Who understands what a woman goes through when facing infertility? She is often plagued by questions. What is the issue? Can it be fixed? Why is this happening?
There are four major areas where women particularly suffer when faced with the failure to conceive: social, economic, personal, and physical. Let’s take a look at each one and the burden it lays on women’s shoulders.

The Social Toll

“In many cultures, childless women suffer discrimination, stigma, and ostracism.” – Weiyuan Cui
Although numerous studies have found that male infertility is the cause in 50% of couples’ inability to conceive, the social stigma still falls disproportionately on women across cultures. According to an article in the WHO Bulletin, “Ugandan women are not accepted by society unless they have a child.” Gossip swirls around these barren couples. Husbands often have extra-marital affairs. The woman is treated like she has a disease and is barred from attending family gatherings such as funerals.

Even in the US, social stigma for infertile women exists. According to a study by the American Society of Reproductive Medicine, 1 in 5 infertile women experience discrimination or prejudice directly because of their fecundity. Feeling guilt and shame, women are prone to hiding “information about their diagnosis from friends or family…” The stigma may “also strain relationships…”

The Economic Toll

How much does infertility treatment cost? How much is a woman or a couple willing to pay to have a child? The price varies greatly depending on the type of treatment, the country and region it’s being offered in, and whether or not health insurance covers infertility issues. For example, in Uganda, a single IVF cycle costs around $4,900, an amount equivalent to 9 years of savings. A quick Google search reveals that the average cost of an IVF cycle in the US can range from $3,300 to $20,000, with an average of about $12,000. In a nation where 59% of the citizens are only one paycheck away from homelessness, this is an insurmountable sum. If a woman chose this route of treatment, it would likely take several tries before the procedure succeeded, meaning a financial toll of $12,000 to $36,000. This price tag is likely to either clear out the woman’s savings, place her into substantial debt, or both, leaving precious little to raise a child should the procedure succeed.

The Personal Toll

Women with low fecundity not only face pressures from society, but from themselves. One study compared the level of anxiety and depression experienced by 149 women with infertility, 136 with chronic pain, 22 undergoing cardiac rehabilitation, 93 with cancer, 77 with hypertension, and 11 with HIV. The study found that women experiencing infertility had “global symptom scores equivalent to the cancer, cardiac rehabilitation, and hypertension patients…” and concluded that “psychological symptoms associated with infertility are similar to those associated with other serious medical conditions.”

There are other personal tolls to consider in addition to the emotional and psychological. Tobacco smoking in women is dose-dependent with decreased fertility, meaning the more a woman smokes the less fertile she is. Smoking is linked to ovulatory disfunction and even early menopause. Overcoming addiction is a challenge on its own, but knowing that smoking has already damaged the chances of having children may not be the best motivator to help women quit.

For women with polycystic ovary syndrome, obesity is an added complication. Ovulation and menstrual dysfunction are just the beginning. Obesity increases the risk of miscarriage and decreases the effectiveness of treatments like IVF. Addressing this barrier to conception requires a major lifestyle change. Readjusting eating and exercise habits can also lead to feelings of shame, anxiety, and depression, only to be added to the threat of future childlessness.

The Physical Toll

Infertility can be caused by a range of physical conditions including ectopic pregnancies, tubal occlusion from infections such as STD’s, postpartum complications, or unsafe abortions. These injuries to the reproductive tract can lead to recurrent infection and pain. Chronic pelvic inflammatory disease can lead to tubal scarring. Chlamydia, a common and curable STD, can cause “tubal infertility” if left undiscovered and untreated.
Women with certain genetic conditions, cancers, and couples in which one or both partners are HIV positive also face obstacles to natural conception. Common cancer treatments such as radiation and antiretrovirals to stave off HIV can decrease fertility dramatically. Women are left with impossible decisions to make about risk and safety for themselves and a future child.

Improving the Burdens

Improving the Social Burden

At the risk of sounding glib, it is this author’s view that “haters gonna hate.” If friends, family, and neighbors are ostracizing a woman because of assumed infertility, it’s a sign of ignorance and lack of compassion more than anything else. Infertility is no more embarrassing than a heart murmur or eczema: it’s just they way her body is at that moment.
But this attitude can only work in some cultures. In places like Uganda, far more education and a social shifts are needed to chip away at this centuries-old cultural value that a woman only has worth if she bears a child. In the meantime, there are organizations working to get women treatments at reduced costs so that they can go on living full lives within established cultural norms.

Improving the Economic Burden

Most national health programs and medical insurance does not cover treatments such as IVF and hormones to stimulate ovulation (a method that produces fewer eggs, but is less invasive). Pre-conception fertility care is on the minds of many of today’s specialists. More and more, they are urging health policy makers to include infertility prevention, care, and treatment in health-care systems. Take the clinic of Dr. Suneeta Mittal in New Delhi. Her clinic is working to reduce the cost of IVF from $1,300 to $300. “There’s so much stigma attached to being infertile in India,” she says. “It is so important to address this issue.”

Improving the Personal Burden

In a CDC report referenced earlier, the researchers conclude that “psychological symptoms associated with infertility are similar to those associated with other serious medical conditions. Therefore, standard psychosocial interventions for serious medical illness should also be applied in infertility treatment.” They also state that, “While educating women about the connection between their health and behaviors to their chances of having children is a sound idea overall, it does have a potential drawback. ‘[Women] may experience negative psychological effects of the awareness of a diagnosis that does not immediately represent a limitation and may not necessarily predict infertility in the future.’”

Dr. Sheryl Vanderpoel of the World Health Organization is quoted as saying, “Infertility prevention also involves important lifestyle choices.” Some causes of infertility can be stopped before they start. Women should be encouraged not to smoke and be told that infertility is a possible consequence of this lifestyle choice. The same goes for women prone to over-eating and/or avoiding exercise. The CDC chimes in adding, “There is also increasing evidence that lifestyle factors, such as tobacco smoking and obesity, which cause chronic disease and disability later in life, can cause fertility impairment during the reproductive years.”

Improving the Physical Burden

Improving communication with patients suffering from other afflictions will help reduce the burden of infertility as well. For example, a woman undergoing cancer treatments can request to have her ovary relocated away from the radiation area or have her eggs put into cryopreservation for future use. A woman taking antiretrovirals for HIV may also experience decreased fertility and, like the cancer patient, should know about these risks before beginning treatment.

Screening for chlamydia is also a proven, cost-effective way to improve fertility before it decreases. However, few women ask to be screened for this common STD or even think about it during their annual check-ups with a GP or Ob/Gyn. We, as women and as medical professionals, need to keep these facts in mind and talk about them with our fellow women and colleagues.

Infertility treatments can often allow couples to have biological children, but it’s important to remember that there are additional solutions to consider. Surrogacy, sperm donation, egg donation, adoption, and even living without children are all options women – and societies – should be educated about. Infertility and all its tolls drain the best of us. If you or someone you know is suffering mentally, emotionally, socially, economically, or physically, let them know that counseling services are available for women and couples. There, they can learn about and discuss treatment options, adoption services, and even child-free living.