Learning About Infertility: Symptoms, Etiologies, and Treatment

By  at July 22, 2025  , , , , ,  No comments



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Infertility is a common but often misunderstood medical issue. For many couples and singles, a failure to conceive is an unwelcome surprise—especially after months or years of careful recording of cycles, planning, and hope. As pregnancy tests continue to be negative week after week, emotional stress can become so severe that the thought of seeking help seems insurmountable.

But here's the reality: infertility is a medical problem, and it can be treated. As Mark D. Hornstein, MD, a reproductive endocrinologist at Mass General Brigham and director of reproductive endocrinology at the Center for Infertility and Reproductive Surgery at Brigham and Women's Hospital, explains, infertility needs support, care, and compassion—not silence or shame.


What Is Infertility?


Infertility is defined by the American Society for Reproductive Medicine (ASRM) as:

For women or individuals under the age of 35:

+ Not getting pregnant after 12 months of regular, unprotected sex.

For individuals 35 and above:

+ Not getting pregnant after 6 months.

If you fall into one of these categories, it's time to speak with your primary care provider (PCP) or OB-GYN about fertility testing and treatment.


Why Age 35 Matters for Fertility


At 35 years of age, Dr. Hornstein explains, is a milestone—not a strict cutoff point.

"Your fertility doesn't plummet like a rock the moment you turn 35," he says. "But population research shows that's when we really start to notice a decline."

Contrary to individuals assigned male at birth (AMAB), who produce sperm continuously, those assigned female at birth (AFAB) are born with all the eggs they will ever have. This difference means that egg quality and quantity decline over time, making conception more difficult with increasing years.


Signs and Symptoms of Infertility


The most straightforward sign of infertility is failure to become pregnant after the recommended time. That said, there are other signs that can indicate there is an issue.


In Women or People AFAB:


  • No or irregular periods
  • Widespread pelvic pain
  • Terrible period cramps
  • Painful sex


In Men or People AMAB:


  • Trouble getting or keeping an erection
  • Thinning or low semen volume or changes in ejaculate
  • Cloudy urine after ejaculating
  • Swollen scrotum veins (varicocele).

Keep in mind that these symptoms aren't always an indication of infertility. Always visit your provider for the appropriate test and diagnosis.


Infertility Causes


Infertility is due to one or more causes—sometimes without apparent reason. Common causes include:


What Is Secondary Infertility?


Secondary infertility is when someone who previously conceived easily now finds herself unable to get pregnant again. It's much more common than people realize.

Even a short pregnancy interval can make a difference, says Dr. Hornstein. "Three years can be a long time, reproductively. Hormones and egg quality can change dramatically with age," he says.

Other causes are scarring of the cesareans or postpartum infections, or hormonal shifts with age.


Breaking the Silence Around Infertility


Years ago, infertility was a no-no—generally a couples-only secret. But times are changing.

"Social media has helped to normalize infertility," says Dr. Hornstein. "People are posting about their experiences, and that makes others know it's normal—and not their fault."

Infertility is now officially regarded as a disease under the Americans with Disabilities Act. It's not a moral or personal failing—it's a medical issue that needs to be treated and addressed.


How Is Infertility Diagnosed?


The first step is to speak with your PCP or  OB-GYN. From there, they may refer you to a fertility specialist for further testing, which may include:

At Mass General Brigham, Dr. Hornstein and his staff offer in-person and telemedicine visits. Early detection matters: the sooner the diagnosis, the broader the options for treatment.

"If a patient comes to see me at age 43, their options are so much more limited than if they came at age 33," Dr. Hornstein warns.


What Are the Treatment Options for Infertility?


There isn't one solution for fertility treatment. Options are:


Medication


  • Stimulates ovulation in AFAB patients
  • Fixes hormonal imbalance or ED in AMAB patients
  • Surgery
  • Removes blockage or fibroids
  • Fixes endometriosis or scarring
  • In-Vitro Fertilization (IVF)
  • Eggs are retrieved, fertilized, and inserted into the uterus
  • Can include freezing of embryos (cryopreservation)
  • Intrauterine Insemination (IUI)
  • Sperm is inserted directly into the uterus during ovulation
  • Third-Party Reproduction
  • Donor sperm or eggs
  • Surrogacy options, especially for LGBTQ+ parents

"IVF isn't the first or only choice," says Dr. Hornstein. "Most patients don't require it. But they do require advising."


What Makes Mass General Brigham's Fertility Program Unique?


Patients at the Center for Infertility and Reproductive Surgery receive full, multi-disciplinary treatment. The team does more than treat infertility—they also address:

Patients are matched with specialists best suited to their unique challenges. Team members collaborate closely to ensure personalized, effective care.

“We treat the whole person,” says Dr. Hornstein. “Not just the infertility.”


Final Thoughts: Infertility Is a Disease—Not a Deficiency


If you’re struggling to conceive, you’re not alone—and you’re not broken. Infertility affects millions of people, and it’s OK to ask for help.

Whether you're considering treatment for the first time or exploring possibilities after years of attempting, take comfort in knowing that assistance is available—and it starts with a single call.

If you're ready, call a provider. Don't delay. Your future family might be only a step away.".


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