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Infertility and Assisted Reproduction

What Is Infertility?

Infertility is medically defined as the inability to become pregnant after twelve months of regular sexual intercourse without birth control or, for women over age 35, six months. Infertility also refers to women who are unable to carry a pregnancy to term. The Centers for Disease Control and Prevention (CDC) estimates that at least one in ten U.S. women age fifteen to forty-four has difficulty getting pregnant or staying pregnant.1

What Causes Infertility?

For pregnancy to occur, many complex processes and factors need to line up. A woman must produce a healthy egg; a man must produce healthy sperm. Favorable cervical fluid needs to be present so that sperm travel from the vagina to meet the egg while it’s still in the fallopian tube. Timing of intercourse or insemination is critical, since an egg generally lives only twentyfour hours. Once the sperm and egg join, this single cell divides to become an embryo, which must implant properly in the uterine lining before it can grow.

Couples can experience infertility when there is a problem with any one or more of these delicate phases of conception. The CDC estimates that about one-third of infertility cases are associated only with female factors and another one third of problems are associated only with male factors. The remaining cases are caused either by a mixture of male and female problems or by unknown causes.2

Before you begin any kind of fertility testing or treatment, it’s important to be sure you are timing intercourse or inseminations properly. Charting your menstrual cycle and observing your body’s fertility signals can tell you if and when you are ovulating and help you maximize your chances of conceiving. (To learn more, see “Charting Your Menstrual Cycles,” p. 26.)

The Prevalence of Infertility

Though it may seem that infertility is on the rise, infertility rates have remained fairly consistent over time. Societal and behavioral shifts in the last quarter of the twentieth century have certainly allowed us to become increasingly aware of and concerned about infertility. This is largely due to women steadily postponing the age at which they give birth to their first child and because new technologies make it possible for many to overcome infertility.

It’s unclear whether infertility disproportionately affects certain populations. Even though research does not show large disparities in infertility across different groups, social and racial disparities in health status and in the prevalence of certain risk factors (e.g., sexually transmitted infections) suggest that many preventable causes of infertility disproportionately affect the less privileged. Financial barriers also limit access to appropriate diagnosis, evaluation, and treatment and may lead to underestimating the frequency of infertility in the same population groups. On the other hand, delaying childbearing may be more common among professionals and other higher-income groups, making those groups more vulnerable to the effect of aging on fertility.

Excerpted from the 2011 edition of Our Bodies, Ourselves. © 2011, Boston Women's Health Book Collective.


1. Centers for Disease Control and Prevention, “Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth,” December 2005, www.cdc.gov/nchs/data/series/sr_23/_23_025.pdf.

2. CDC, Infertility FAQs,


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