Sexual Health Pt I: Fertility

Daniel Fosselman
Sep 2
3 min read

Updated: Sep 24

Understanding Fertility: Common Struggles, Quiet Pain, and Paths Forward

Fertility rates have declined significantly over the past 50 years, both in the United States and globally. This trend is driven by a combination of factors: delayed childbearing, increased educational and career participation among women, rising economic pressures, and deteriorating metabolic health.

If you’re looking for in-depth medical insights, I highly recommend The Drive podcast by Peter Attia, particularly Episodes #351 (male fertility) and #352 (female fertility). His expert guests cover the science more thoroughly than I ever could.

The Scope of the Issue

Infertility is defined as the inability to conceive after 12 months of regular, unprotected sex. According to the CDC, approximately 19% of couples face infertility, though about one-third will successfully conceive within their second year of trying. On top of that, miscarriage occurs in roughly 15–20% of pregnancies in the U.S. When you combine infertility and miscarriage, it becomes clear: these experiences are far more common than most people realize.

Silent Struggles and Social Isolation

Despite being widespread, infertility and miscarriage often carry a heavy emotional burden. People don’t usually talk openly about them, which can lead to a sense of isolation. Social media only compounds this, as it’s easy to compare yourself to others who appear to be effortlessly starting families. The truth is often more complicated, but appearances rarely show that.

There’s also a painful irony—some people try desperately not to conceive, while others long to but cannot. This imbalance can spark feelings of resentment, frustration, and grief.

Pressure from All Sides

Cultural and family expectations can make things worse. Seemingly harmless questions like, “When are you going to give me a grandchild?” or insensitive comments like, “Your eggs are getting old,” only deepen the emotional toll.

The financial costs of fertility treatments don’t help. The median expense in the U.S. is $5,338 per cycle, with treatments ranging from $1,000 for basic ovulation induction to nearly $20,000 for IVF. These figures don’t include the costs associated with pregnancy, birth, or postnatal care.

The Emotional Weight

Beyond the financial impact, the psychological toll is often immense. Fertility treatments can trigger feelings of inadequacy or failure—questions like “What’s wrong with me?” are common. For men, it may challenge their sense of masculinity; for women, their sense of womanhood.

Sex, once a source of intimacy, can begin to feel like a chore. When combined with financial strain and emotional exhaustion, even strong relationships can be tested. For some couples, the struggle brings them closer. For others, it introduces new fault lines.

Lingering Questions, Lasting Legacies

For couples unable to conceive, the question “What if?” may linger for decades. There are people I care deeply about who desperately wanted children and couldn’t have them. While I try to remind them of the powerful roles they’ve played in my life—as mentors, second parents, or surrogate aunts and uncles—I understand it’s not the same as having children of their own.

Jim Wendler once said:

“If you want to change the world, have kids. If you don’t want to or can’t have kids, coach. If you don’t want to do either, keep your hands off of them.”

I love this quote, particularly the part about coaching. For many kids, a coach, mentor, or teacher did more for them than any parent ever could. They listened. They believed. They cared. Legacies can take many forms—and loving, supporting, and guiding others is a powerful one.

Moving Forward

If you’re struggling with infertility, remember:

You are not alone.
You are not broken.
You are not less worthy.

Fertility challenges are not a reflection of your value. Miscarriage is not a sign you did something wrong. If the medical system is wearing you down, sometimes the best thing you can do is take a break—physically, emotionally, spiritually.

To support your fertility and overall well-being, focus on the foundational pillars of health: