I Think I Might Be Infertile. What Are My Options?

So you and your partner have been trying to have a baby for a while now, and nothing’s working. You’re starting to worry...am I infertile?

We shouldn’t jump to conclusions, but infertility is pretty common. Out of every 100 couples in the United States, 12 to 13 of them have trouble becoming pregnant. Even more women have trouble staying pregnant.

It’s important to note that these infertility problems can be issues with male or female infertility. About one third of infertility cases are caused by fertility problems in men, and one third by fertility problems with women. The other third are either a combination of fertility problems with both parties, or the cause is undetermined.

About 85% of cis hetero couples are able to get pregnant within one year if they’re actively trying. If you haven’t been trying for that long, it might be best to stay the course and try not to worry about it. If you’ve been trying a year or longer, both you and your partner might want to see a fertility specialist.

Problems that cause female infertility

There are more things that can go wrong with a woman’s body that can cause infertility than there are with a male body. There’s a lot of moving parts, after all.

worried young woman holding pregnancy test

Firstly, a woman needs functioning ovaries, fallopian tubes, and a uterus to get pregnant. Issues with any of these organs can result in fertility problems. 

Here are some common issues that women can have when trying to become pregnant.

Ovulation disorders

Ovulation is when a woman’s body releases an egg, and it happens every month. If this doesn’t happen or only happens sometimes, it could be the cause of fertility problems. This issue can also crop up if a condition makes the person trying to become pregnant not have a period.

Some causes of ovulation problems include:

  • PCOS or polycystic ovarian syndrome 
  • Premature ovarian failure
  • Poor egg quality
  • Hyperprolactinemia
  • Thyroid problems
  • Diminished ovarian reserve
  • Functional hypothalamic amenorrhea
  • Menopause
  • Chronic conditions like AIDS or cancer

Fallopian tube obstruction

Certain issues may cause the fallopian tubes to be blocked or swollen. This is called tubal occlusion. Risk factors include endometriosis, history of pelvic infection, history of appendicitis, history of gonorrhea or chlamydia, or a history of abdominal surgery.

It’s possible to take an x-ray of the tubes to see whether they’re blocked through a surgical procedure.

Abnormal uterine contour

This just means that there’s issues with either the structure or tissue of the uterus. This condition can be caused by congenital anomalies, fibroids, polyps, leiomyomas, surgical changes, synechiae, and adenomyosis.

A transvaginal ultrasound can be performed to look for fibroids or other abnormalities, and then other tests can be performed to look closer.

Problems that cause male infertility

Men can have fertility problems, too. It’s important for both partners to get checked for issues to determine what’s going on. Here are some of the most common conditions that affect male fertility.

Hormonal disorders

Hormones are important to the production of sperm, and they can throw off the whole system if they’re out of whack. These hormones can become unbalanced because the hypothalamus or pituitary glands aren’t working like they should. These glands in the brain are largely responsible for testicular function. If they’re not working properly, this can lead to low or no sperm production.

Conditions that can cause this dysfunction include benign and malignant (cancerous) pituitary tumors, congenital adrenal hyperplasia, exposure to too much estrogen, exposure to too much testosterone, Cushing’s syndrome, and chronic use of medications called glucocorticoids.

Disruption of testicular or ejaculatory function

If you can’t ejaculate properly or your sperm count is way low, you’re gonna have problems conceiving. 

Some issues that can cause this include:

  • Trauma to the testes
  • Cancer treatment
  • The removal of one or both testes
  • Varicoceles, which causes the testicles to overheat and affect the number or shape of the sperm (yes, really)
  • Heavy alcohol use, steroids, smoking, or drug use
  • Cystic fibrosis
  • Diabetes

Okay, so if you and your partner do have an infertility problem, it’s impossible to know which one of you has the issue. How do you get diagnosed?

How infertility is diagnosed

First, your doctor is going to talk with the two of you and see if they can figure out a simple solution. They’ll ask you how often you have sex and your lifestyle habits. Make sure you’re honest, because saying you have sex more often than you do or that you don’t smoke isn’t going to help make a baby happen.

The doctor might suggest some things to try to get pregnant that don’t require tests or medical treatment, like changing up how often you have sex or drinking less alcohol. This may seem annoying, if you’re completely sold on the infertility thing. But it’s good to follow the doctor’s orders, especially if you can save yourself lots of time and money.

