Mary Ann Romans
Infertility is a sad, frustrating and familiar struggle for many men and women. "One in eight people of childbearing age are inflicted with infertility," according to Dawn Gannon, the regional operations manager of the Northeast Region of RESOLVE: the National Infertility Association. "It is a disease just like cancer or diabetes." Although the Centers for Disease Control and Prevention (CDC) puts the numbers closer to seven to 10 percent, it does classify infertility as a disease, defined as not being able to get pregnant after trying for one year. Our experts further define the condition as not being able to get pregnant for six months if the woman is beyond the age of 35, or not being able to carry a fetus to term. Assisted Reproductive Technology (ART), most commonly through of as the transfer of fertilized eggs into a woman's uterus, has been used as a treatment since 1981. "It is what most people commonly believe fertility treatment is all about," says Jeffrey Russell, MD, FACOG, a board certified reproductive endocrinologist in Delaware. But there are actually many different treatments available, from medication to surgery.
Whether you are just beginning your own struggle with infertility or know someone who is, our experts are here to give you the latest information on causes, treatment options and more.
"Most people assume that infertility is a woman's problem," Gannon says. "But that is a huge myth. It is more like 35 percent male, 35 percent female, 20 percent mixed and 10 percent unexplained."
"The good news," says Dr Russell, "is that we are seeing treatments for infertility achieving a success rate of 90 percent right now."
Christos Coutifaris, MD, PhD, is the director of the Reproductive Endocrinology and Infertility Division at University of Pennsylvania School of Medicine. Dr Coutifaris, considered a top expert in the field of infertility and reproductive medicine, tells us that there are many causes for infertility. "A thorough initial screening needs to be done to determine the cause or causes of the infertility," he says. "Usually you can catch most of the problems."
"One of the first things I do is talk to patients about overall body health and lifestyle," Dr Russell says. "These things can affect fertility."
According to Dr Russell, the following are lifestyle choices that can negatively affect the chances of conception:
- Excesses of caffeine
- Excesses of sugar
- General bad nutrition
- Hot tub and whirlpool use for men
- Recreational drugs and prescription drugs
Patients are tested first for the most common fertility problems; the number of tests done will be determined by what the initial test results show. A typical screening will begin with a check for ovulation, as well as a sperm analysis. A testicular biopsy to measure sperm production can be done if needed.
Additional testing may include an examination of the uterus and fallopian tubes, most likely performed by ultrasound or tiny camera (laparoscopy), to make sure everything is normal and open. The next step, Dr Coutifaris says, is evaluation of the ovarian reserve, or the amount of remaining eggs the woman has. This determined by measuring hormone levels, and can tell the physician the level of treatment that should be followed. The less reserve that is available, the more aggressive the treatment that is prescribed. Additional hormone tests may be performed, such as a female thyroid level and a male hormone level.
"If help is needed to ovulate, there are fertility medications available," Dr Russell says. "There are also ways to move the sperm closer to the egg, such as artificial insemination." This is a procedure in which sperm is injected into the woman to make fertilization more likely than by natural means.
"Surgery can be done to correct an anatomical problem or remove endometriosis," Dr Russell says. Endometriosis is a condition in which the tissue that lines the uterus, normally shed during menstruation, grows outside of the uterus. This tissue can block fertilization.
"The most advanced treatment is IVF," says Dr Russell. "This is creating fertilization in a lab. In a sterile, controlled environment, the fertilized egg is incubated for three days before being injected into the uterus."
"The bottom line," Dr Coutifaris says, "is that IVF truly provides you the best outcome in the shortest period of time."
Intracytoplasmic sperm injection (ICSI) takes IVF one step further by actually injecting an egg with a single sperm to fertilize it. IVF then takes place as usual. This procedure may be used in cases of low sperm count or motility, or with a limited healthy egg reserve. If there is a male blockage, the sperm may be exacted from the testes with a needle. "In terms of guiding couples," Dr Coutifaris says, "the more severe the problem, the sooner they should try IVF with ICSI."
Top four myths of infertility
Gannon states there are four widespread myths about infertility:
1. Men are not affected at all by infertility.
Gannon tells us that infertility affects both men and women physically and emotionally.
2. Just relax and you'll get pregnant.
Gannon says this myth gets around through all of the stories about couples who decided to adopt or stop trying to get pregnant, only to have it happen. This myth hurts couples for two reasons: one, it puts the responsibility or blame for not getting pregnant on the couple; two, it may prevent infertile couples from seeking help.
3. Previous IVF treatments will cause a natural pregnancy.
While the phenomena has been known to happen on rare occasions, there is no basis in fact for this myth.
4. Trying to make a baby can be fun.
While any excuse for intimate relations may seem like a blast, Gannon tells us the reality is far different. "You have to schedule your sex, and it's not fun," she says. "People who are not struggling with infertility don't understand that there is a lot of pressure with sex."
What couples should know
"Couples should understand that it is a very emotional roller coaster," Dr Russell cautions. "Treatment requires multiple visits to the doctor's office, and it brings in a lot of scientific information on what should be a natural process."
"Infertility strikes people at the heart of who they are," Gannon says. "It can be hard on a mar-riage. Women tend to want to talk about it, and their partners don't." She adds, "Fertility treat-ment can take over your entire life. "
Cost for treatment may vary by the type of the procedure, the number of treatments, and even the state in which the treatment is performed. "A cycle of oral medication can cost $300 to $500," Dr Coutifaris says. "Injectable drugs raise the cost an additional $1,500 to $2,000; IVF can cost $5,000 to $7,000 per cycle, with an additional $1,000 to $2,000 for ICSI," he adds. Dr Russell puts the IVF expense at $8,000 to $10,000 per cycle. Testing can also carry costs, although some insurance companies may cover the expense for certain diagnostics. "A sonogram or ultrasound can cost $100 to $200, and laparoscopy can cost $2,000," Dr Coutifaris says.
Dr Coutifaris would like potential patients to know that there are risks involved, especially with a multiple pregnancy. "Anything above twins is bad," he says. "There are many risks to the mother and the babies. The media has glamorized multiple pregnancy, but it is very important for couples to realize that the goal is to have one healthy baby at a time."
How to find a doctor
If you are ready to find a doctor, our experts recommend going straight to a reproductive endocrinologist. "For anyone who ever suspects there is a problem -- for example, if you are having recurrent miscarriages -- seek treatment from a specialist right away," Gannon says. "The biggest mistake many people make is to stay with their regular OB/GYN for too long."
"The best way to find a physician," says Christos Coutifaris, MD, PhD, with the University of Pennsylvania School of Medicine, "is to contact the Society for Reproductive Endocrinology and Infertility. It is very important to get someone who is board certified," Dr Coutifaris says.
Despite the costs and the emotional and physical risks, more and more couples are turning to fertility treatments. According to our experts, new advances are always on the horizon.
"If you are not able to conceive naturally," Gannon advises, "There is a light at the end of the tunnel."
For more information on locating a doctor, visit the following resources:
The Society for Reproductive Endocrinology and Infertility.
Click on the "Find Member" link.
RESOLVE: The National Infertility Association.
Click on "Find My RESOLVE" for local chapters. These chapters generally publish a list of recommended specialist in your area.
Penn Fertility Care (The Hospital of the University of Pennsylvania)
Under some insurance plans you may need to see a specialist in your network, and that may limit your choices. Some states do not have any mandatory coverage for infertility treatment, so your insurance may not cover any treatment expenses.