By Cheryl Alexander
If fertility issues have you feeling a little less than hopeful, then take heart.
There is good news regarding the latest advances in infertility treatments that
are making it possible for more people than ever before to become parents.
Understanding Your Condition
According to WebMD, the classic definition of infertility is the failure to
cause a pregnancy within one year. This is age-dependent, however.
“Six months of trying is the cutoff for prospective parents aged 35 or older,” says Edmund Sabanegh Jr., M.D., director of the Center for Male Fertility at
the Cleveland Clinic in Ohio. Women age 40 and over should wait no more than
three months.
To help cool anxiety, a quick physical exam and history can be done even before
a year or six months to rule out any major causes of infertility. This type of
exam may reassure future parents that there is nothing wrong and that if they
continue to try, they will likely be able to conceive a child within a year. In
fact, approximately 85 percent of couples will conceive a child within a year
of trying.
“If there is an obvious factor in their history that is suggestive of a fertility
problem, such as a history of cancer or certain chemical exposures, we may do a
full evaluation earlier,
” Dr. Sabanegh says. “In these cases, it doesn’t help to wait a year, and we may lose the window of opportunity for pregnancy.”
There are a few exceptions to these recommendations. Patients who have irregular
menstrual periods (cycles that are 35 days or longer between periods) or have
had previous pelvic infections such as PID should seek advice from their
gynecologist for an earlier referral.
After trying for one year, doctors usually recommend a full infertility workup.
Lots of factors can contribute to infertility, and a full workup will help
identify exactly what is causing the problem. Doctors will examine potential
causes of both male and female infertility. The results will help dictate and
guide infertility treatment.
The Process
First, consult an infertility specialist, and Houston is home to some of the
best. Make certain you see a board certified reproductive endocrinologist
infertility specialist. Board certified reproductive endocrinologist
infertility (REI) specialists have completed: 1) four years of medical school,
2) four years of residency training with an OB/GYN specialty, 3) two to three
years of fellowship training with an REI specialty, and 4) passed the national
REI written and oral test along with the OB/GYN specialty written and oral
given by the American Board of Obstetrics and Gynecology.
The additional two to three years of training beyond the OB/GYN specialty
focuses on assisted reproductive techniques, advanced microsurgery of the
pelvic organs, disorders of the anatomy which may affect fertility and sperm
disorders. This additional training is invaluable and will increase a couple
’s probability of conception.
Keep in mind as well that some insurance plans will only reimburse fees for
infertility services if the doctor is a reproductive endocrinologist and
infertility specialist. In addition, The American Board of Obstetrics and
Gynecology recommends patients seeking advanced infertility treatments see a
board certified REI.
Dr. Sabanegh often suggests that men get tested first. “Routine semen analysis is quick and relatively inexpensive,” he tells WebMD. “Before we put women through invasive, expensive and painful tests, we better
have a pretty good idea that those tests are necessary,
” he says.
For couples who want to complete the evaluation as quickly as possible, many
doctors will initiate a workup on both partners simultaneously. Many couples
will often have more than one factor at the root of their infertility.
If a problem is identified in terms of the ovulation process, the first-line
infertility treatment is typically to administer a drug that stimulates
ovulation along with intrauterine insemination (IUI), a fairly low-tech
procedure where sperm is injected directly into the uterus to hopefully
fertilize a waiting egg.
If that fails, many couples advance to in vitro fertilization (IVF). IVF
involves combining eggs and sperm outside the body in a petri dish. Once an
embryo or embryos form, they are then placed in the uterus where they will
hopefully implant.
A typical IVF cycle involves four main stages.
•Stage One: Ovarian Stimulation – Ovarian stimulation for IVF is designed to stimulate the maturation of ovarian
follicles, which contain an egg that is released during ovulation and involves
the use of fertility medications that promote the simultaneous maturation of
multiple follicles. During the ovarian stimulation stage, a woman
’s progress is monitored with hormone testing and ultrasound.
•Stage Two: Egg Retrieval – Before the eggs can be retrieved from their follicles, human chorionic
gonadotropin (hCG), a fertility medication that acts to stimulate ovulation, is
administered. Approximately 36 hours later, the eggs can be harvested using an
ultrasound-guided aspiration technique. This procedure is performed under
anesthesia, so there is no discomfort.
•Stage Three: Fertilization and Cell Division – The eggs are then fertilized by sperm, taken from either the male partner or a
donor, that has been analyzed and specially prepared. For couples who are
undergoing IVF at least partly because of male factor infertility, the chances
of fertilization may be increased by using intracytoplasmic sperm injection
(ICSI), during which an individual sperm is injected into each individual egg.
Fertilized eggs, embryos, start as a single cell, but undergo rapid cell
division. By the fifth day, the embryo has approximately 100 cells and is
called a blastocyst. Then a test may be performed to allow for the transfer of
only those embryos which are healthiest.
•Stage Four: Embryo Transfer – Embryo transfer may be one of two types: three-day transfer or blastocyst
transfer. The procedures differ only in the level of development of the embryo
prior to transfer.
The embryos are passed through a slim catheter into the uterus.
Success Rates
Improvements in medication, microsurgery and in assisted reproductive
technologies (ART) make pregnancy possible for most couples who pursue
treatment. More than two-thirds of infertile couples are able to make their
dreams of having a child come true. However, success rates vary from patient to
patient and from situation to situation.
Weighing the Pros and Cons
The obvious reward of infertility treatment is the beautiful baby boy or girl
that arrives a few months after treatment, but couples must be aware of the
risks in order to make the best decision.
Millie Behera, M.D., a reproductive endocrinologist at Duke University Medical
Center in Durham, N.C., says,
“The biggest risk seen with any type of infertility treatment is multiple
pregnancies.
” Risks inherent in multiple pregnancies include pre-term labor and birth, which
poses greater risks of illness, disability and death. There is also a higher
chance of miscarriage and other maternal complications with multiple births.
“Over stimulation is a risk if women are given too high a dose of drugs to
stimulate ovulation. This is marked by melon-sized ovaries, pain, discomfort,
nausea, vomiting and fluid in the belly. Women who are over stimulated may also
become dehydrated and their blood can become thickened and clots may develop,
” explains Dr. Behera. “There hasn’t been good data on the long-term outcomes of these drugs,” she says.
Insurance coverage is a question to consider for many seeking treatment. Most
insurance plans cover the initial consult with an REI specialist and the
diagnostic portion (the testing) to find out why you are not able to get
pregnant. The infertility treatment itself may be covered in part or
completely. Although the trend is toward more insurance plans covering
infertility, there are still plans that offer no coverage.
If infertility becomes a question for you and your partner, remember, the best
place to start is at your primary care or ob-gyn
’s office. The fertility problem may turn out to be quite simple, such as not
having intercourse near the time of ovulation. If it is more serious, then your
ob-gyn will refer you to an REI specialist.
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