What is “infertility” really?

As a followup to all those abbreviations, today I thought I’d try to shed some light on the meaning of infertility and a few related terms.  There are many misconceptions around it, and I may only scratch the surface – but if someone learns something from what I write, then I will have done my job!  At the very least, I hope that some of you out there will appreciate my attempts to help clarify what is often a confusing and misunderstood subject.

First, I personally believe that the word “infertility” is a misnomer and is not used the way it should be.  By the rules of the English language, “infertile” should basically translate to “not fertile.”  That suggests that people who are struggling with infertility are not fertile at all and therefore are incapable of reproducing – which, much of the time, is simply not the case!  I think that most people struggling with “infertility” should actually be said to be struggling with “subfertility”, as in “less fertile” than average.   If you tell someone unfamiliar with these terms or conditions that you are “infertile”, they may assume that you cannot have your own biological children – and may be very confused if and when you finally succeed and do have a baby of your own.  However, if you could tell them that you are “subfertile” then they would have a better chance of understanding that you may have the capability to have kids, but that you are more likely to need more time, support and/or intervention to make that happen.  I will continue using the terms “infertile” and “infertility” because they are the most widely used that I’ve seen, but in your mind, it may help to regularly translate the words to “subfertile” and “subfertility” as a more accurate representation of what we are really talking about.

Even the definitions of the word “infertility” can vary, probably adding to the confusion.  I looked up the web definition on WordNet, and this is what came up:

“sterility: the state of being unable to produce offspring; in a woman it is an inability to conceive; in a man it is an inability to impregnate”

As I stated above, the way that the term infertility these days rarely actually means “sterile”, so this could be very misleading (and is from what one would hope is a fairly reliable source.)  Another definition I found, from the Free Online Dictionary, seemed more accurate for current use of the term:

“1. Absent or diminished fertility.
2. The persistent inability to conceive a child.”

This definition leaves the door open to the possibility that even if a couple may be less fertile than optimal and/or has been taking longer than average to have a child, it could still happen (and is actually quite likely in many cases.)

That may help clear up confusion at the surface of the issue, but it is of course more complicated than that.  For example, when a couple struggling with infertility, people assume all too often that the problem lies with the woman – that if she is not getting pregnant, there must be something wrong with her.  And that is not always the case either!  In fact, men are just about as likely to have problems with fertility with women are.  (Even in the definitions above, you will notice that they are inclusive of both genders.)  From what I have read, of all the couples struggling with infertility, it seems like about a third of the time the woman has one or more issues, and a third of the time the man has one or more issues (which is what my husband and I have apparently been dealing with).  The remaining third of infertile couples tend to fall into 2 camps: for some, both the man and the woman have one or more known fertility issues; and for the rest, there are no known issues so far with either partner.  This last group tends to be classified with “unexplained infertility” – and while it may be slightly reassuring that the doctors can’t find anything “wrong” with them, I suspect it is one of the hardest positions to be in.  At least when you know there is an issue, there may be things you can do to treat it or otherwise help yourselves to overcome it.  When there are no known issues, yet you still struggle for a long time to have children, it can raise so many questions about why it’s not happening and what you could be doing differently, if anything, to help things along.  Because the male factor infertility that my husband and I face is sometimes not considered as serious of an issue as many others (they say many couples with low sperm morphology may still go on to get pregnant without too much trouble), I sometimes deal with these types of questions myself – but even so, we have had that one thing to “blame” and try to “treat” with supplements and healthy living.  So I can’t pretend to fully understand what it is like for couples who truly have unexplained infertility, but I do feel for them.

Regarding the known reasons for fertility issues, they are numerous, and some are better understood than others.  I won’t get into that here, but I will mention one distinction that should be made when using the phrases “trying to conceive” and “getting pregnant.”  These terms are often used interchangeable and refer in a general sense to the quest to produce a child via pregnancy (regardless of how you got there.)  If someone is trying to conceive or trying to get pregnant, it seems pretty clear what their end-goal is.  However, just because that person may have tried for a while and does not have that baby yet does not necessarily mean that they are having “trouble conceiving” or “trouble getting pregnant.”  While that may be the case for many people, there are some who don’t seem to have as much issue with conceiving but have trouble *staying* pregnant – that is, maintaining a healthy pregnancy long enough to result in a “take-home baby.”  For various reasons, these people may be at a higher risk for chemical pregnancies and miscarriages – so for them, they are not just “trying to conceive”, but more specifically, are “trying to get and STAY pregnant.”  (Of course, that is the goal for everyone TTC, but it has added significance for those who have that specific issue.)  The main point is that if someone has been “trying to conceive” for a long time, you should not assume that they necessarily have “trouble conceiving” - they may just have trouble carrying a pregnancy to term (and sometimes people have both issues).  In fact, many people who try to conceive have suffered losses of one kind or another, simply because it is actually a fairly common occurrence – and if it happens early, many don’t even realize they have had a loss.  However, it isn’t a topic that people tend to speak about openly, so you might not realize what someone has been through or just how widespread the issue can be.  Some people I know might be surprised to learn that I believe I’ve had a couple of chemical pregnancies, since I haven’t told anyone I know personally except my DH and my doctors.  Because any kind of a loss can be emotionally and physically painful, it’s just something that many people don’t want to talk much about, if at all.  Knowing the varied meanings behind the use of these phrases can help you to be more aware and sensitive to the fact that everyone’s situation is unique.

But wait, there’s more!  Yet another fertility term that ought to be addressed is “secondary infertility.”  This is the unfortunate circumstance when the couple already has at least one child and is now struggling to have another. My understanding is that there are various scenarios in which this term can be used, but they all apply.  The most straightforward example you run into is a couple who had little to no trouble conceiving their first child (and possibly others as well), but are suddenly faced with infertility when trying to grow their family further.  As another example, the couple may have struggled to have their first child (i.e. dealt with primary infertility) and are now struggling yet again to have another child – I think this case may be more of an extension of the primary infertility, or could also fall into the secondary infertility category because the couple already has one or more kids.  Yet another possibility is if either partner had a child from a previous relationship, and then that partner turns up with a fertility issue when trying for a child with their current partner, that can be considered a secondary fertility issue for the couple. 

There are many other confusing terms that I may address down the road, but I hope this at least helps clear up the heart of the infertility matter.  For me, I think I prefer to say that “I have no known fertility issues, and we are not infertile, but we are struggling with infertility as a couple.”  Hopefully after reading this post, that statement makes perfect sense to you!