After Jenny DiBenedetto and her husband married in 2008, they quickly tried to start a family. In her early 30s, DiBenedetto was eager to have children, but despite using ovulation tests and knowing when she was most fertile, the pregnancy tests were negative. Her doctor prescribed hormone supplements but remained optimistic that she would eventually conceive with continued efforts.
For many women, the path to pregnancy can be lengthy. “The chance of getting pregnant for a healthy couple is no more than 20 percent each month,” said Dr. Alan Copperman, a specialist in reproductive endocrinology. Factors like smoking, age, weight, and certain medical conditions such as PCOS, endometriosis, or thyroid issues can further lower these chances.
Though DiBenedetto and her husband had no obvious infertility risks, they struggled for months to conceive. Eventually, they consulted a reproductive endocrinologist for guidance. Fertility treatments like IVF can help many women, and 16 states now require health insurance to cover some of these treatments.
In this guide, experts explain the causes, diagnosis, and treatments for female infertility.
How Conception Works
For pregnancy to happen, sperm, eggs, unblocked fallopian tubes, and a uterus are necessary, explained Dr. William Hurd, a reproductive endocrinologist. The process involves the release of a viable egg from the ovary, which travels through the fallopian tube to the uterus. It must meet sperm within 12 to 24 hours to become fertilized. After fertilization, the egg needs to stay in the tube for 30 hours before traveling to the uterus to implant and grow.
Risk Factors for Infertility
Irregular ovulation or failure to ovulate causes 40 percent of female infertility cases. “How regular are your periods?” is one of the first questions doctors ask, says Dr. Hurd. If periods are irregular or skipped, ovulation might not be happening.
Polycystic ovary syndrome (PCOS), an imbalance of reproductive hormones, affects 1 in 10 women of childbearing age and often causes ovulation problems. Hypothyroidism, high prolactin levels, extreme exercise, being overweight or underweight, or conditions like diabetes or liver disease can also interfere with ovulation.
Low ovarian reserve, or fewer eggs, also decreases fertility. Women naturally lose about 1,000 eggs a month from puberty, and those over 35 face a higher risk of low ovarian reserve. Smoking can reduce egg count—studies show nonsmokers are almost three times more likely to get pregnant through IVF than smokers. A family history of early menopause, having only one ovary, or previous chemotherapy can also contribute to low ovarian reserve.
Fallopian tube blockages, often due to pelvic inflammatory disease from infections like chlamydia or gonorrhea, can also affect fertility.
Other uterine problems, such as fibroids or polyps, can hinder implantation. Women with an irregularly shaped uterus might face difficulties in pregnancy as well.
Male Partner’s Role
It’s important to remember that male fertility issues contribute to one-third of fertility problems in couples. Doctors recommend sperm tests for the male partner when a couple struggles to conceive.
When to See a Doctor
If you’re under 35, infertility is considered after a year of unsuccessful attempts to conceive; for women over 35, it’s after six months. However, you can see a doctor sooner if concerned. “Many younger people visit after about six months of trying,” Dr. Hurd said. It’s also advisable to consult a doctor after two or more miscarriages, as this may indicate underlying issues that can be treated.
Fertility Tests
To evaluate fertility, doctors begin with a physical exam and questions about your menstrual cycle, your relationship status, and any past pregnancies. Blood tests can identify hormonal issues, ovulation problems, or low ovarian reserve.
Further tests might include a hysterosalpingogram (HSG) to check if fallopian tubes are open or an ultrasound to examine uterine abnormalities. A transvaginal ultrasound may also be used to estimate ovarian reserve.
Even if tests don’t show a clear problem, some women may still face difficulties conceiving due to slight imbalances, as happened to DiBenedetto. Despite low ovarian reserve, she eventually succeeded with IVF.
Treatment Options
If ovulation is irregular, doctors may prescribe drugs like Clomid, which works for 70-90% of women but increases the likelihood of twins. Injectable drugs and intrauterine insemination (IUI) are other options. DiBenedetto tried three rounds of IUI without success.
For blocked fallopian tubes, laparoscopic surgery or IVF may be recommended. IVF is often the next step if other methods don’t work.
Paying for Treatment
Most insurance plans cover fertility testing for women who’ve tried to conceive for a year (under 35) or six months (over 35). However, pre-testing may require out-of-pocket payment. Sixteen states mandate insurance coverage for infertility treatments, though IVF is often excluded due to its high cost. DiBenedetto, living in South Carolina, had to pay out-of-pocket for her treatment.
Some states protect women’s fertility before undergoing treatments like chemotherapy, and coverage is slowly improving, according to Dr. Copperman.
Support During Infertility
Infertility can be emotionally challenging, and support groups can help. Resolve, a nonprofit, compares the grief of infertility to losing a loved one. Loved ones should listen and offer support without minimizing the pain, DiBenedetto and others shared. Comments like “Everything happens for a reason” can feel dismissive during such a trying time.
DiBenedetto’s story ended positively. After IVF, she became pregnant and gave birth to her son Sam in 2013. Using a frozen embryo, she later had her daughter Rosie in 2015.
“While frustrating, it worked out as it was meant to,” DiBenedetto said.
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