Infertility generally refers to a failure to become pregnant after one year of regular, unprotected intercourse. The clinical definition of “regular” intercourse is every two to three days.

After one year of regular sex, approximately 84% of couples will have conceived naturally, with this figure rising to 92% after two years and to 93% after three years. After three years of not conceiving, the likelihood of a couple achieving pregnancy in the following year falls to 25% or less. About one in seven couples in the UK have difficulty conceiving, which translates as 3.5 million people.

Infertility has many potential causes, which may involve the man, the woman or both partners. In some cases, no cause of the problem can be determined, in which case the infertility is described as “unexplained.” Of the causes that are known, the most common among women are irregular ovulation, endometriosis and blockage of the fallopian tubes. Among men, the most common cause is a sperm disorder.

Infertility represents a major crisis for most couples, with both partners experiencing loss in ways that affect them as individuals, as family members and as members of society as a whole. Examples of these losses include:

• Loss of the experience of pregnancy and birth
• Loss of opportunity to pass on family genetics
• Loss of chance to contribute to the next generation
• Loss of chance to parent or become a grandparent
• Low self-worth and self-esteem
• Loss of family stability
• Loss of sense of control over destiny
• Loss of sense of hope for the future
• Loss of work productivity

Infertility can have a highly negative impact on self-esteem, with individuals who previously had successful and well-planned lives, suddenly feeling they have lost control of their destiny. A combination of the body failing to respond as expected, a sense that life has been put on hold and having to face the disappointment of failure to conceive month after month, can leave both partners at an increased risk of depression.

Worldwide, around 70 to 80 million couples are currently experiencing infertility. For most individuals having a child is an important part of their life plan and being unable to conceive represents a major life problem. There are also many men and women, with children from a previous relationship who are desperate to conceive with their current partner.

Infertility in the Western world

Studies by Greil in 1997, and Brokvich and Fisher in 1998 showed that involuntary childlessness in the Western world has various psychological and psychosomatic effects, especially among women. The most common effects are distress, depression, anxiety, reduced self esteem, somatic complaints, reduced libido and a sense of blame and guilt.

When the social and cultural consequences of involuntary childlessness are considered, they are often related to studies of elderly individuals with no children. Studies have shown that elderly, frail people with no children receive less social support and a less substantial framework for independent living compared with those of the same age who do have children.

Some studies also report on how childlessness can impact on a couple’s communication with friends and family who have children. Childless couples can perceive well-meant remarks made at social gatherings or birthday parties, for example, as negative. However, couples can also find those close to them supportive, with relatives or good friends giving the couple the opportunity to participate in the “world of children” by sometimes taking care of their own children or taking them to school, sports activities or music lessons, for example. One study of childless couples found that 10% of couples adopt this type of strategy as a way of coping with never having their own children.

Infertility in developing countries

Many studies have also been carried out into the effects of childlessness in the developing world. Unlike in the Western world, although psychological effects are found, the main concerns for childless couples in developing countries are the social and cultural effects.

Many women from these countries consider their lives as hopeless if they cannot conceive. In many cultures, childless women face discrimination, ostracism and stigma if they fail to become pregnant or carry a baby to term. They may even be regarded as non-human or described as “cursed”. Furthermore, in most of these countries, there is a poor availability of infertility services and in vitro fertilization (IVF) procedures are unaffordable.

The situation is further worsened by the fact that women in these countries face a lack of support, both emotionally and financially. Gamal Serour, president of the International Federation of Gynecology and Obstetrics explains that in sub-Saharan Africa, “women are not encouraged by their male partners to seek modern technical treatments.” This, combined with the unavailability of fertility services, means the path for women seeking fertility care because they wish to conceive is often a lonely one.