Perspective | Myths and Facts about Infertility

By: Dr. Aritra Pradhan

The inability to give birth to a child when desired is a very personal and stressful life experience. There are lots of myths about getting pregnant and infertility. Chances are you've heard a lot of them from relatives and friends who were just trying to make you feel better. It is helpful to separate some of the common myths from the truths regarding important subjects such as the causes and nature of infertility and the care of infertile couples. But when you're trying to conceive, it is important to separate fact from myths. In fact, it's crucial to do so because believing some of those myths could prevent you from getting the care and treatment you need.

MYTH: Infertility is primarily a female problem.

FACT: Infertility is no longer regarded as ‘her’ problem. It is important for couples to understand that the causes of infertility are almost equally shared by the female ( 40%) and male (40%) partners. In addition, frequently the causes are multiple (20%) with some belonging to each side of the fertility “equation”. This is commonly referred to as mixed factor infertility. The critical point to understand about causes is how important it is to discover what they are. Just knowing one (i.e. blocked Fallopian tubes in a woman or a low sperm count in a man) does not mean that others do not exist. A full investigation by a knowledgeable infertility specialist is essential to saving time, money and emotional energy. Modern infertility treatment focuses on the couple as a unit, recognizing they are a team who will work together to resolve this problem.

Myth – “Infertility is a rare disorder.”

FACT – Primary infertility is understood to be the failure of a couple to conceive after one year of unprotected intercourse. In the female older than 35, it is generally defined as no conception in six months since problems with infertility increase with age and age reduces the likelihood that treatments will be successful. Actually, 1 in 10 couples are infertile in the U.S. and approximately 15% of American women of childbearing age receive care for infertility each year.

MYTH: There is no hurry to get pregnant! Look at all the women in the news having babies well into their 40's and even 50's!

FACT: The vast majority of women, who become pregnant after crossing the age of 43, have used another women's egg or even adopted an embryo to achieve conception. In addition, there are significant health risks to both the mother and the baby when the mother is in an advanced reproductive age. These facts should not deter a woman from seeking consultation from her gynaecologist or a reproductive specialist about her unique situation and potential for success. Fertility begins to decline in a woman starting at age 27. At 35, that decline speeds up, and after 40, it declines even more steeply. A healthy lifestyle cannot stop the natural process of aging.

MYTH: Just relax. Infertility is a psychological problem that's all in your head.

FACT: Although the disappointment and frustration associated with wanting a child and experiencing failure is very well recognized, the reality is that infertility always has an underlying physical cause. Discovering the cause(s) and exploring treatment methods brings a measure of relief to most, regardless of their ultimate decisions about fertility services. The relationship between the couple will almost always undergo some strain and many have reported difficulties in communication and sexual satisfaction. It is vital, therefore, that infertile couples begin, early in their experience, to talk about individual feelings and reactions to their specific situation. Some have found it very helpful to seek counseling with health care professionals that have expertise in this area.

MYTH: Adoption increases the chances of becoming pregnant.

FACT: Almost every couple that has had difficulty becoming pregnant probably has heard the story about someone who became pregnant shortly after adopting. This myth is an offshoot of the “just relax” myth, assuming that adoption relieves the anxiety and stress that presumably were causing the infertility. In fact, infertile couples who adopt are no more likely to become pregnant than couples who do not. Though adoption is a wonderful way to build your family, no one should adopt because they think they will get pregnant naturally because of it.

MYTH: Services for infertility (like IVF) are too high tech and too expensive for most couples to consider.

FACT: The truth is that IVF is expensive but many couples find if that is what their situation dictates, there are acceptable ways to manage the costs. The other truth is, although IVF is usually every couple's best chance for pregnancy, most couples do not need it. The majority of infertile couples who achieve pregnancy do so without employing the most expensive, most ‘high tech’ interventions.

MYTH: If you're young, you don't need to worry about infertility.

FACT: Age is only one factor of many when it comes to infertility. It's true that as you age, your chances of facing infertility increase. But even a couple in their early 20s  has a 7% chance of dealing with infertility. Dealing with infertility is challenging and exhausting and brings with it a great number of new, sometimes anxiety-producing experiences. Finding the right physicians, nurses, and counselors to guide you through this unfamiliar territory is very important. Talking with your primary care or gynaecology provider will help put you on the path of discovering the truths and strategies you may use in your very own quest for a child.

Myth : Many infertile couples are trying too hard. If they would just relax, they would conceive right away.

