Statistics on infertility can, at times, feel staggering. According to recent studies, between 12% and 15% of couples in the United States are unable to conceive after one year of trying to conceive. Globally, 48.5 million couples experience infertility.
Infertility: a social stigma
Statistics like these feel so overwhelming because of the stigmas often associated with infertility, which often create feelings of shame and failure. Those stigmas have several roots. Because many cultures view starting and raising a family as a societal norm, the inability to do so can create feelings of inadequacy. In the worst instances, some dealing with fertility issues can become the victims of discrimination. Not surprisingly, rather than face those stigmas, many choose to keep their struggles secret, which leads to further feelings of isolation.
Infertility affects both men and women equally, with approximately one-third of the causes stemming from male issues, one-third from female issues, and one-third from a combination of both. Women, however, more often feel the impact of infertility more acutely, either through social or self-stigmas that leave them feeling devalued.
Infertility presents diversity, equality, and inclusion issues
The situation becomes even more critical for women of color, particularly Black women. Studies show they're twice as likely to experience infertility as white women, but almost half as likely to seek treatment, in part because of more difficulty accessing fertility care.
Infertility also presents critical challenges for the LGBTQIA+ community. Many are denied coverage for IVF treatments, for example, because health plans often require a medical diagnosis of infertility, which is defined in heterosexual terms, to prove that the individual or couple cannot conceive children through sexual intercourse. As a result, many have felt excluded from conversations not only about the stigmas of infertility but also the available treatments.
Supporting individuals experiencing infertility
Fortunately, leading companies have begun to offer help—clinical, emotional, and financial—to those dealing with infertility. In this blog, we'll not only cover some infertility basics but also look at ways that you can help your employees navigate this very personal journey by destigmatizing infertility in the workplace. We'll discuss:
- What infertility is and its causes
- Infertility prevalence
- Why infertility is stigmatized
- The effects of infertility stigma
- The impact infertility has on employees in the workplace
- How to destigmatize infertility in the workplace
What is infertility?
As mentioned above, infertility is the inability to conceive after 12 months of regular unprotected sexual intercourse. The definition differs slightly for women aged 35 and over because fertility steadily decreases with age. For these women, infertility is the inability to conceive after six months of unprotected sex.
Infertility can be classed as primary or secondary infertility. Primary infertility is when a pregnancy has never been achieved by an individual. Secondary infertility is when someone cannot conceive or carry a baby to term after having given birth at least once previously.
What causes infertility?
Infertility is often a complex issue, and a multitude of factors can contribute to a diagnosis simultaneously. In 30% of cases, infertility is unexplained, with no determinate cause found. However, there are a range of well-known causes of infertility, some of which can be resolved with medical treatment, some of which can be overcome with fertility assistance, and some of which cannot be treated.
Female infertility
Female infertility can be caused by various factors that affect the reproductive system. Some common causes of female infertility include:
- Ovulatory disorders: Problems with ovulation–the release of eggs from the ovaries–can lead to female infertility. Conditions such as polycystic ovary syndrome (PCOS), hormonal imbalances, and thyroid disorders can disrupt normal ovulation.
- Fallopian tube issues: Blockages or damage to the fallopian tubes can prevent an egg from meeting the sperm as is needed for conception. This may be due to pelvic inflammatory disease (PID), endometriosis, or previous pelvic surgery.
- Uterine problems: Abnormalities in the uterus, such as polyps, fibroids, or structural abnormalities, can interfere with implantation or the ability of a fertilized egg to develop.
- Endometriosis: This is a condition where tissue similar to the lining of the uterus grows outside the uterus. Endometriosis can cause scarring, adhesions, and inflammation, affecting fertility.
- Age: Female fertility declines with age, especially after the age of 35. As a woman gets older, the number and quality of her eggs decrease, making it harder to conceive.
- Pelvic Inflammatory Disease (PID): Infections, such as sexually transmitted infections (STIs) including chlamydia and gonorrhea, can cause inflammation and scarring in the reproductive organs, leading to infertility.
- Thyroid disorders: Problems with the thyroid gland can affect the menstrual cycle and disrupt fertility. Both hypothyroidism and hyperthyroidism can be associated with infertility.
- Lifestyle factors: Certain lifestyle factors can impact fertility, such as smoking, excessive alcohol consumption, obesity, and extreme exercise.
- Genetic factors: Some genetic conditions can affect fertility. For example, women with Turner syndrome may experience ovarian dysfunction.
Male infertility
Male infertility can be attributed to various factors that affect sperm production, quality, or delivery. Some common causes of male infertility include:
- Low sperm count (Oligospermia): A low sperm count can decrease the likelihood of fertilization. This can be caused by factors such as hormonal imbalances, infections, or genetic conditions.
