Infertility: what you need to know from Dr. Leslie Saltzman

Dr. Leslie Saltzman

fertility benefit wallet and app

Many of us have friends or family who have struggled to conceive, or have first-hand knowledge of the effects infertility can have on all areas of life. It’s common. So common that according to the World Health Organization (WHO), infertility affects one in every six couples trying to conceive through intercourse at some point in their lives. That’s five million couples in the United States. Though infertility is often framed through a heterosexual lens, it affects LGBTQ+ people, too, who tend to be even more marginalized by infertility. 

For those who struggle, it can be a heartbreaking, lonely, expensive journey without nearly enough support. Many feel deep frustration, shame and even depression over fertility struggles. For those undergoing treatment, the financial and physical pain associated can also become a challenge. For these reasons and many more, many people don’t talk about infertility publicly. 

This taboo has led to general confusion and misinformation about infertility. To help clear up questions and continue to break down cultural stigmas surrounding infertility, Ovia Health’s Chief Medical Officer, Dr. Leslie Saltzman, has put together the basics for every parent-to-be to know. Share these insights with your workforce or members. 

What is infertility?

Infertility is typically defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse, or when an egg and sperm are exposed to each other for more than 12 months without achieving pregnancy. Infertility can be primary, when a pregnancy has never been achieved, or secondary, when at least one prior pregnancy was achieved.

The causes of infertility

Infertility may be caused by a number of reasons, but it’s not always possible to identify the cause. It’s also important to note that women are not solely responsible for infertility; it’s estimated that about a third of infertility is female-related, a third is male-related, and a third is unknown.

Some known causes of female infertility may include:

  • Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome
  • Hyperprolactinemia, a condition in which you have too much prolactin, which is the hormone that stimulates breast milk production
  • Thyroid problems 
  • Uterine or cervical abnormalities, including abnormalities with the cervix, polyps in the uterus, or the shape of the uterus
  • Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may cause infertility by blocking the fallopian tubes or stopping a fertilized egg from implanting in the uterus
  • Fallopian tube damage or blockage, often caused by scarring from infections or endometriosis
  • Endometriosis, which occurs when endometrial tissue grows outside of the uterus, may affect the function of the ovaries, uterus, and fallopian tubes
  • Early menopause (also called primary ovarian insufficiency) when the ovaries stop working normally before age 40
  • Pelvic adhesions, bands of scar tissue that bind organs that can form after pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery
  • Cancer and its treatment, certain cancers can impair fertility, and treatments, including radiation and chemotherapy, may affect fertility

Some known causes of male infertility may include:

  • Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm.
  • Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
  • Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking medications to treat bacterial infections, high blood pressure, and depression also can affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise body temperature and may affect sperm production.
  • Damage related to cancer and its treatment, including radiation or chemotherapy. Cancer treatment can impair sperm production, sometimes severely.

Is infertility prevention possible?

Some types of infertility are unfortunately not preventable. However, there are several lifestyle changes you can encourage your workforce and members to make that may increase their chances of getting pregnant. Couples using intercourse as their family-building method should have intercourse several times around the time of ovulation for the best chances of conception. Using a cycle-tracking app like Ovia to learn when you are most likely to be ovulating can help increase your chances.

Here are some more tips for men and women that can help increase the odds of pregnancy:

  • Avoid recreational drugs and tobacco use, which may contribute to infertility.
  • Avoid alcohol. It may impair your ability to conceive and have a healthy pregnancy.
  • Avoid high temperatures in hot tubs and baths, as they can temporarily affect sperm production and motility.
  • Limit medications that may impact fertility, including both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don’t stop taking prescription medications without medical advice.
  • Exercise moderately. Regular exercise may improve sperm quality and increase the chances of achieving a pregnancy. If you’re a woman, be aware that exercising so intensely that your periods are infrequent or absent can affect fertility.
  • Limit caffeine. Women trying to get pregnant may want to limit caffeine intake to 1-2 cups of coffee per day
  • Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility.

When assistance and benefits are needed

If your members have tried the above and are still struggling, the best place to direct them is an OB/GYN, midwife, or fertility specialist (reproductive endocrinologist). They can also ask their primary care doctor or provider for recommendations. Members may want to think about fertility treatment if:

  • They’re younger than 35 and have been trying to get pregnant for at least a year.
  • They’re 35 or older and have been trying to get pregnant for at least six months.
  • They’re over 40
  • They’re trying to get pregnant, and have irregular, very painful or no periods.
  • They’re trying to get pregnant, and have conditions like endometriosis, pelvic inflammatory disease, or a past miscarriage.
  • They think there may be a male factor (like a history of testicular trauma or past infertility with another partner).

If you want to support their decision-making and journey further, you can invest in a trusted partner like Ovia. With access to Ovia, members can lean on a certified fertility specialist or other coaching experts for support. Ovia’s Care Team helps answer member questions about infertility, listen to frustration, navigate the next steps, and offer ongoing support.

What infertility benefit options are available?

Investing in fertility solutions for members is a clear path to reduce the risk and expenditures for all parties — members, employees, payers and employers. But what options are available? 

Traditional fertility coverage has included funding fertility treatments and rounds either by committing a certain dollar amount per year or lifetime use or fully covering a certain number of rounds. However, in recent years, more preventative measures have grown in popularity. Many have seen success in using cycle tracking to reduce unnecessary fertility treatment. Through Ovia’s fertility algorithm trained on millions of menstrual cycles over more than 12 years, our solution may reduce unnecessary artificial reproductive technology use, risk, costs and multiple gestations by helping people better identify their fertile window and achieve pregnancy on their own.

For example, compared to non-Ovia Health users, Ovia Health members have observed up to:

  • 65% reduction in ART utilization*
  • 47% reduction in multiple gestations*
  • 54% reduction in preterm delivery*
  • 24% reduction in c-sections.*

Fertility struggles are difficult for so many reasons, from the emotional strain to the cost and the time for treatments. But offering a benefit that helps avoid unnecessary ART treatments, supports improved outcomes post-conception, and eases cultural stigmas surrounding fertility struggles can help families grow, keep healthcare costs low, and increase retention.  

Want to learn more about fertility support – from preconception health, to cycle tracking, care navigation, and emotional support – visit oviahealth.com.

*Note that these outcome(s) reflect(s) the greatest improvement experienced by a single client for this/these clinical condition area(s). Other clients experienced different outcomes in this/these clinical area(s). Actual results may vary based upon initial prevalence rate and engagement rates.