For centuries, pregnancy has been a visible process in women. Because she carries the fetus, it was assumed that any “failure” in the process must originate in her body. However, science shows that problems achieving pregnancy are distributed similarly between men and women.

“Thirty percent of infertility cases are due to female causes, another 30% due to male causes, 20% involve factors from both partners, and in the remaining 20%, after the usual tests, no clear explanation is found,” Alberto Galindo, professor, researcher, and dean of the Faculty of Medicine at the Complutense University of Madrid in Madrid, Spain, an expert in perinatal medicine and human reproduction and an elected full academician in ob/gyn at the Royal National Academy of Medicine of Spain, told EL MÉDICO INTERACTIVO, part of the Medscape Professional Network. Galindo said that placing all the responsibility on the woman “is very unfair,” given that the burden of infertility is shared equally between men and women.

Male Infertility Is Feminized

Laboratory techniques involve both men and women. Although in some cases assisted reproductive treatments require preparing sperm to ensure fertilization of the egg — especially when characteristics of the semen do not allow conception to happen naturally — it is the woman who will carry the pregnancy, a fact that reinforces the social and cultural bias that the responsibility lies with her.

This perception is supported by recent research, such as the study “Gender Biases in Male Infertility and Its Impact on Women: A Qualitative Exploration,” which shows that male infertility tends to be socially feminized, leading women to shoulder responsibility for treatment and reproductive expectations even when the cause is male infertility. The study highlights that these culturally rooted beliefs create emotional pressure and added stigma for women in couples with male infertility, underscoring the need for more gender-sensitive care and support from health professionals.

The Right to Choose

The World Health Organization (WHO) periodically publishes reports on how social stigma disproportionately affects women, regardless of the cause. The WHO notes that infertility has significant negative social impacts, especially for women who often face violence, divorce, social stigma, emotional stress, anxiety, and low self-esteem.

The agency reminds us that people and couples have the right to decide the number, timing, and spacing of their children and that infertility can hinder the exercise of these essential rights. A diverse group of individuals — including heterosexual couples, same-sex couples, older adults, individuals who do not have sexual partners, and those with certain medical conditions such as serodiscordant couples or cancer survivors — may require infertility management and fertility care services. Inequities in access disproportionately affect poor, single, less educated, unemployed, and other marginalized populations, the WHO says.

Maternity Support Measures

Society is aware that there is a biologically more favorable time for motherhood and fatherhood, but whether that time fits a person’s life or professional plans is another matter. Couples know this reality; however, personal, work, or economic circumstances do not always make it possible to have a child when it would be biologically preferable. And when they can finally consider it, in many cases, they encounter difficulties achieving pregnancy.

This is a social and health problem that justifies the support measures for motherhood that the governments of developed countries are promoting, with the aim of ensuring that forming a family is not perceived as “a huge challenge.” In this regard, policies on financial support, work-life balance, and family assistance can help ensure that having one or more children does not become an even greater obstacle.

People Are Having Children Later

The first baby born through assisted reproduction was Louise Brown, born on July 25, 1978, in Oldham, England. Since then, reproductive reality and parenting habits have undergone major changes. In his more than 20 years of clinical and teaching practice, Galindo emphasized that the most important change has been the delay in motherhood. “The rise in pregnancies among women aged 35-45 years is striking, when previously it was very uncommon. It is now very common to care for pregnant women over 40. Years ago, it was a rarity; today we see it every day,” he explained. This is a social and health transformation of great significance, aided by advances in assisted reproduction, which have expanded the possibilities of achieving pregnancy at increasingly advanced ages.

“It is frustrating for many women and couples who consider parenthood a life goal to not be able to achieve pregnancy. The frustration is logical and, in some cases, intense. There are also women and couples who decide from the outset not to have children; for them, the decision means something very different from that of those who want a child and cannot have one,” Galindo said.

Although the rate of complications is higher than in younger women, most pregnancies at older ages progress satisfactorily. This reality builds confidence and encourages many women to consider motherhood beyond age 40, supported by medical monitoring and advances in assisted reproduction.

This story has been translated from Univadis Spain, part of the Medscape Professional Network.