Fact: Relaxation alone won't help anyone become a parent. Instead of booking that Puerto Vallarta vacation, infertile couples should schedule a doctor's appointment. One or both partners may have a correctable medical condition that stands in the way of conception. If there's no obvious physical explanation for infertility, a doctor can suggest lifestyle changes that could boost the odds of parenthood.

Myth : Most couples can conceive any time they want.

Fact: According to Resolve, more than 7 million Americans of childbearing age have fertility problems. Even under the best circumstances, conception is tricky. It's not unusual for a perfectly healthy, fertile couple to try for several months or more before achieving a pregnancy. And the longer couples wait to have children, the more difficult it can be: By the time the average woman reaches her early forties, half of her eggs are no longer viable. However, most couples who can afford fertility treatments can eventually conceive, if they are open to the use of egg donation.

Myth : Women don't start to lose their fertility until their late 30s or early 40s.

Fact: According to a report in the journal Human Reproduction, a woman's fertility starts to decline at age 27, although this isn't clinically significant. Most women of this age can still get pregnant, of course, but it might take a few more months of trying. But by the time a woman reaches 35, her chances of getting pregnant during any particular attempt are about half of what they were between the ages of 19 and 26.

Myth : Boxer shorts and loose pants are the ideal garb for prospective fathers.

Fact: Researchers at the University of New York at Stony Brook put this piece of conventional wisdom to the test and concluded that underwear style is unlikely to significantly affect a man's fertility. What that comes down to is that wearing roomy shorts probably won't help a man become a father -- but on the other hand, it won't hurt, either.

Myth : Little can be done to improve a man's sperm count.

Fact: No matter how sparse his troops may be, a man still has reason for hope. Many men who produce little or no sperm have blockages or other treatable conditions. Lifestyle changes -- such as quitting smoking, losing weight, and staying out of hot tubs -- may also help. Some research also found that men who bicycled more than five hours per week had a lower sperm concentration than either couch potatoes or men doing other types of exercise. For this reason, some fertility experts recommend holding off on biking if you and your partner are trying to conceive (and resuming the sport after you're successful).

Myth : A man's fertility doesn't change with age.

Fact: While some men can father children into their 80s or 90s, male fertility isn't age-proof. As reported in Human Reproduction, a man's fertility usually begins to dip after about age 35. The decline is generally slow and gradual, but it can speed up dramatically if a man develops a condition that hampers sperm production (such as an infection in the genital tract).

Myth : Vasectomy reversals are rarely successful.

Fact: According to a report from the Johns Hopkins Medical Institutes, some patients have a better than 50/50 chance of fathering a child after a vasectomy reversal. However, the longer a man waits to have a reverse vasectomy, the lower the odds.

Myth : Infertility means you can't have a child.

Fact: Infertility means that you have been unable to have a child naturally after a year of trying. With the proper treatment, many people go on to have children. In addition, there is a possibility of a couple conceiving without treatment if the woman is ovulating and has one open tube, and the male partner has some sperm in his ejaculate. This rate may be lower than you would hope, but it is not zero.

Myth : Age only affects women’s fertility, not men’s

Fact: Women experience a significant decline in fertility, sometimes as much as 50 percent, between the ages of 32 and 37. However, women aren’t the only ones affected by age.

“Like female infertility, male infertility rates increase with age,” says Dr. Thomas Price, an infertility specialist at Duke Fertility Center. “After the age of 40, a man is likely to start experiencing decreases in semen volume and motility.”

Myth : If you already have a child, you don’t have to worry about infertility

FACT: Data shows that approximately 30 percent of infertility happens after the first child. This means even if a couple already has a child or children, they can experience difficulty in getting pregnant later.

Myth : Your health doesn’t impact fertility

Fact: In reality, one of the largest factors of fertility for men and women comes down to health.“If we try to live a healthy lifestyle, it will really help address infertility issues,”

Myth: Having sex daily will increase your chances of conception.

Fact: Some men and women believe daily sexual intercourse improves the odds of conception. "Most couples believe that the more you try, the higher the success rate," says Dr. Ali Dabaja, a urologist and reproductive medicine specialist with the Henry Ford Health System in Detroit. "The truth is that conceiving is all about timing. Having sex daily will therefore do little to improve fertility," Dabaja says. A man's sperm can live for 48 to 72 hours in a woman's reproductive tract, he notes. That means having sex every other day is sufficient when a couple is trying to conceive. For couples trying to conceive, timing intercourse to the "fertile window," the five to six days leading up to and including ovulation, is essential, says Lauren A. Wise, a professor of epidemiology at Boston University's School of Public Health.

Myth: If the ejaculate looks normal, there's no issue with the sperm.