If this doesn’t work, your fertility specialist will run some tests. 

Tests for men

The first thing a fertility doctor will want to look at is whether you’re producing enough healthy sperm. They’ll probably do a semen analysis first. This will either involve masturbating into a cup in the office or bringing one home and using it there. This may seem awkward and very clinical, but it’s an important part of the process. 

Your doctor might also perform hormone or genetic testing. This is a blood test to determine the amount of testosterone and whether you have any genetic defects. 

There are other tests that might be performed, but they’re rarer. These include a testicular biopsy or imaging, like a brain MRI or transrectal ultrasound.

Tests for women

First, you’ll have a regular gynecological exam to figure out if there’s some sort of easy, glaring fix. If this doesn’t work, some common fertility tests are:

  • Ovarian reserve testing, to check to see how many eggs are available for ovulation
  • Ovulation testing, where a blood test measures your hormone levels to determine whether you’re ovulating
  • Hysterosalpingography, which checks for a blockage in your fallopian tubes by injecting x-ray contrast into your uterus and looking at whether it comes out your fallopian tubes
  • Pelvic ultrasound, to check for uterine or ovarian disease

You probably won’t have to have all of these tests before the problem is found. Your doctor will select the ones they think are most relevant to you.

How infertility is treated

Once your doctor figures out any issues, they might recommend treatments. Some issues can be dealt with and the couple can conceive normally after, rather than requiring the use of IVF or other reproductive intervention. 

It’s important that couples support each other and don’t blame each other for any fertility issues. It’s no one’s fault, and the partner with the problem is probably feeling a lot of shame. You need to be together on this journey and not hold anyone accountable for things that are out of their control.

Treatment for men

It’s possible to increase a person’s sperm count through certain medical interventions and lifestyle changes. It’s best to try this first before turning to expensive treatments.

First, you might change some lifestyle factors that can affect sperm count. These include reducing harmful substances (like alcohol, drugs, or cigarettes), exercising regularly, discontinuing certain medications, or starting new meds. Your doctor might also recommend you change the timing and frequency of when you have sex. (If you need some help spicing up your sex life while you’re trying to have a baby, we have tons of articles all over our blog!)

In some cases, surgery is recommended. This can get rid of a sperm blockage. You can also get surgery to repair a varicocele, which will increase the chance of pregnancy.

Treatment for women

Many causes of female infertility cannot be treated. However, there are treatment options for some conditions that women might experience.

Your OB/GYN might recommend stimulating ovulation using fertility drugs. They regulate your ovulation and make sure it happens each month. Fertility drugs can be hard on your body, so make sure you check with your doctor to figure out the right one for you.

Another option is surgery. Your surgeon might be able to remove endometrial polyps, a uterine septum, intrauterine scar tissue and some fibroids through hysteroscopic surgery. Endometriosis, pelvic adhesions, and larger fibroids might be able to be removed using laparoscopic surgery.

If these treatments don’t work, either for the male or female partner, it might be time to consider assisted reproductive technology.

What is assisted reproductive technology?

Assisted reproductive technology (or ART) is an umbrella term for all fertility treatments where the eggs and embryos are handled outside of a person’s body. This includes IUI and IVF. 

Let’s explore these options, shall we?

In vitro fertilization (IVF)

In vitro fertilization is the most common type of ART used today. It involves collecting both sperm and eggs from the couple and combining them in a lab. They are allowed to grow for three to five days, turning them into embryos. Then, multiple embryos are implanted into the woman’s uterus.

The process can be intense. The woman must inject hormones so she’ll produce multiple eggs each month during ovulation. These hormones can, frankly, make people a little crazy. Pumping hormones into your body does weird things. 

The doctor will determine the right time in your cycle to harvest the eggs. They have to be retrieved right before they emerge from the follicles in the ovaries. If they’re taken out too early or too late, the process won’t work.

Eggs are retrieved by a doctor using a hollow needle. The woman can decide between being mildly sedated or going under full-blown anaesthesia. It’s not a long procedure, but if you’re very anxious about the outcome, it might be best to go under.

Then, the eggs are mixed with your partner’s sperm. It’s important he donate on the same day, so everything is as fresh as possible.

Then, the couple just has to wait, which can be agonizing. Sometimes, IVF can fail even at this stage. If the sperm or eggs are damaged, they might not be able to fertilize properly. However, if everything goes well, the couple will come back in three to five days for implantation.