- Poor sperm motility (Asthenospermia): Sperm needs to swim effectively to reach and fertilize an egg. Poor sperm motility can result from various factors, including genetic abnormalities, infections, or testicular overheating.
- Abnormal sperm morphology (Teratospermia): Sperm with irregular shapes may have difficulty penetrating the egg. This can be due to genetic factors, hormonal imbalances, or environmental influences.
- Ejaculation disorders: Problems with ejaculation, such as retrograde ejaculation (when semen enters the bladder instead of emerging through the penis) or premature ejaculation, can contribute to male infertility.
- Varicocele: A varicocele is a swelling of the veins that drain the testicle. It can lead to decreased sperm production and quality. A varicocele can be treated with a surgical procedure.
- DNA fragmentation: DNA fragmentation refers to the presence of breaks or damage in the DNA strands of sperm. Excessive fragmentation can affect the sperm's ability to fertilize an egg.
- Obstruction of the reproductive tract: Blockages or obstructions in the tubes that carry sperm can prevent them from being ejaculated. Blockages can result from infections, surgery, or congenital conditions.
- Hormonal imbalances: Disorders affecting the hormonal regulation of sperm production, such as problems with the pituitary or thyroid glands, can contribute to male infertility.
- Testicular factors: Conditions that affect the testicles, such as undescended testicles, testicular injury, or the presence of tumors can impact sperm production.
- Environmental factors: Exposure to certain environmental toxins, chemicals, or radiation can harm sperm production and quality.
- Lifestyle factors: Habits such as smoking, excessive alcohol consumption, and drug use can negatively affect sperm production and function.
- Age: While not as pronounced as in females, male fertility can decline with age. Advanced paternal age has been associated with a higher risk of genetic abnormalities in offspring.
- Genetic factors: Some genetic conditions can affect male fertility, such as Klinefelter syndrome, where a man has an extra X chromosome.
How common is infertility?
If the statistics below seem surprising, it's because the stigma and secrecy surrounding infertility often obscure just how common it is:
Percentage of married women 15-49 years of age in the U.S. who are infertile: 0 births: 19.4%; 1 or more births: 6%
About 9% of men and about 11% of women of reproductive age in the United States have experienced fertility problems.
12.2% of women aged 15-49 have used infertility services
33% of American adults report that they or someone they know has used some type of treatment in order to try to have a baby.
U.S births via assisted reproductive technology more than tripled between 1996 and 2016.
Why is infertility stigmatized?
Infertility stigma can arise for many reasons, which can differ depending on geographical location, culture, and socioeconomic status. For example, infertile women experience the negative effects of childlessness to a greater degree in developing countries than in developed societies. Infertility stigma can also vary according to gender, with infertile women and men’s experiences of infertility-related stigma being similar in some regards but also vastly distinct.
Social perceptions
Social perceptions play a significant role in contributing to infertility stigma. For example, in many societies, there is a strong emphasis on biological parenthood and the notion of the nuclear family. This is often perpetuated by media representations of families and can contribute to unrealistic standards that infertile individuals are compared to and also internalize.
Societal expectations and pressures regarding parenthood can further contribute to the stigma surrounding infertility. Couples who cannot have children or are delayed in becoming parents due to infertility may face scrutiny and judgment, reinforcing the idea that parenthood is an expected and necessary life path.
Familial attitudes
Infertility stigma can also be derived from a much smaller subset of people, including an individual’s close family. Familial attitudes related to infertility may be because some parents may have strong expectations for their children to provide them with grandchildren. The desire to see the family grow and pass on traditions can create added pressure on couples facing fertility challenges and make them feel like they aren’t meeting their familial duty.
In cultures where family lineage and the continuation of the family name are highly valued, there may be intense pressure on individuals or couples to conceive and produce an heir. Infertility may be viewed as a threat to the continuity of the family line, leading to heightened expectations and psychological distress.
Gender roles
Traditional gender roles can play a role in the stigma surrounding infertility. In some cultures, infertile women, in particular, may face additional scrutiny and blame, reinforcing gender-based stereotypes and contributing to feelings of shame.
According to a study published in BMC Women’s Health, stigma affects women significantly. Chinese women usually have high family decision-making power. This coupled with the importance placed on fertility and the ability to bear children, means that according to society, “childlessness is always the women’s fault”. As a result, infertile women experience moderate to high levels of female infertility stigma in China and suffer not only personal grief due to their circumstances but also rejection and economic deprivation.
Misconceptions and lack of understanding
Lack of awareness and understanding about the causes of infertility can contribute to misconceptions and judgment. People may make assumptions about the reasons for infertility, attributing it to personal choices or behaviors, without considering the complex medical and emotional factors involved.
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