Choosing to start a family is typically a joyous decision. But for some couples, fertility issues can make it a frustrating and emotionally taxing process.
Infertility is diagnosed after the inability to conceive after one year of unprotected sex, according to the American Society for Reproductive Medicine (ASRM). For women age 35 and older, the inability to conceive after six months is generally considered infertility. In the U.S. Centers for Disease Control and Prevention’s (CDC) National Survey of Family Growth, 1 in 8 couples reported having trouble getting pregnant or sustaining a pregnancy between 2004 and 2010. Worldwide, an estimated 48.5 million couples are impacted by infertility.
Fertility issues affect men and women
Infertility is often viewed as a women’s issue, but is really a couple’s disease, according to Joanne Armstrong, M.D., M.P.H., senior medical director and head of Women’s Health at Aetna.
Infertility affects about 15 percent of couples worldwide.
In fact, the National Infertility Association notes that approximately one-third of infertility can be attributed to the woman; one-third attributed to the man and one-third attributed to the combination of both partners or is unexplained.
Researchers of a 2015 study published in Reproductive Biology and Endocrinology estimate there are at least 30 million men worldwide that are infertile. A separate study also found fertility rates among men in the world has decreased by 15 percent.
“Despite the fact that fertility issues can be caused by either or both partners, men may not pursue help or treatment because of stigma,” Armstrong said. “It can be devastating for a man to find out he is the reason for infertility.”
Diagnosing fertility issues
The evaluation of infertility includes physical exams and laboratory testing. Conditions affecting the ovaries, Fallopian tubes and uterus can contribute to infertility in women. Aging is also a factor, according to the CDC.
Infertility among men is determined by the evaluation of sperm quality in a semen analysis, including the volume, concentration, motility and shape of sperm. A physical examination can identify reversible causes of male infertility, such as the presence of varicoceles, a condition where the veins on the testicles are large and cause them to overheat, potentially leading to fertility issues. Certain medical conditions, such as diabetes and cystic fibrosis, or treatment with chemotherapy or radiation, can also affect semen.
Environmental factors like smoking, heavy alcohol use and drug use can impact fertility in both men and women.
If fertility issues are suspected, Armstrong recommends both partners visit a physician specifically trained in infertility care to determine how to best proceed with evaluation and treatment. She emphasizes the importance of supporting each other: “A couple that works together to deal with infertility can lay some important foundation for the hard work of parenting down the road.”
Editor’s note: Aetna typically covers diagnostic infertility services for its health plan members to determine the cause of infertility. Aetna also covers certain infertility treatments for some members (depending on plan design), such as in vitro fertilization, ovulation induction with injectable infertility medications, artificial insemination or assisted reproductive technology, but they have to register with the National Infertility Unit (NIU). Members can also search for an infertility specialist within Aetna’s network.For those who are not Aetna members, check with your insurance provider to determine what is covered for infertility treatment.