It's harder to getpregnantthan you think.That may be music to your ears if you're young,single,and nowhere near ready for kids.But for many couples trying to conceive,the reality ofinfertilityis daunting,stressful,and extremely life-interrupting.
"People are always surprised to find out how bad humans are at reproduction," say Alan B.Copperman,M.D.,director of the division of reproductive endocrinology and infertility at Mount Sinai Hospital and medical director ofReproductive Medicine Associates of New York."Not all eggs are normal,not all normal eggs implant.There's actually only about a 15 to 20 percent chance in any given month that a couple will conceive," he adds.
In the U.S.,6.7 million women between the ages of 15 and 44 have an impaired ability to get pregnant or carry a baby to term,according to the CDC.About 6 percent of married women 15 to 44 years of age are unable to get pregnant after one year of trying—which is when the "i" word starts to get thrown around,and doctors begin to ask questions and run tests to check the woman's reproductive system and the man's sperm count.
"If we look at all causes of infertility,we would attribute the largest cause to male,40 percent," explainsMeike L.Uhler,M.D.,a reproductive endocrinology and infertility specialist at the Fertility Centers of Illinois.Sometimes,it can be the sole cause;other times,it's just one out of a few factors affecting a couple's ability to conceive.
So what else could be going on?For women,these are the most common causes of infertility (roughly in order).
1.Polycystic ovary syndrome (PCOS)
PCOS is the most common cause of infertility in women,according to theCDC.The condition is caused by a hormonal imbalance that results in a series of small cysts on the ovaries.It also throws your whole cycle out of whack,causing irregular periods,or even no period at all for a few months at a time.Shockingly,millions of women are living with it without even knowing—according to thePCOS Foundation,10 percent of women of childbearing age are affected,but less than half are diagnosed.See your doctor if you're experiencing thesesubtle signs of PCOS.
2.Other hormonal factors that impact ovulation
Irregular ovulation is the main cause in about 25 percent of infertility cases,according to theMayo Clinic.While PCOS is the most common of these,causing 70 percent of irregular ovulation-related infertility cases,hormonal imbalances can impact or interrupt ovulation in other ways and lessen your chance of conceiving.
In most of these scenarios,the main culprit is dysfunction of the hypothalamus in the brain and its attached pituitary gland,which is responsible for secreting reproductive hormones.Changes in the levels of follicle-stimulating hormone,luteinizing hormone,and the hormone prolactin,can all impact ovulation.
One of these disorders is calledprimary ovarian insufficiency(previously called premature ovarian failure),which is when a woman's ovaries stop functioning normally or become depleted before they reach 40 years old.It's less common than PCOS,affecting 1 in 100 women younger than 40,and can also be caused by genetics or an autoimmune factor,according toThe National Infertility Association.
Endometriosisis a condition where the tissue that lines the uterus starts to grow in other places,like the ovaries,behind the uterus,or in the fallopian tubes,causing irritation and the development of scar tissue (adhesions).Besides being extremely painful (though some women may experience no pain),it can make it very difficult to get pregnant by blocking the fallopian tubes,disrupting implantation,causing inflammation in the pelvis,and even altering egg quality,according to theAmerican Society for Reproductive Medicine.Adhesions can also form after pelvic surgeries or trauma to the reproductive organs,such as dilation and curettage (D&C) during pregnancy termination or miscarriage,or a previous C-section.