BY DR. CAROLYN KAPLAN
According to The Center for Disease Control and Prevention, infertility is a disease that affects more than 7.3 million Americans, or 1 in 8 couples of childbearing age. The diagnosis of infertility is often very overwhelming for patients. Not only are they faced with the news that conceiving a child is only possible through medical treatment, they are also presented with information that is totally new to them. New medical jargon along with recommendations for treatments and tests that are completely unfamiliar can be very intimidating for the newly diagnosed.
To maximize the chance of pregnancy, couples should have frequent intercourse for the few days when egg release (ovulation) is most likely—usually in the middle of the menstrual cycle, which is about halfway between the first day of two periods. Women who have regular periods can estimate when ovulation occurs by measuring their temperature at rest (basal body temperature) each day before they get out of bed. A decrease suggests that ovulation is about to occur. An increase of 0.9° F (0.5° C) or more suggests ovulation has just occurred. Or women may use home ovulation predictor kits. Some attention should also be given to caffeine, poor diet, stress, lack of proper exercise, and body weight (too low/too high), all of which can impair fertility in women and should be thoroughly explored before starting an infertility treatment.
Infertility is a disease of the reproductive system and occurs equally in males and females. When a couple is unable to conceive, testing should be initiated after one year of trying with unprotected intercourse when the female is under 35, and six months of trying when the female is over 35. If a woman has irregular periods, then she should be evaluated as soon as she is ready to become pregnant. The cause of infertility may however be due to problems in the man, the woman, or both:
-Problems with sperm (in 35% of couples)
-Problems with ovulation (in 20%)
-Problems with the fallopian tubes in the pelvis (in 30%)
-Problems with mucus in the cervix (in 5% or fewer)
-Unidentified factors (in 10%)
Conception is a complicated process. When just one of these factors is impaired, infertility can result. The good news is nearly 90% of infertility cases are treatable with medication, surgery or assisted reproductive technologies, such as in vitro fertilization. It is critical for couples to consult with infertility specialists who can determine the cause of their problems. At that point, a plan can then be customized to fit their unique situation and move them along on the path to conceiving a child.
Infertility patients are dealing with an emotionally charged medical issue, so it is important for couples to take time to learn about their options. They deserve an environment that fosters trust and mutual respect, where questions are welcome and encouraged. One of the most challenging aspects of the infertility experience is dealing with the emotional ups and downs relating to medical treatment, and the uncertainty about outcomes. Often, infertility patients get support from family and friends, but sometimes a support group, such as Resolve, the national infertility support group, or a psychologist trained in the stresses of infertility, may improve results. Alternative therapies, such as acupuncture and mind-body medicine, are showing benefit to patients as well.
The first step with your doctor should be an infertility evaluation. The main concern during the evaluation is to only conduct the tests that will give the physician clues to the cause of infertility and ultimately lead to the development of an effective treatment plan. There are a number of tests that have traditionally been conducted as part of the initial work up but may be unnecessary in many cases, such as the diagnostic laparoscopy, post-coital test, and endometrial biopsy.
The evaluation will lead the physician to determine the cause of infertility. These tests should include a full medical history and physical, a male infertility evaluation, hormone level evaluation, and HSG (hysterosalpingogram) test to rule out anatomic problems. Some common and very treatable diagnoses can include ovulatory disorders, PCOS, male factor, tubal factor, recurrent miscarriage and Endometriosis. As women wait longer to conceive, age may become a significant factor in all of these.
Once these steps are taken, many couples are on the way to fertility success. Again, 85–90% of infertility cases are treatable with drug therapy or surgical procedures, and fewer than 5% need advanced reproductive technologies like IVF. Of the women who seek medical intervention for infertility, approximately 65% give birth.
Dr. Carolyn Kaplan, Medical Director of in vitro fertilization with Georgia Reproductive Specialists (GRS), is board certified in Obstetrics/Gynecology and Reproductive Endocrinology. The GRS team includes physicians, embryologists, nurses, counselors, financial advisors, and laboratory technicians, with offices in Atlanta, Alpharetta, and Decatur. www.ivf.com.