a reproductive endocrinologist, an ob-gyn with special training in infertility. Men may also see a urologist. Clinicians will provide patients with a series of tests to determine the cause(s) of infertility and may recommend lifestyle changes to improve fertility. For additional information on evaluating infertility, refer to the American College of Obstetricians and Gynecologists.

In cases where spontaneous pregnancy doesn't happen, couples can still achieve a pregnancy through use of medication, surgery, artificial insemination (most frequently intrauterine insemination or IUI) and assisted reproductive technologies like in vitro fertilization (IVF) and preimplantation genetic testing (PGT) on embryos. According to the American Society of Reproductive Medicine, 85 to 90 percent of infertility cases are treated with medication or surgery and less than 3 percent of patients receive IVF services15.

Infertility treatment often involves significant financial, physical, psychological and time commitments.

What about other pathways toward parenthood?
There are numerous pathways to parenthood – for people facing infertility and not – and parenthood is defined by so much more than biology. Through third-party reproduction, families can be created through egg, sperm, and embryo donation, and/or the help of a surrogate or gestational carrier. For others, they may become parents though fostering, adoption or step-parenting. And for some their pathway toward parenthood ultimately ends with a decision to live childfree.

Hadassah empowers women to help heal our world. Together.

1 National National Survey of Family Growth 2015-2017. (conducted by the Centers for Disease Control’s National Center for Health Statistics); National Institutes of Health. Data from the National Survey of Family Growth. National Health Statistics Report 67.
2 National Survey of Family Growth 2015-2017 (conducted by the Centers for Disease Control’s National Center for Health Statistics)
3 Reproductive Facts, American Society for Reproductive Medicine
4 Infertility, Office of Women’s Health, U.S. Department of Health and Human Services
5 National Survey of Family Growth 2015-2017
6 Infertility in the Jewish Community, Jewish Fertility Foundation
7 Evaluation and Treatment of Polycystic Ovary Syndrome, Carrier Frequencies for Common Genetic Diseases by Ethnicity
8 Carrier Frequencies for Common Genetic Diseases by Ethnicity
9 Jewish Women and BRCA Gene Mutations, Centers for Disease Control
10 Unexplained Infertility, American Society for Reproductive Medicine
11 Reproductive Facts, American Society for Reproductive Medicine
12 What is PCOS?, Centers for Disease Control
13 Risk of Chromosomal Abnormalities in Early Spontaneous Abortion after Assisted Reproductive Technology: A Meta-Analysis, PLoS One
14 Recurrent Pregnancy Loss: Etiology, Diagnosis, and Therapy, Obstetrics & Gynecology
15 Reproductive Facts, American Society for Reproductive Medicine

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