Fact: Sperm are microscopic, and the majority of the ejaculated fluid is not sperm. "The only way to tell for certain if there is a male factor with fertility is to do a sperm analysis. This simply involves having the semen analyzed by trained technicians."

Myth: Taking supplemental testosterone can enhance a man's fertility.

Fact: Taking testosterone actually reduces male fertility, says Dr. Thomas A. Molinaro, a reproductive endocrinologist at Reproductive Medicine Associates of New Jersey in Eatontown, New Jersey. Taking supplemental testosterone can improve a man's libido and energy levels, but it suppresses the body’s production of natural testosterone, Molinaro says. "In effect, this can shut down sperm production," he says.

Myth: You will have multiple pregnancy births.

Fact: It is true that fertility treatment increases the risk of having a multiple pregnancy. However, most twins result from spontaneous conceptions — couples who conceive on their own! Triplets or more are a different story; approximately 15% of triplet and 7% of quadruplet pregnancies were conceived spontaneously.

The increased risk of a multiple pregnancy during fertility treatment is a result of the medication used to cause or boost ovulation. Approximately 5-8% of pregnancies conceived with the use of clomiphene citrate, an oral fertility drug, are twins. Triplets or greater occur very infrequently. Use of gonadotropins, which are injectable fertility drugs, result in twins about 15% of the time and more than twins in about 3% of cycles.

The risk of multiple pregnancies is also increased with IVF. Younger women are more likely to have twins than those who are somewhat older. For example, in this country approximately one third of women under the age of 35 undergoing IVF will have twins, whereas less than 10% of women over 42 will have twins. The risk of triplets is low in all age groups because most women under 35 will have only one or two embryos transferred.

Though fertility treatment generally increases the risk of a multiple pregnancy, the majority of individuals and couples will have a single baby!

Myth: People think IVF always works.

Fact: Though we would like for all individuals and couples trying to get pregnant to be successful, unfortunately, there is no fertility treatment, including in vitro fertilization (IVF), that always works for everyone. The likelihood of success in an IVF cycle is impacted by a number of factors, the most important being the age of the female partner. Information collected from almost all of the IVF programs in the country found that women under 35 had a 41% chance of having a baby from a single IVF cycle. The chance of success drops to 32% in women between the ages of 35 to 37, and 22% in women between the ages of 38 to 40. That number is even lower in women over 40 years of age. Success rates also vary with the number of embryos transferred; the likelihood of pregnancy increases with when more embryos are replaced, but so does the risk of a multiple pregnancy. The chance to have a baby from IVF increases when more than a single cycle is done. Though not everyone who undergoes IVF treatment will have success, the majority will!

Myth: Babies conceived through ART will have a higher chance of birth defects, low birth weight or developmental delays.

Fact: Though we hope all babies will be born without any problems, unfortunately this is not the case. Children conceived naturally to couples who have never struggled with infertility have a 3 – 5% risk of birth defects and a 1 – 2% likelihood of experiencing developmental delays. Pregnancies conceived naturally in women experiencing infertility may be at a slightly higher risk for pregnancy complications.

IUI, when used without stimulation medication, does not appear to further increase the risk of birth defects or developmental delays. Pregnancy-related complications are increased with ovarian stimulation, though this can be largely attributed to risks associated with multiple pregnancy.

Babies born from IVF maybe a little smaller than those conceived naturally, though they are typically still in the normal range. The majority of studies have not found an increased risk of birth defects in babies conceived with IVF. The use of intra-cytoplasmic sperm injection (ICSI), which is typically used when sperm quantity and/or quality is reduced, is associated with a very slight increase in chromosomal abnormalities and birth defects.

Fortunately, if there is an increase in problems such as birth defects, low birth weight, and developmental delays in babies conceived through ART, it is very small. The overwhelming majority of babies born as a result of fertility treatment are fine!

A FEW ONE LINERS:

MYTH: A woman’s menstrual cycle is 28 days.

FACT: Normal cycle lasts anywhere from 21 to 36 days.

MYTH: A woman can get pregnant on only one day of her cycle.

FACT: Once the egg is released, it is viable for 12 to 24 hours, but a woman can get pregnant from having intercourse five days prior and two days after ovulation.

MYTH: Stress causes infertility.

FACT: Stress does not cause infertility, but may delay ovulation by the suppression of hormones.

MYTH: Sperm live for only several hours.

FACT: Infertile cervical liquid, sperm can live up to five days.

About author:  

Dr. Aritra Pradhan is a Consultant IVF Specialist at Srishti Fertility Centre, Srishti Hospitals & Research Centre in Dibrugarh

Phone: 9706903500, 8107180409