At this point, the doctor will transfer one or more embryos into the uterus. All this involves is putting a catheter through the vagina and cervix into the uterus. Not the most comfy, but less invasive than the egg harvesting process. 

Usually, your doctor will recommend transferring at least three embryos to give you the best chance that one will stick. However, this is a choice that each couple has to make.

This is an important decision, because there’s a chance more than one of them will implant. This is how Octomom happened. Even if you would be okay with having triplets (or more!), carrying multiple babies makes the pregnancy higher risk and increases the chances that the woman could miscarry. 

If your doctor does discover multiple fetuses, they will probably offer you the option of selective reduction. This involves reducing the number of fetuses you’re carrying down to a reasonable number. Some people aren’t okay with this because of moral reasons, so you should talk to your fertility specialist about your options beforehand.

After the embryos are inserted, you’ll stay in bed for a few hours before getting discharged. Then all you can do is cross your fingers and wait. If you don’t experience any issues, your doctor will do a pregnancy test on you about one to two weeks later to see how things turned out. 

What in vitro fertilization feels like

It can be hard to imagine what it feels like to undergo IVF treatment. Here are some accounts of women who actually went through it so you can judge for yourself.

“In my experience, IVF made me feel more in touch with my body. Who really ever gets to see their ovaries and eggs and close ups of their embryos? I recall being amazed at the baby-making process. None of the process ever hurt...I looked at it as a scientific step in a very scientific process. The embryo implanting procedure was very special, as I watched life go into my body.” -Jenn, 44

“IVF was one of the most physically draining experiences for my body. I always felt like a pin cushion trying to find a new spot to poke with the injections. They never tell you that you will actually run out of spaces to inject the needle. My body would throb and ache from the medicine. I would have to manage the different emotions like anxiety, sadness, and frustration from the additional hormones I was adding to my body all day. But I wouldn’t change it for the world because it got me where I am today with two beautiful little ones.” -Katy, 32

“Going through IVF is like getting completely naked, going to a red carpet event alone, and screaming 'I can't have a baby!' I remember spending months with my legs in stirrups, my husband injecting me daily in the abdomen, and doctors putting things in and taking things out of my uterus while trying to make me as 'comfortable' as possible.” -Supna, 40

“The IVF process for me was something like going to Vegas: overspending, excitement, and fear. Let's roll the dice and see what happens! There's fear of 'if this doesn't work, then what?' and of spending so much money. Then excitement that this could finally be the answer to your prayers. The stages of IVF can be mentally and emotionally taxing. You can only move to the next phase of the process if you were successful. The last stage of embryo implantation was the toughest. You pray that it takes and it works. The second round of IVF, we went in for implantation....none of the embryos survived the thaw. It was crushing. All of the effort for months and nothing. We had to start from the top again, I'm very thankful it was successful.” -Carrie, 43

The process is difficult. But as you can see, there’s hope at the end of the tunnel.

Intrauterine insemination (IUI)

You probably know IUI by its more common name: artificial insemination. In this process, the sperm are injected straight into the woman’s uterus. A direct pipeline helps if the sperm have trouble making their way there on their own, whether it’s because the guy has low sperm count or the woman has endometriosis blocking stuff.

Artificial insemination is a much less invasive procedure than IVF. First, a doctor will make 100% sure you’re ovulating before the procedure, because there’s no point otherwise. They might use an ovulation kit, blood test, or ultrasound.

Then, the man must produce a sample of his semen. He should avoid having sex for two to fve days before the procedure to make sure he has a high sperm count. 

He might be able to collect the sample at home, or he can do it in a private room. Partners are usually allowed to come in and help things along. However, if you decide to do it at home, the sample must be washed within an hour of collection, so you’d better hurry back.

Then, the sperm will be transferred to the woman’s uterus using a catheter put through the vagina and cervix. And bam, you’re done!

How much do they cost, and how successful are they?

ART procedures are costly, and they are far from 100% effective. The CDC reports that the percentage of ART cycles that ended in a live birth were:

  • 31% in women younger than 35 years of age.
  • 24% in women aged 35 to 37 years.
  • 16% in women aged 38 to 40 years.
  • 8% in women aged 41 to 42 years.
  • 3% in women aged 43 to 44 years.
  • 3% in women older than 44 years of age.

