Involuntary infertility

When we talk about involuntary infertility, we are usually referring to situations where people have been regularly trying to get pregnant on their own for a year or so. It is easy to become disheartened when you see all the posts on social media by other people celebrating the joy of their pregnancies, while you continue to try without success – but involuntary infertility is actually very common, and many people find it difficult to get pregnant. It may, perhaps, be comforting to know that impaired fertility – in other words, when it is more difficult and takes longer to get pregnant – is much more common than total infertility. And it can often be possible to receive help, with the first step being a fertility investigation.

How common is involuntary infertility?

Difficulty getting pregnant is a growing problem, and it is estimated that as many as 10–15 percent of all heterosexual couples have experienced fertility problems at some point. One of the reasons for this is that, these days, many people start trying to conceive at an older age. But even those who succeed in conceiving a first child can sometimes experience difficulty getting pregnant again, and we usually refer to such situations as secondary infertility.

Reasons why some people experience involuntary infertility

There can be many different reasons why it is difficult to get pregnant, and both physiological and medical factors can play a part. It is usually estimated that about one third of cases are related to the woman’s eggs or uterus, and one third are related to the man’s sperm. In the remaining cases, there may be a variety of reasons why people are unable to get pregnant – and sometimes it is simply never possible to find out the actual reason.

Infertility related to the woman’s eggs or uterus

Apart from the fact that age is a factor when people are trying to get pregnant, there are also many other reasons why it can be more difficult to conceive. Often, it has to do with irregular or missed ovulation (which in turn can be due to a number of different root causes), or the occurrence of changes in the fallopian tubes or uterus. Examples of possible causes of involuntary infertility include:

• Using pharmaceuticals that affect ovulation and the menstrual cycle.
• Having undergone radiation therapy or chemotherapy.
• Fibroids in the uterus or cervix.
• Endometriosis, which can make it more difficult for eggs to attach or be fertilised.
• PCOS, a disorder that can affect ovulation.
• Sexually transmitted diseases such as chlamydia and gonorrhoea, which can impair the functionality of the fallopian tubes.
• Congenital conditions that, for example, affect the uterus or sex chromosomes.
• Obesity or low body weight.
• Hormonal abnormalities or imbalances.

Infertility related to the man’s sperm

It is just as common for involuntary infertility to be related to the man’s sperm as the woman’s eggs or uterus. Sperm-related problems can vary in nature – the man may have too few sperm, or his sperm may have decreased mobility. It is often difficult to pinpoint an exact reason why too few sperm are formed or why sperm have poor mobility, but this could be due to one or more of the following reasons:

• Hormonal abnormalities or imbalances, for example testosterone deficiency.
• Sexually transmitted diseases.
• Inguinal hernia.
• Previous surgery on the testicles.
• Previous use of anabolic steroids.
• Congenital conditions that can, for example, cause chromosomal disorders.
• High temperature around the testicles (e.g. due to many hot baths).

Unexplained infertility

As already mentioned, for some who experience involuntary infertility it is simply not possible to identify a reason why they are unable to get pregnant, despite having performed tests and investigations. This is usually referred to as unexplained infertility. Sometimes there can still be causes that simply weren’t identified during the investigation, such as undiagnosed endometriosis or thyroid disorders – but in other cases it can remain a mystery for life. Not receiving an explanation as to why they are unable to get pregnant can often be difficult for people to deal with. It is often easier to accept something if you have a reason, and when there is no apparent reason it is easy to start blaming yourself, your life choices or your partner. There are, admittedly, certain lifestyle factors that affect a person’s fertility, but if you are already living a relatively healthy life then you must simply try to come to terms with the fact that you have done what you can, but that life may have other plans. Excessive focus on details in an attempt to control an uncontrollable situation often leads to worry, brooding and depression. Instead, working to find acceptance of the fact that you cannot control or influence everything in life is usually the best way to deal with a difficult and uncertain situation – even though we all know that this is not always particularly easy. The important thing is to be aware that even those who experience unexplained infertility are entitled to receive help with assisted reproduction.

What is the best way to deal with involuntary infertility?

For many people, it can be difficult to talk about not getting pregnant, as it can feel extremely personal, and the fact that everyone else is seemingly able to get pregnant so easily does not make the situation any easier. But what you must remember is that, from the outside, we rarely get to see how long everyone else has had to struggle and try before they finally succeed... And talking about what we are going through can often help us through the toughest times. For some, it may suffice just to vent their frustration and discuss their feelings with their partner if they are in a relationship, but sometimes it can be necessary to find another person to talk to, especially if all your efforts and struggles are placing a lot of pressure on your relationship with your partner. When there are two of you longing desperately for a child, it can easily place an enormous strain on your relationship and sex life when the only thing that matters is seeing that magical plus sign on the test stick. Nor is it particularly easy to “stop thinking about it”, as trying to get pregnant involves a lot of planning in terms of timing your ovulation and fertile days. So perhaps the key is not to place excessive demands on yourself – it’s quite natural that trying to get pregnant will take up a large share of your thoughts, and it’s completely reasonable to feel sadness and frustration when you don’t succeed. But if the quest to get pregnant is occupying the whole of your life, you may need to seek outside help in order to help you handle the situation. Many fertility clinics have counsellors that you can talk to, and they often have a good appreciation and understanding of what you are going through, as they have met many other people in the same situation. Naturally you can also contact your local medical centre and speak with their psychosocial support team.

For most people, this journey ends with the arrival of a child, often via biological means and sometimes via adoption, but this is not always the case for everyone, in which case you need to devise different strategies to deal with and accept the fact that life will perhaps not be exactly as you had hoped.

Please note that all information above is based on Swedish recommendations.