Infertility: Causes, remedies and options

Coping with infertility can be painful for couples.

Story highlights

  • Infertility affects one out of every six couples
  • Infertility is 30% due to male factors, 30% due to female factors
  • Many experts believe age is the chief cause of female infertility

(CNN)Baby-making seems easy. There is a lot of education, even anxiety, around preventing unwanted pregnancy once we become sexually active. But many couples dealing with infertility would dispute the notion that getting pregnant is as simple as shelving birth control. Dr. Jamie Grifo, program director for NYU's Fertility Center, sees struggling couples in his clinic every day.

"Understanding how much infertility can impact your life can help you make better decisions about when you start and how you go about it," said Grifo.
    To assist with that goal, here are answers to five frequently asked questions on infertility.
      1) How common is infertility?
      Infertility is classically defined as a year of trying unprotected sex without conception. Infertility today affects one out of every six couples.
      "The reality is that it's much harder to get pregnant than many of us believe," said Grifo.
        It used to be thought that infertility was primarily a woman's problem, but that is not the case. Men and women are affected almost equally, with 30% due to male factors, 30% due to female factors. The other 40% is often due to a mixture of problems, or is referred to as "unexplained."
        But the trend today is putting more of the focus on women.
        "The social trend of delaying childbearing -- the older age of women when trying to conceive -- is the single biggest factor in infertility today," Grifo said.
        2) What causes infertility in women?
        Irregular menstrual cycles are a common reason for infertility. Absent or infrequent periods, prolonged and excessive bleeding, and bleeding or "spotting" between periods can all make it difficult to predict when ovulation will occur so that a couple can make a baby.
        There are also a number of diseases and conditions that can contribute to infertility. Smoking and weight also play a role. Smoking can reduce a woman's chances of getting pregnant by affecting ovulation, and miscarriage occurs at a higher rate among pregnant women who smoke. And according to the American Society of Reproductive Medicine (ASRM), about 12% of all cases are because a woman weighs too much or too little.
        But many experts believe age is the biggest cause of female infertility, playing more of a role for women than for men. "If you look at fertility curves, there's about a 50% decline in the ability for a woman to get pregnant from age 30 to 40 and every two years [after 40] it is cut in half," says Grifo. "Then pretty much by the age of 44 anyone who is achieving pregnancy is using an egg donor and not talking about it. Very few women over the age of 44 get pregnant with their own eggs."
        Age plays a key role because the number of available eggs drops dramatically as a woman ages, as does the chromosomal normality of each egg.
        "Women have seven million eggs as a fetus, 1 to 2 million when they are born, 600,000 went they hit puberty," explains Grifo. "And every month she wastes 500 eggs to ovulate the one good egg, and many times it's not a good egg. By age 40, 97% of the eggs she had at puberty are gone."
        Men, on the other hand, are constantly making fresh sperm every 90 days, said Grifo, so those cells remain young and healthy even though the man is older.
        "So while there is a measurable decline in male fertility with age, it's very modest," said Grifo. "Whereas with women it's very clearly defined. Pretty much over the age of 44 female fertility approaches zero."