For many couples, these odds are high enough to try. And there is some good news: since its inception in the United States in 1981, assisted reproductive technology has resulted in over 200,000 babies.

However, these procedures are very expensive. On average, one round of IVF costs $12,000 on average. When adding in medications, this increases by around $3,000 to $5,000. 

IUI is less expensive. Generally, it only costs $300-$1,000 per cycle and less with insurance. 

Some insurance companies do cover these procedures, so even if you can’t afford these treatments, you should still check in with your insurance. However, you’ll still have to pay your deductible, which, let’s be real, is probably pretty high. (#MedicareForAll)

Unfortunately, neither IVF or IUI is a one and done thing. Many couples need several rounds before they conceive.

One study in Britain found that about two thirds of women under 40 were able to conceive after six rounds of IVF. Six! For those of you keeping track at home, that could cost $102,000 or more. And even then, it just might not work.

Like with IVF, you might need to try artificial insemination a few times before it works for you, and there’s no guarantee that it will work at all. A doctor might recommend that you do three to six cycles before you give up. Again, not cheap, and very mentally taxing.

This isn’t to discourage people from trying these methods. However, it’s important to know what you’re going into and weigh all of your options.

How to cope with infertility treatments

Infertility treatments are stressful, both emotionally and physically. It’s important that you’re ready to deal with these issues as they arise, and that your partnership is strong going into the process. (Remember: a baby is not a good way to try to save a relationship or marriage.)

Here are some tips about coping with the stress of infertility treatments.

Get therapy.

Therapy may not be the answer to everything, but it never hurts, either. Talking about your experiences, either in individual or couples therapy, will help you navigate them and identify how you’re feeling. If you choose to go together, you can figure out how fertility treatments are affecting your relationship, too.

Have a support system.

It’s possible you won’t feel comfortable sharing your infertility journey with everyone. Many women feel ashamed, and many men feel emasculated. However, having someone in your corner besides your partner can make a world of difference. 

Pick at least one trusted friend or family member to be a part of your team. They can take you to appointments if your partner is at work and listen to you cry on the phone at two a.m. when the hormones are kicking in.

Also, consider joining a support group. RESOLVE, or the National Infertility Association, has support groups all over the United States. If you can’t find one near you, try Facebook groups like Infertility TTC Support Group or TTC with Male Factor Infertility. You can also search “infertility” plus your state/city/country to see if there’s more support either in real life or online.

Learn as much as you can.

Knowledge is power. It can help you feel more enfranchised if you know what is going on with your body. Don’t be afraid to ask questions. Between doctor’s appointments, write your questions down, either in a notebook or just in the notes app on your phone. Make sure you know what’s going on.

However, don’t spend all your free time Googling information, including everyone’s bad experiences. Sometimes it’s good to take a break and trust your doctor.

Don’t be in denial.

This will be a stressful time for you and your partner. Don’t try to downplay it and act like everything’s fine. Accept that you might need to ask for help or cut back on obligations for a while. This is normal. Taking care of yourself and your partner should be the priority.

How to deal with a negative outcome

If you’re undergoing IVF or IUI, there’s a pretty good chance your first cycle will fail...and maybe your second or third. Here are some ways you can work to come to terms with an outcome that you didn’t want.

Give yourself permission to feel your emotions.

It’s normal to mourn what could have been after a failed cycle. You put so much blood, sweat, and tears into something that didn’t end up happening. It’s normal (and healthy) to be upset.

Don’t be afraid to cry. It’s not a weakness to show your emotions. Whether you need to get angry at the universe or lay on the floor crying, both are valid reactions.

Don’t blame yourself.

It’s human nature to blame yourself when something like this happens. However, realize that you did all that you could to make this happen. You did everything right, and the clinic did all they could. It’s all up to fate, and sometimes things don’t work out. Don’t beat yourself up about it.

Take some time off.

If you can, take some time off work or other obligations. Give yourself time to mourn. Even a day or two can help you feel better. If you want, perhaps you and your partner can do something fun to distract you, like go on a mini vacation or stay at a fancy hotel nearby.

Turn to your support systems.

If you’re in therapy or part of a support group, turn to these people. They know what you’re going through, and the people in your support group have probably experienced this before. They can help. If you have a therapist, ask to make an emergency appointment to talk about things. If you don’t have these resources, ask to spend some time with a friend who knows about your treatments. Getting your mind off things and just having coffee can help.

