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National Infertility Awareness Week in the US is recognized April 18th-24th. We love to normalize having difficult and important conversations. Even some of our country’s leaders and known celebrities have talked openly about the difficulty of expanding their families. Former First lady Michele Obama talked about the shame and emotional toll of miscarriages, and her journey of in vitro fertilization in her book “Becoming”. According to the CDC, infertility can affect about 7% of married women aged 15 to 45 and in about 8% of couples with infertility, a male factor is the only cause found. BIPOC women can experience even higher rates of infertility when socioeconomic factors or undiagnosed medical factors are factored into account. Yet, infertility is rarely talked about in everyday conversations; it is a topic of discussion that is left in the dark and only brought up when it happens to you.
In this post, we will break the barriers of infertility by discussing possible causes of infertility and when to seek treatment as well as education and recommendations from OBGYN, Dr. Ashlee Green, and fertility nurse, Nicole Antonio, RN. We hope that education and freely talking about infertility can empower you with awareness and preparedness.
Ashlee N. Green MD, MS is a PGY4 Resident Physician Department of Obstetrics and Gynecology at Rutgers Robert Wood Johnson Medical School.
Infertility is a disease that affects millions of both men and women of reproductive age worldwide. It is defined as the inability to achieve pregnancy within 12 months of regular unprotected intercourse. It is estimated that between 48-186 million individuals live with infertility worldwide.
Facts of Infertility:
- Affects 1 in 8 women
- Affects approximately 15% of all couples and within this group male infertility issues contribute to 30% of all cases
- Almost 9% of men aged 25-44 years in the United States reported that they or their partner saw a doctor for advice, testing or treatment for infertility during their lifetime
- 12% of US women used fertility services between 2006 and 2010
- White women were almost 2x as likely than Black or Latinx women to do so
- 15% of non-Hispanic white women used medical help to get pregnant
- Only 8% of (non-Hispanic) Black women and 7.6% of Hispanic women reported using medical help to get pregnant
- Causes of infertility can be linked to genetic, medical and stress
As a fertility nurse at one of the largest IVF centers in the United States, Nicole Antonio, RN, has spent the last five years helping men and women build families and navigate the journey through fertility treatment.
3 Things A Fertility Nurse Wants You to Know
In light of National Infertility Awareness Week, a fertility nurse shares three things that are helpful for everyone to know regardless of race, ethnicity, sexual orientation, religion, or socioeconomic status.
1. Start With Your AMH
Women are born with all the eggs we will have in our lifetime. Each menstrual cycle, our bodies work to mature several ovarian follicles – think immature eggs – with usually only one egg reaching maturity. The mature egg is ultimately ovulated with the hope of creating a pregnancy. The eggs that did not reach maturity disintegrate, reducing the number of available eggs for future pregnancies.
Ladies, if you are curious about your fertility status, an easy first step to take is to ask your OB/GYN to check your Antimüllerian hormone (AMH) level via blood test. AMH is a hormone secreted by the ovarian follicles. In theory, the higher the number of available ovarian follicles, the higher the AMH level. Low AMH levels could indicate decreased ovarian reserve. AMH testing is a useful preliminary tool that can assist in identifying potential reproductive challenges and in determining if further fertility screening is needed.
2. Reproductive Struggles: Causes
Many are unaware that 1 in 8 couples have difficulty achieving or sustaining a pregnancy. Additionally there is an incorrect assumption that fertility is usually a female problem. Reproductive struggles can be due to challenges faced by one person or both partners.
Examples of common reproductive challenges include but are not limited to:
- Low ovarian reserve
- Sperm Abnormalities
- Irregular menstrual cycles
- Uterine challenges
- Genetic issues
Sometimes, multiple diagnostic tests are needed to determine the cause. Other times, even after multiple tests, there are cases of unexplained infertility, where there is no identified cause for reproductive challenge.
3. Financial Tips
Fertility struggles are not only emotionally draining, but added financial expenses associated with treatment can prevent many patients to proceed with treatment. Here are some of the best financial tips I share with my patients:
- Some clinics offer financial assistance to qualifying patients. Ask about your eligibility for financial programs. It never hurts to ask!
- There are a number of fertility grants available. RESOLVE has a great list of resources to review and apply for: https://resolve.org/what-are-my-options/making-infertility-affordable/infertility-treatment-grants-scholarships.
- Fertility medications are typically not included in the cost of treatment. Oftentimes medications are not covered by insurance or insurance does not offer significant savings. Patients should shop around and compare the prices between different specialty pharmacies. They should compare the insurance-related price and the self-pay price for all medications. Additionally, some drug manufacturers and some specialty pharmacies offer assistance programs for qualifying patients to purchase medications at a reduced price.
https://www.cdc.gov/reproductivehealth/infertility/index.htm
https://www.webmd.com/infertility-and-reproduction/male-fertility-test
https://www.wellandgood.com/fertility-treatment-disparities/
https://infertilityawareness.org/
