The term “infertility” often has a negative social stigma that is damaging to many couples hoping to start a family. The reputation that precedes infertility is often blamed on women, which can cause a lot of pressure and lead to misinformation about the topic. While infertility affects women at different stages in life, aging is an important contributing factor to the decline in women’s fertility. Infertility can be defined in many terms, but the CDC defines infertility as a woman aged 35 years or younger not being able to get pregnant after one year or longer of unprotected sex. Furthermore, a woman aged 35 years or older, can be considered infertile after 6 months of unprotected sex[1]. Many couples experience infertility correlated to genetics and reproductive health, but this problem also involves other complex issues like social, economic, and cultural implications[2]. Fertility is an important societal issue, and the World Health Organization (WHO) states that nearly 50-80 million people face some sort of infertility. Ever since the first IVF baby was born in 1978, the demand for fertility treatments has increased and driven many patients to look at the scientific world for new developments to conceive children or genetically test their embryos[3]. Science has paved a pathway with new techniques to treat infertility, like IVF, pre-implantation genetic testing or screening (PGT/S) of embryos, and other modern instruments that offer more opportunities to improve infertility care[4]. While all of these technological advancements help infertility patients, many questions remain about what the leading causes of infertility are.
In 2009, Roupa et al. conducted a study in Greece to investigate which were the most prevalent causes of infertility in women of reproductive age[2]. In the study, the women of reproductive age ranged from 20 to over 50 years of age. This study consists of 110 infertile women who sought medical assistance from the Center for Assisted Reproduction for a period of two months. From this center, these women were randomly sampled and agreed to participate in the study. To collect data, researchers constructed a specific questionnaire that included demographic data and questions concerning their infertility.
The results from this study showcase the broad causes of infertility — specifically the top three leading causes. The first leading cause of infertility problems, 27.4%, was issues with the fallopian tubes, which may reference the blockage or scarring of the fallopian tubes[5]. This can result from malformation, endometriosis adhesions, inflammatory diseases, infections, and sexually transmitted diseases[6]. The fallopian tubes serve as channels for the transportation of eggs to the uterus[6] but if the fallopian tubes are blocked, the eggs are not able to move from the ovaries to the uterus which makes the sperm unable to fertilize the egg[5]. The second leading cause of infertility problems, 24.5%, is due to unknown causes. This is almost a quarter of the study’s results, which leads to the conclusion that further and more in-depth research needs to be done to investigate the causes of failed conception like further individualized treatment[7]. The third leading cause of infertility problems, 20.0%, was due to disorders of menstruation. Disorders of menstruation is a broad term to classify physical or emotional problems that affect the normal menstrual cycle, unusually heavy or light bleeding, and missed periods[8]. Some examples of menstrual disorders are abnormal uterine bleeding, the absence of menstruation, and Premenstrual Syndrome (PMS), to name a few[8]. Although there were other infertility causes like problems in the uterus (9.1%), sexual disorders (2.6%), and ovarian deficiency (3.6%), the three major leading causes that affected the majority of the study were fallopian tube problems, unknown causes, and disorders of menstruation.
There are disorders, syndromes, and diseases that give women insight into the possible causes of infertility they experience, but still, nearly a quarter of the study participants weren’t able to identify their issue. Although more research has started to be done, only 151 articles related to the study of infertility have been published from 2001 to 2021[9], illustrating that infertility needs to be focused on more within modern research. Age is an important factor for fertility because the health of eggs is reflected by both the quantity and quality of the eggs[10], but age is just one cause. There are more causes of infertility that women suffer from that go beyond being at a “reproductive age” that are undiscovered. The reality is that the infertility research field is understudied due to the lack of funding compared to other fields, like cancer. From 2016 to 2019, the National Institutes of Health (NIH) awarded less than 100 projects totaling around $83 million for female-based research on infertility[11], while awarding more than 16,000 grants for cancer research and over $14 billion in funding.[12]. The lack of awards, less than 100 projects awarded in three years, is a shocking statement that highlights the lack of funding the field has. Many causes of infertility are understudied because of the lack of funding, thus the rate of development has been hindered. The truth is that infertility is increasing every year, and fertility rates in the United States have gradually declined from 1990 to 2019. In 1990 there were about 70.77 births each year for every 1,000 women aged 15-44, and by 2019 there were 58.21 births per 1,000 women in that age group[13]. If fertility rates continue to decrease year by year, and no stable funding is available for the sexual and reproductive healthcare system, a true epidemic will occur. The government needs to start taking this problem seriously and allocate stable funding towards researching the numerous causes of infertility. Not only would this benefit many women who have no diagnosis of infertility but it would help the fertility rates around the nation go up.
