Health

Myth: The Majority of Infertility Is Due to Age and STDs.

By Rachel Gurevich, About.com GuideApril 27, 2011

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As I did yesterday, I am busting another infertility myth today in honor of National Infertility Awareness Week and RESOLVE's Bust a Myth Challenge.

Today's Myth: The majority of infertility is caused by careerism (leading to late motherhood) in women or STD infections.

In other words, the majority of infertile couples wouldn't be infertile if they either avoided STDs with safe sex practices, or if they didn't wait too long to have kids.

What's Wrong with This Myth

There are a wide variety of causes for infertility, and the majority of them are not preventable. (More on this below.)

Yes, it's true that there is an increasing number of women dealing with age-related infertility. More couples are deciding to start their families later in life. But this still does not make up the majority of infertility cases.

It's also true that STD infections, which lead to pelvic inflammatory disease (PID), are a leading cause of preventable infertility. They are not, however, a leading cause of infertility itself.

What's (Possibly) Behind It

When you read about infertility in the media, it seems the stories can be put into three basic categories:

Celebrity news, especially the "dirt" and gossip. Who is using a surrogate, what "offensive" terms are they using, did they or did they not use IVF, and so on. There are few positive celebrity infertility stories.
News on the extreme or controversial and rare side of things, like talking about women looking for surrogates in India (interesting, but far from 95% of infertile couple's experience), or Octomom stories, or egg donors who had an unfortunate experience (rare, but it happens.)
Preventable infertility stories, either on age and fertility, weight and fertility, or STDs.

But why does the media seem to focus on infertility this way?

With celebrities, it's obvious and not unique to infertility. The media reports on what celebrities eat for breakfast, so we can expect them to report on their family building ventures. The extreme stories also make sense, as they sell the most papers or garner the most page views.

But why when talking about every day folk do they choose to focus on age, weight, and STDs? How come there aren't more articles on Primary Ovarian Failure and varicoceles and endometriosis and fibroids? Where are the articles on PCOS that do not only focus on the weight angle? Why aren't we reading about unexplained infertility? Where are those stories?

My theory is that people feel much safer when they can blame you for your health problems, than consider the idea that life is unfair and disease sometimes randomly affects people (even those living healthy lives). It's much easier to tell you to "just adopt" or to pay for infertility treatments yourself when they can point their fingers and say, "You did this to yourself, stop whining about it already."

Harsh? Yes, but it's probably true.

If people would admit that infertility can affect anyone, then they have to consider the frightening possibility that their close friends or they themselves can experience it. It would lead to feelings of vulnerability, and in general, people don't like feeling vulnerable.

I'm not saying the world is full of uncaring people who like to blame others for their health problems. I'm saying the world is full of vulnerable people who are afraid that health problems (and other tragedies) might not always have a preventable cause, and therefore, subconsciously prefer to blame rather than empathize.

What the Facts Are

So what does lead to infertility in most couples? There have been a number of studies, but I think one of the best to consider is one done in Israel, and only recently published in 2011. I like this study because in Israel, fertility treatment and testing is paid for by government mandated insurance. So unlike studies done by fertility clinics in America (where you can expect more bias towards those with insurance or money), you can get a better view of the general population.

This study looked at a nine year period, at two clinics, and included 2515 couples altogether. This is some of what they found:

The mean age for the patients was 29.6 years, with about a 6 year range on either side. The youngest were 23, and the oldest were 36.
Primary infertility accounted for 65% of couples. That means that 35% were experiencing secondary infertility (or infertility after already having had at least one child.)
Male factor infertility affected 45% of couples.
Problems with ovulation affected 37% of couples.
Tubal damage affected 18% of couples.
Infertility affected just the female partner in 30.6% of cases, and solely the male partner in 29.2%.
Unexplained infertility was 20.7%, and was likely from undiagnosed endometriosis.

By looking at these statistics, you can already see that age is not the major cause of infertility. In these two clinics, most patients were under 35 years of age, and 45% of cases involved male infertility (which means even when dealing with a woman over 35, her age would be an additional issue, not the sole issue).

You can also see that STDs are not to blame for the majority. How can you tell? STDs cause tubal damage, so at most, only 18% of the couples possibly had STDs to blame for their infertility. But since there are a variety of reasons for tubal damage, and it's unlikely that all 18% of the tubal factor infertility cases were due to STD damage, even that would be an overestimate.

The bottom line? The majority of infertility is not caused by age or STDs. The majority of infertility is not preventable.

And I think it's important to say that even for those who do experience preventable infertility, they still deserve our empathy, concern, and care. We don't look at a 70 year old having a heart attack and say, "Well, he's old, why should I care?" We don't look at a woman with diabetes and say, "Well, she is obese, why should insurance pay for her insulin?" That's crazy.

Should people do whatever they can to prevent health problems? Yes. But our job is not to ignore them or brush off their troubles. We should not stand here in self-righteousness and use blame to push away uncomfortable feelings in ourselves.

We should all stand, together, and do what we can to treat and support every couple who wants a child but struggles due to infertility - regardless of cause.