Thousands of couples try to conceive every year. For some, success is harder to reach. Couples who try to conceive for more than a year without success—six months if the woman is over 35—are diagnosed as infertile. Infertility affects approximately 15 percent of couples who are trying to conceive, though the same underlying problems that are at the root of infertility may invisibly affect couples who are not.
In about one third of infertile couples, the problem rests primarily with the man; in a similar number, it rests primarily with the woman. Any of several issues can be at fault in either case. In male-factor infertility, the problem is generally low sperm count, though prostate issues, obesity, or smoking may also play a part. Women might fail to ovulate for a number of reasons, including anorexia or polycystic ovarian syndrome, or it might be a problem preventing implantation such as endometriosis, or there might be an obstacle at some other point in the process.
In a surprising number of cases, the culprit is asthma. In a recent study, more than a quarter of women with a history of asthma reported having had difficulty becoming pregnant. Close to a third of women with untreated asthma had trouble conceiving. In fact, in the study, women with asthma who were properly treated were infertile at a rate barely higher than that of women who did not have asthma at all. This is consistent with previous findings that showed that women who discontinued asthma treatment during pregnancy had a heightened risk of premature labor.
In a different study, researchers found that couples who are having fertility problems frequently resign themselves to this fate, even when there is treatment that may be able to help and in spite of increased awareness of options. In many cases, the researchers found, cost was an obstacle, though recent changes in insurance law are helping to make treatments more widely available. Another reason for the under-utilization of infertility services is that people may fear that the procedure will be more difficult or complicated than it is. In many cases, simple treatments suffice, or even changes in practice that don’t require medicine or technology at all.