Works Cited –
- CDC. (2023, April 26). What is Infertility? Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/features/what-is-infertility/index.html
- Roupa, Z., Polikandrioti, M., Sotiropoulou, P., Faros, E., Koulouri, A., Wozniak, G., & Gourni, M. (2009). Causes of infertility in women at reproductive age. Health Science Journal, 3, 80–87.
- Eskew, A. M., & Jungheim, E. S. (2017). A History of Developments to Improve in vitro Fertilization. Missouri Medicine, 114(3), 156–159.
- de Santiago, I., & Polanski, L. (2022). Data-Driven Medicine in the Diagnosis and Treatment of Infertility. Journal of Clinical Medicine, 11(21), 6426. https://doi.org/10.3390/jcm11216426
- Eunice Kennedy Shriver National Institute of Child Health and Human Development—NICHD. (n.d.). Retrieved April 18, 2024, from https://www.nichd.nih.gov/health/topics/factsheets/infertility
- Han, J., & Sadiq, N. M. (2024). Anatomy, Abdomen and Pelvis: Fallopian Tube. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK547660/
- Sadeghi, M. R. (2015). Unexplained Infertility, the Controversial Matter in Management of Infertile Couples. Journal of Reproduction & Infertility, 16(1), 1–2.
- Igbokwe and, U. C., & John-Akinola, Y. O. (2021). KNOWLEDGE OF MENSTRUAL DISORDERS AND HEALTH SEEKING BEHAVIOUR AMONG FEMALE UNDERGRADUATE STUDENTS OF UNIVERSITY OF IBADAN, NIGERIA. Annals of Ibadan Postgraduate Medicine, 19(1), 40–48.
- Zhu, H., Shi, L., Wang, R., Cui, L., Wang, J., Tang, M., Qian, H., Wei, M., Wang, L., Zhou, H., & Xu, W. (2022). Global Research Trends on Infertility and Psychology From the Past Two Decades: A Bibliometric and Visualized Study. Frontiers in Endocrinology, 13, 889845. https://doi.org/10.3389/fendo.2022.889845
- George, K., & Kamath, M. S. (2010). Fertility and age. Journal of Human Reproductive Sciences, 3(3), 121–123. https://doi.org/10.4103/0974-1208.74152
- Gumerova, E., Jonge, C. J. D., & Barratt, C. L. R. (2021). Research Funding for Male Reproductive Health and Infertility in the UK and USA [2016 – 2019] (p. 2021.08.23.456936). bioRxiv. https://doi.org/10.1101/2021.08.23.456936
- McIntosh, S. A., Alam, F., Adams, L., Boon, I. S., Callaghan, J., Conti, I., Copson, E., Carson, V., Davidson, M., Fitzgerald, H., Gautam, A., Jones, C. M., Kargbo, S., Lakshmipathy, G., Maguire, H., McFerran, K., Mirandari, A., Moore, N., Moore, R., … Head, M. G. (2023). Global funding for cancer research between 2016 and 2020: A content analysis of public and philanthropic investments. The Lancet Oncology, 24(6), 636–645. https://doi.org/10.1016/S1470-2045(23)00182-1
- Bureau, U. C. (n.d.). Stable Fertility Rates 1990-2019 Mask Distinct Variations by Age. Census.Gov. Retrieved May 2, 2024, from https://www.census.gov/library/stories/2022/04/fertility-rates-declined-for-younger-women-increased-for-older-women.html