Causes of Infertility: When Should You Start Worrying?

Infertility, a challenge faced by a significant number of couples worldwide, often remains shrouded in silence and misinformation. According to data, seven in 10 women have never spoken to their physicians about their fertility health.

BlackDoctor.org spoke with Dr. Olutunmike Kuyoro (Dr. Tumi), a reproductive endocrinologist and infertility specialist at Advanced Fertility Center of Chicago and Francisco Center of Chicago, to delve into the critical aspects of fertility health. Dr. Tumi, who joined the Chicago practice after completing her fellowship in reproductive endocrinology and obstetrics and gynecology training in New York, highlights the significance of National Infertility Awareness Week to break the silence on infertility, spotlight important conversations around reproductive health, and empower individuals to seek the information and support they need.

“There are many women who would never discuss fertility with their doctors. So, for one, it allows us to break the silence and the stigma around fertility struggles,” Dr. Tumi notes. “Having this week really allows us to create a national platform where we can normalize these conversations and help people feel a little less isolated and more empowered to speak up, ask questions, and importantly, seek help…”

Why the Conversation Around Infertility Has Been Limited

Dr. Tumi outlines several reasons why many couples avoid discussing their infertility challenges:

Stigma and Shame: Infertility can feel deeply personal, and many experience it as a reflection of their identity, masculinity/femininity, or self-worth — especially in cultures that place high value on parenthood.
Gendered Pressure: Women in particular often face disproportionate blame or social pressure, making it harder to speak openly without fear of judgment.
Lack of Awareness and Education: Many people don’t realize how common infertility is (affecting one in six couples globally) or misunderstand the causes and treatments.
Emotional and Financial Strain: The process of fertility treatments can be physically grueling, emotionally draining, and financially inaccessible — all of which can isolate individuals and limit open discussion.
Privacy Norms: Reproductive health is often seen as a private matter, and people may not feel comfortable sharing until much later — if at all.
Dr. Tumi

The good news is that, over the last five to 10 years, there has been an increase in people discussing infertility, according to Dr. Tumi:

Celebrities and Influencers: Public figures have begun sharing their journeys with IVF, miscarriages, and fertility struggles, helping normalize the conversation.
Social Media Communities: Platforms like Instagram, Reddit, and TikTok have fostered support networks and story-sharing among people experiencing infertility.
Corporate Benefits and Advocacy: Companies offering fertility benefits (e.g., IVF, egg freezing) are contributing to workplace dialogue about reproductive health.
Shifts in Medical Framing: Fertility is now more often seen as a health condition rather than a “failure,” helping reduce shame and sparking open discussions.

Understanding the Causes of Infertility

Although infertility is common, many people don’t realize how prevalent it is unless they are personally affected.

According to the Cleveland Clinic, infertility is a condition of your reproductive system that causes trouble conceiving. It can affect anyone and has many causes.

According to the American Society for Reproductive Medicine, infertility affects 10-15 percent of couples, making it one of the most common diseases for people between the ages of 20 and 45.

A comprehensive fertility workup involves evaluating both partners.

For women, the evaluation focuses on several key areas:

Ovarian Reserve: Assessing the quantity and quality of a woman’s eggs.
Fallopian Tubes: Ensuring the tubes are open and unobstructed.
Uterine Cavity: Examining the inside of the uterus for any issues that might interfere with implantation or lead to miscarriages.

Common conditions like endometriosis, where tissue similar to the uterine lining grows outside the uterus, can create an inflammatory environment, impacting egg quality and implantation.

“Endometriosis is having tissue that’s only meant to be found within the uterine cavity being scattered outside of the uterine cavity. So this can be anywhere in the body, but commonly, we’ll see it in the pelvis and in the abdomen,” Dr. Tumi explains. “And what this predisposes to is an inflammatory environment that could affect egg quality and count, and the likelihood of an embryo implanting. One of the most common signs of endometriosis is having painful periods. And unfortunately, a lot of people think that this is normal. This is one of the reasons why endometriosis goes undiagnosed for a long time. And at the time when it’s diagnosed, in the majority, it has caused significant reductions to a woman’s fertility.”

Polycystic Ovary Syndrome (PCOS) is another significant factor.

“The term ‘polycystic’ is a little bit of a misnomer. When you hear it, you might think that someone has lots of cysts in their ovaries, and these are not actually cysts. What it is is that some women patients with PCOS oftentimes have a higher than average number of follicles in their ovaries, which means that their count may be on the higher side. However, with PCOS, there is an abhorrence or a distortion in the normal communication between the brain and the ovary. And so although they have all of these follicles, they are not growing the way they should, and eggs are not being released in the way they should,” Dr. Tumi adds.

One of the hallmarks of PCOS is irregular ovulation and heavy periods. “If you’re not ovulating regularly, that can affect your ability to become pregnant,” Dr. Tumi shares.

Dispelling Myths About Male Fertility

When it comes to the role men play in infertility, there are several myths, including many people thinking that infertility is solely a woman’s issue.

“Male-factor infertility accounts for about 30–50 percent of cases,” Dr. Tumi notes. Many people think that if the man is otherwise healthy, he should be fertile, and that’s not always true. There could be things like genetic conditions, past infections that could affect the quality of the sperm. Something that men also don’t realize is that, although it’s not to the extent it is for women, age does matter for men. Another thing that men might think is that if he already has kids, then fertility might not be an issue. Again, sperm health can change over time.”

