The Saddest Epidemic

Richard and Diana Barger of Virginia could be a textbook case of an infertile couple. Diana's fallopian tubes and left ovary are blocked with scar tissue, ironically the result of an intrauterine device (I.U.D.) she used for three years. Even if an egg did manage to become fertilized, the embryo might be rejected by her uterus, which has been deformed since birth. Richard has his own difficulties: his sperm count is 6.7 million per milliliter, considerably below the number ordinarily required for fertilization under normal conditions. Says Diana: "I never thought getting pregnant would be so difficult."

The Bargers are victims of what Reproductive Endocrinologist Martin Quigley of the Cleveland Clinic calls "an epidemic" of infertility in the U.S. In the past 20 years, the incidence of barrenness has nearly tripled, so that today one in six American couples is designated as infertile, the scientific term for those who have tried to conceive for a year or more without success. More than a million of these desperate couples seek the help of doctors and clinics every year. Women no longer carry the sole blame for childless marriages. Research has found that male deficiencies are the cause 40% of the time, and problems with both members of the marriage account for 20% of reported cases of infertility.

Doctors place much of the blame for the epidemic on liberalized sexual attitudes, which in women have led to an increasing occurrence of genital infections known collectively as pelvic inflammatory disease. Such infections scar the delicate tissue of the fallopian tubes, ovaries and uterus. Half of these cases result from chlamydia, a common venereal disease, and 25% stem from gonorrhea.

Other attitudes are also at fault: by postponing childbirth until their mid-or even late 30s, women risk a barren future. A Yale University study of 40 childless women found that after 35 years of age, the time it takes to conceive lengthens from an average of six months to more than two years.

Other surveys have found that such athletic women as distance runners, dancers and joggers can suffer temporary infertility. The reason is that their body fat sometimes becomes too low for the production of the critical hormone estrogen. Stress can also suppress ovulation; women executives often miss two or three consecutive menstrual periods.

Infertility is easier to trace in men, but often much harder to treat. The commonest problems are low sperm counts and blocked sperm ducts. Among all men, 15% have varicose veins on the left testicle, which can reduce sperm production. Certain drugs and chemicals such as insecticides can also lower sperm counts. A man's fecundity also decreases with age, although not with the dramatic finality of female menopause. Happily, the source of infertility in couples can be diagnosed 95% of the time, and half of all these cases can be treated.