Infertility — the inability to get pregnant after 12 months of regular, unprotected sexual intercourse — affects about 1 in 10 American couples. A diagnosis can alter relationships, lead to depression and anxiety, and threaten lifelong expectations of parenthood. Thankfully, medical advances such as in vitro fertilization (IVF) have made it possible for certain couples to conceive, but these treatments carry risks and are often poorly understood. Here are five common misconceptions.
The headline of a 2010 U.S. News & World Report articlepromised readers that they would discover “How Stress May Be Causing Your Infertility.” An article on WebMD claims that doctors believe “the stress of actually undergoing infertility treatments can be so great it can stop even the most successful procedures from working.” Anyone who has personally experienced infertility has heard some variant on the advice: “Relax, you’re trying too hard. Just take a break and you’ll get pregnant.”
While stress and infertility can be connected, stress does not cause infertility or treatment failure. A meta-analysis of 14 studies with 3,583 women undergoing fertility treatments found that pretreatment emotional distress was not associated with outcomes. Research showing an association between stress and infertility usually does not fully account for the indirect effects of stress, such as alcohol use, increased smoking, infrequent sex and dropping out of treatment.
The picture is further complicated by studies that find participation in psychological counseling may improve pregnancy rates. However, other studies have found that these effects areevident only in couples not receiving medical treatments. Whilecounseling can help couples reduce stress and cope more effectively with the uncertainty of infertility, couples should not expect counseling to increase their chances of pregnancy. Ultimately, the myth that stress causes infertility unfairly places the responsibility for treatment failure or success on the shoulders of the woman, a conclusion that is not supported by science.
Because women get pregnant and men don’t, people often believe that infertility must be related to what’s happening in the female body. Historically, biblical writings, Egyptian papyruses and the medical texts of the classical Greeks show that infertility was a common condition and that women were primarily blamed. These convictions formed cultural traditions and misperceptions that have lasted for centuries. While the Centers for Disease Control and Prevention’s website correctly notes that infertility is not always a woman’s problem, it still incorrectly reports that in just 8 percent of infertile couples, the man is solely responsible.
In fact, men and women are equally responsible for an infertility diagnosis. According to the U.S. Department of Health and Human Services Office on Women’s Health and the National Institutes of Health, about one-third of cases are attributable to men, one-third are attributable to women, and the rest are a combination of male and female factors or unexplained problems. Most male infertility is related to low sperm count, poor sperm movement and abnormal sperm shape. Irregular ovulation, endometriosis, polycystic ovary syndrome and diminished ovarian reserve due to age contribute to female infertility. Combined infertility is diagnosed when both partners contribute in some way (for example, if the man has low sperm count and the woman has infrequent ovulation).
Women throughout the world are delaying the age when they have children. In the United States, the mean age of first-time mothers in 2016 was 26.6, the highestever recorded. In 2003, a “60 Minutes” reportfound that educated professional women who intended to delay childbearing to pursue their careers had significant misperceptions about age and fertility, believing that medical treatments and good health could extend the biological clock well into a woman’s 40s and even 50s — an attitude that has also been found in undergraduate students. Fertility clinics can also perpetuate this myth with well-intentioned but misleading statements, such as the Fertility Centers of Illinois’ assertion that “advanced medical technology . . . allows us to extend the biological clock for many women.”
Because of the progressive decline in the quality of a woman’s oocytes (eggs) over time, there isn’t a way to naturally extend the biological clock. Nutrition, exercise and healthy living are great in other ways, but they can’t halt this inevitable decline, which begins at age 32 and becomes more rapid at 37. The closest we have come is temporarily stoppingthe clock through oocyte cryopreservation (egg freezing), but this has limitations and isn’t always an ideal solution. Women freeze their eggs at an age when egg quality is declining rapidly or already past its peak. Furthermore, when the American Society for Reproductive Medicineremoved the “experimental” label from oocyte cryopreservation in 2012, it stopped short of recommending elective egg freezing for those hoping to delay childbearing, pending additional data on the safety, efficacy, cost effectiveness and emotional risks of the procedure.
In an IVF procedure,a sperm and an egg are fertilized outside the body, and the resulting embryo or embryos are transferred to the uterus. Although it has miraculous promise, its success rates and stresses are largely misunderstood. A study of 8,194 people from eight countries, including the United States, found that “close to 90% of the adults surveyed knew about in-vitro fertilization (IVF), but less than one-quarter of them knew about the chances of success of this assisted reproductive technology.” OB/GYN residents have likewise been found to have unrealistic expectations and incomplete information about IVF, as have men who believed they were fairly knowledgeable about the procedure.
The overall success rate for having a child using one round of IVF in the United States is between 25 and 29 percent, according to the CDC. Because an average round costs $10,000 to $15,000, this can be an expensive gamble for couples. IVF is also stressful, emotionally taxing and physically invasive, which can lead patients to postpone the treatment or drop out altogether. Unsurprisingly, IVF success rates are linked to age. Women under 35 have the best chances of ultimately giving birth (43 percent). After age 37, success rates drop dramatically. Women ages 41-42 have a only a 10 percent chance of IVF success, while women over 44 have only a 2 percent chance.
A 2018 study found that 76 percent of women prefer counseling from their doctors when it comes to age-related pregnancy risks. Other research has found that a similar proportion of women believe that their providers are the best sources of information about reproductive health. Medical professionals themselves concur that it’s important to have these conversations: More than90 percent of U.S. OB/GYN residents believe they should initiate discussions with their patients about childbearing intentions.
Yet these discussions rarely take place, and research indicates that gynecologists and nurses have gaps in their knowledge about issues such as the management of polycystic ovary syndrome and the impact of smoking and age on fertility. Even when physicians do have the right information, many are reluctant to engage with patients for fear they might increase their patients’ emotional distress or be perceived as pushing childbearing. One possible solution is for physicians to practice preconception counseling with patients during their peak fertility years. By doing so in a neutral, nonjudgmental way, they can give patients information that maximizes their reproductive choices.