For men, a semen analysis is crucial to assess sperm health, evaluating factors such as:

Volume: The amount of semen.
Motility: The movement of the sperm.
Concentration: The number of sperm.
Morphology: The shape of the sperm.

Another myth surrounding male infertility is that it’s just about testosterone levels, leading to misinformation being spread online about testosterone supplements.

“Turning to testosterone therapy without a doctor’s guidance is not a very good idea because it can actually suppress the body’s natural production of testosterone. And some people don’t realize that they’re actually making themselves infertile by taking these supplements, and sometimes the changes that these supplements can do to the body can be irreversible. So it’s very important that you’re not taking these over-the-counter supplements without speaking to a doctor about it,” Dr. Tumi advises.

Common Fertility Myths Debunked

Beyond male fertility, Dr. Tumi addresses other common fertility myths:

“If you’re healthy and fit, you won’t have fertility problems.”

- - Truth: While general health helps, fertility depends on many factors — age, genetics, hormones, and reproductive health — not just fitness or diet.

“You have to try for at least a year before seeing a doctor.”

- - Truth: That’s true if you’re under 35. If you’re over 35, it’s recommended to see a fertility specialist after six months of trying.

“IVF guarantees a baby.”

- - Truth: IVF is a powerful tool, but not a guarantee. Success rates vary widely by age, egg quality, sperm health, and other factors.

“You can’t get pregnant after 35.”

- - Truth: Fertility declines with age, especially after 35, but many people do conceive naturally or with help also in their 40s.

“If you already have a child, you can’t be infertile.”

- - Truth: This is called secondary infertility, and it’s very real. Many couples struggle to conceive again after a first pregnancy.

“Stress is the main cause of infertility.”

- - Truth: While stress can impact hormones and cycles, it’s rarely the sole cause. Biological and medical factors are typically more significant.

“Egg freezing is a guarantee for future pregnancy.”

- - Truth: Egg freezing offers a chance, not a promise. Success depends on age at freezing, egg quantity, and future health.

“Natural remedies can cure infertility.”

- Truth: While lifestyle changes and supplements can support reproductive health, they can’t replace medical intervention when needed.

The Impact of Age on Fertility and Planning Accordingly

Age is a significant factor affecting fertility for both men and women.

“For women, your peak fertility is usually in your early 20s and your late 20s. And that fertility begins to decline more noticeably around the age of 35, and that decline actually becomes steeper after the age of 37. But by the time we’re in our 40s, the chances of natural conception are seen as very low, they’re between five to 10 percent per menstrual cycle,” Dr. Tumi shares.

This decline isn’t just about the quantity of the eggs, but the quality of eggs as well.

“The other thing to highlight about quantity is that it not only decreases the risk of conceiving, it actually it also increases the risk of miscarriage due to chromosomal issues in the egg,” Dr. Tumi adds.

While the decline in male fertility is more gradual, sperm quality, motility, and DNA integrity can be affected around the age of 40-45, also increasing the risk of certain conditions in offspring.

When Should Trouble Conceiving be a Sign of Concern?

Infertility is typically diagnosed after one year of trying to conceive without success for couples where the female partner is under 35, or after six months for those where the female partner is 35 or older.

During this time, doctors will use your diagnostic workup to identify potential tubal, uterine, ovarian, or male factors. According to Dr. Tumi, in about a third of cases, the cause remains unexplained.

Treatment options vary depending on the diagnosis. Common approaches include:

Intrauterine Insemination (IUI) with Ovulation Induction: Placing a concentrated sperm sample directly into the uterus around the time of ovulation. Success rates are generally between 12-18 percent.
In Vitro Fertilization (IVF): Fertilizing eggs outside the body in a lab, followed by embryo transfer into the uterus. This involves ovarian stimulation, egg retrieval, fertilization, embryo development, and embryo transfer.

Fertility Preservation: Freezing Eggs for the Future

There has been a growing trend of individuals and couples delaying parenthood for various reasons, including career, education, and later partnerships. This shift is influencing conversations around fertility planning and options.

Egg freezing has become an increasingly popular option for individuals wanting to delay parenthood.

The process, which is similar to the egg retrieval phase of IVF, uses medications to stimulate the ovaries to produce multiple eggs, which are then retrieved and frozen for future use.

The optimal time for women to consider egg freezing is typically in their 20s and early 30s, when egg quantity and quality are generally at their peak. While egg freezing can still be a viable option in the mid to late 30s, the potential for a successful live birth may be lower, Dr. Tumi notes.

Starting the Conversation About Infertility

If you are struggling with infertility and feeling overwhelmed, Dr. Tumi offers advice on how to initiate conversations with your doctor:

Start with your experience: A simple, honest opener like, “We’ve been trying to conceive, and it’s been harder than expected. Can we talk about what’s going on?” is a great starting point.
Write down concerns beforehand: Jot down the duration of trying, menstrual irregularities, family history, and any questions about testing, timelines, and next steps.
Remember, your doctor is an ally: Don’t hesitate to express your feelings and concerns.
Seek a second opinion if needed: If you feel your concerns are being dismissed, it’s okay to seek another medical perspective.
Know when to seek help early: Don’t delay seeking professional advice if you have concerns about your fertility.