- INFERTILITY
Factors affecting
male fertility
If a woman is unable to get
pregnant after one year of
trying, she and her partner
may be facing infertility.
In the United States, about
8 percent of infertility cases
are caused by a male fac-
tor alone. Risk factors for
male infertility include obe-
sity and substance use, but
some risks are beyond an
individual’s control. A study
conducted in Sweden found
that men with fathers who
smoked had a 50 percent
lower sperm count than
those with nonsmoking
fathers. And while men can
avoid the high temperatures
of hot tubs, climate change
may also pose a risk. A 2018
study in beetles found that
one heat wave reduced
sperm production by about
75 percent, but females
were not affected. —T M
Today’s immigration crises have no simple remedies. But
when undocumented U.S. residents lack access to preventive
medicine and care, they bring all their care needs to emer-
gency departments—where use by the uninsured costs about
$38 billion a year more than non-emergency care would.
Uninsured patients suffer from lack of health-care access,
and a woman’s risk of being uninsured increases if she has a
low income or is Hispanic/Latina. Women living in rural com-
munities are more likely than women in other areas to struggle
with poor health; they have limited access to mammograms
and other screenings, and maternity care, because only 6 per-
cent of the nation’s ob-gyns work in rural settings.
Other factors discourage women from accessing the sys-
tem. Although the Affordable Care Act attempted to lower
financial barriers, seeking care still takes money—for child-
care, transportation, and out-of-pocket costs. That can be
prohibitive for women because they often earn lower wages,
have fewer financial assets, and have higher rates of poverty
than men. In the United States, a woman also is statistically
likelier than a man to be covered by health insurance as a
dependent and is thus at greater risk of losing coverage if
she then is widowed or divorced or if her policy-holding
spouse or partner becomes unemployed. For these reasons
and more, about one in four U.S. women has had to delay or
forgo health care in the past year because of costs, a Kaiser
Women’s Health Survey found.IN THE QUEST FOR WELLNESS, WOMEN CONTEND with one
variable that men do not: a reproductive system designed
to bear offspring. Whether or not they ever give birth, most
women are equipped to do so for some portion of their lives.
Depending upon circumstances, that can become a blessing,
a burden, a political football, a societal issue. Ultimately, it’s
the most personal health issue of all.
Arizona is a pediatric surgeon who loves kids and wants
to have her own with her same-sex spouse. Fortunately for
them, and for singles and couples who need help to conceive,
there are options, including surrogacy, embryo donation, egg
donation—and sperm donation, a global industry valued at
about four billion dollars. Arizona and her partner decide on
sperm donation. She has an IUI (intrauterine insemination)
and is elated when her pregnancy test is positive. Unfortu-
nately, on her first ultrasound, there is no heartbeat.
Infertility^6 —not being able to get pregnant or to sustain
a pregnancy—affects about 10 percent of U.S. women ages
15 to 44 (some 6.1 million women), according to the Cen-
ters for Disease Control and Prevention. But the good news
about infertility is that the majority of cases can be treated
by conventional therapies such as surgery or medication
(and only 3 percent require the use of in vitro fertilization, or
IVF). Compared with decades ago, there’s much more hope.
What of the women who don’t want children yet? Or ever?
Roughly 60 percent of U.S. women ages 15 to 44 years use82 NATIONAL GEOGRAPHIC