To read part one of this series, click here.
Somewhere in your junior high school, you were likely compelled to learn about mental and sexual health, given material about family planning and informed about the biological process of conceiving a child. But typically, one aspect of sexual health was left out of the lesson plan – infertility.
Statistics and causes
Some six percent of married women in the U.S. are unable to become pregnant after one year of unprotected sex and 11 percent of women, regardless of marital status, have difficulty getting pregnant or carrying a pregnancy to term, according to the Centers for Disease Control and Prevention. In general, infertility is defined as failure to conceive after one year of unprotected sex. Unfortunately, numerous studies find that African-American women are more at risk for infertility than any other race or ethnic group. Although women hold primary risks for infertility, according to Dr. Matthew Will, physician at Midwest Fertility Specialists, about 40 percent of fertility complications lead back to men. Causes for women can be age related as well.
Some medical treatments, such as chemotherapy can contribute to infertility. However, it is rare that cancer patients fall between the 25 to 45 age range, with the exception of breast, testicular and childhood cancer, said Dr. Lori Minasian of the Division of Cancer Prevention at the National Cancer Institute.
“For those patients, typically there is chemotherapy used to treat them aggressively,” said Minasian. “With young people, you want to treat them aggressively because they have the longest potential of survival. Most of those therapies have a negative effect on fertility.”
Minasian adds that experts have been searching for ways to protect cancer patients’ fertility during chemotherapy. Goserelin, also known as Zoladex, is an implant used to thin the lining of the uterus before an operation. It works by stopping the production of some of the sex hormones, which the body makes naturally, and as a result puts a woman’s eggs at rest during chemotherapy according to Minasian.
The first visit
Gaining the courage to visit a fertility specialist is one of the first steps to treatment. The experience at the first visit depends upon the patient, said Dr. Will. Some women may not have undergone testing yet, while others may be seeking a second opinion from a specialist.
As a part of the first visit, women are asked about their gynecological past, partner’s health and family infertility history. About 15 to 25 percent of women will experience a miscarriage at some point in their life.
“I ask if the patient has had a family member that has experienced menopause early, or if anyone in their family has had multiple miscarriages, because unfortunately having a miscarriage is common,” said Will. “With that being said, multiple miscarriages are a clinical red flag and that maybe additional testing is warranted.”
Almost all specialists break testing down by specific factors involved including the ovaries, the tubes, the uterus and sperm. The test for ovarian function involves hormonal levels drawn at a certain time during the patient’s menstrual cycle. Tests for the tubes involves a procedure called a Hysterosalpingograman, an x-ray of the fallopian tubes and uterus. Testing on simply the uterus can be one of several methods where a small telescope is used to view inside the cavity of the uterus. The sperm are evaluated by a standard procedure of human analysis.
Dr. Mary Gallenberg of Mayo Clinic explained that while herb products claiming to treat infertility can be labeled as “all natural,” individuals should consider important issues surrounding fertility herbs.
“Until researchers more clearly define the risks and benefits of herbs and supplements, conventional treatment for infertility appears to be the best option,” she said.
Although many seek alternative treatments, thousands of couples occupy waiting rooms of fertility specialists to seek advanced treatment. Male infertility is managed by a urologist who may recommend IVF (In Virto fertilization), the main form of Assisted Reproductive Technology (ART), or Intrauterine Inseminations (IUI), common procedures also recommended for women.
IVF should be used for couples who have severe male infertility, blocked fallopian tubes or when a woman is over the age of 38.
Dr. Will explains IVF as the technology that offers the highest chances of success with pregnancy but also the most invasive. It involves fertility injections that mimic natural signals the brain sends to the ovaries but at higher levels. Women are then placed on fertility medications for 10 to 14 days, are closely monitored and then egg retrieval is done, which takes about 20 minutes. Once the eggs have been fertilized, 3-5 days later they are transferred to the uterus.
The world’s first successful IVF procedure was done in 1978 and was introduced to the U.S. in 1981. In 2004 more than 122,000 births were conceived using IVF.
A recent study by the University of Chicago Medical Center finds African-American women undergoing IVF are only half as likely as white women to become pregnant during the process. Their scientist also discovered that miscarriages, after IVF, occurred twice as often among African-Americans than whites.
IUI is the process of collecting and injecting sperm into a woman’s uterus, eliminating the lengthy journey sperm have to travel to fertilize. This is a cost effective way to treat infertility considering it costs much less than IVF treatments. It is often used to treat mild male factor infertility and couples with unexplained infertility.
Other treatment options include hormones, other types of ART, procedures in which both eggs and sperm are handled outside of the body, including Zygote intrafallopian transfer (ZIFT), a tubal embryo transfer; Gamete intrafallopian transfer (GIFT), transferring eggs and sperm into the fallopian tubes; and Intracytoplasmic sperm injection (ICSI), a single sperm is injected into a mature egg. Freezing eggs is also an option.
Dr. Andrea Braverman of The American Society for Reproductive Medicine said egg freezing is now an established treatment.
“Each woman needs to assess the benefits of egg freezing,” said Braverman. “If you’re 25 that’s different from being 35 or 39 and (egg freezing) shouldn’t be seen as a 100 percent guarantee.”
Third Party Reproduction
Another option involves a third party, which may consist of donor eggs, sperm, embryos or surrogacy and gestational carriers. Third Party Reproduction often causes many social and ethical issues due to its unusual way of reproduction. Despite the chaos, the first pregnancy through egg donation happened in the mid-80s.
During surrogacy, the surrogate undergoes IUI or IVF with sperm from a male or from a sperm donor. The surrogate provides the eggs and is genetically related to the child. Gestational carriers are not genetically related to the child as she carries and delivers a child created from the egg and the sperm of the intended parents, donor egg, donor sperm or donated embryos.
With lab work and medical tools come risks, and in the means of infertility that may mean birth defects. Dr. Will said this is the most common topic he addresses.
“Researchers have looked at long term outcomes of children produced from IVF and neurodevelopmental outcomes from kids five and 10 years old seem to be the same as the general population,” he said.
The process of beginning a family can be stressful and provide basic wear and tear to one’s mental state. Braverman refers to the journey as an emotional tsunami for many.
“It is one of those life events no one is really prepared for and for many people it’s the first major life crisis and something we can’t control,” said Braverman. “With infertility the No. 1 emotion is feeling as if your life is out of control. For many individuals, especially women, it’s a monthly cycle of grieving a loss. Two weeks you’re trying (to conceive) and then for two weeks you’re hopeful and acting as if you’re pregnant, and when you’re not, for some it’s almost as if they’re losing a baby every month.”
She recommends counseling to those who allow their situation to control their lives and to those who would like to be proactive and seek assistance early on. Online forums and meet up groups are also suggested as support systems. To become a loyal supporter, family and friends should ask the patient how they can assist them.
“Sometimes we think we should know but everyone is so different. Don’t be afraid to ask,” she said. “Meet that person where they are and not try to ‘fix’ it for them.”