Figure out if you want to try again.

This can be a tough question, and it’s one only you and your partner can answer. If this is your first or second round, you might be optimistic about trying again. But if this is your sixth or seventh, you might be tired of disappointment and putting all these hormones into your body.

The good news is, if IVF or IUI aren’t working for you, there are other options to consider.

Alternative treatments if ART doesn’t work

If you want a baby but IVF and IUI aren’t working out, there are other options you can consider. Although they might be a little different from what you’d always pictured, they’re a way for you to get a beautiful loving child.

Donated sperm

If a man’s sperm aren’t viable, a sperm donor can be a great option. This allows his partner to carry a baby and still have a biological element, if that’s important to them. Donor sperm can be used for in vitro fertilization or IUI. 

Couples who use donor sperm can decide whether to choose someone in their lives to donate or to use a sperm bank. Using a sperm bank is more expensive, but you know that the donors have been carefully screened for basically all medical conditions. Most sperm banks even ask questions about occupation and education.

Acquiring donor sperm can cost anywhere from $300 to $4,000. It depends on where you get the specimen from and the company you choose.

Donated eggs

If a pregnancy issue has to do with a woman’s eggs, but she could carry a child to term otherwise, donor eggs may be an option. The process for donating eggs is kind of a bitch, so getting these eggs is generally more expensive than it is for donor sperm.

Generally, an egg donor is paid between $5,000 and $10,000. This is because the donor needs to undergo similar treatments to those during IVF, which involves injecting yourself with hormones. It’s difficult, and she deserves to be fairly compensated.

Egg donors are put through the same screening process as sperm donors are, if not one that’s more rigorous. You don’t have to worry about your eggs being healthy.

Surrogacy

If a woman can’t carry a baby to term but the couple still wants to use the male partner’s eggs, surrogacy is an option. However, it’s the most expensive option on the list, and for good reason. 

If you want someone to carry your baby, you’re gonna have to shell out some major cash. Usually, this ranges from $100,000 to $150,000. Holy shit!

But I guess it makes sense. Think about it this way: a surrogate is taking nine months off of her life to carry your baby. She’ll have to deal with all of the normal issues, like morning sickness, cankles, and cravings for pickles and mint chocolate chip ice cream. Plus, the 150k will also go towards her medical bills. 

Okay, but let’s say you’re not down to shell out 150 Gs. There’s one option some people forget.

Adoption

Most people never pictured themselves adopting. They wanted a biological child, for various reasons. However, plans change.

There are three main choices when it comes to adoption. First, you can go with a private adoption agency. They generally help couples find pregnant mothers who want their child to be adopted. If you’re looking for an infant and want your kid to look like you (let’s be real, if you want your kid to be white), agency adoption might work.

Unfortunately, agency adoption is the most expensive type. You’ll pay about $40,000 to adopt a baby this way.

You could try international adoption, or getting a child from another country. This cost will vary by country. For example, adoptions from China are least expensive, costing around $36,000. Adoptions from Ethiopia cost about $46,000. So this isn’t exactly a money-saving opportunity.

There’s one last option: adopting from the foster care system. In the U.S., there are almost 108,000 kids in foster care waiting to be adopted. Globally, that number is much higher. Adopting a child gets them out of the system and gives them a new chance at life.

Although it’s sometimes possible to get infants from foster adoptions, the ages can range from toddlers to 17 year olds. The median age is eight years old.

Some potential parents don’t want to adopt a foster kid because of their “baggage.” This is a little unfair, as everyone has baggage at some point in their lives. They still deserve a happy home, and you could help them work with the pain they’ve had in their life. Also, if a child’s past is too much for you, you can always decline adopting them and pick someone else.

Here’s the thing about adopting a child in need from foster care. It works out to be literally free. Like, free free. You might pay about $2,000 in fees, but then you’ll recoup these expenses from federal or state programs once the adoption is finalized.

I had no idea this was a thing? I can’t tell you what to do, but definitely consider helping out one of the foster care kids, okay?

Infertility doesn’t have to mean your chances of a family are dashed. It just means the process might be a little different (and involve more needles and ejaculating into plastic cups) than you might have hoped.

You have options, and you are not alone.