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by Lissa Poirot
It seems everywhere you turn, another couple is telling their story of in vitro fertilization (IVF) while bouncing a beautiful baby on one knee. Sets of twins run around the local playground as their parents discuss the double blessings of IVF treatments. It’s been months for you, and you’re still not pregnant. Maybe it’s time to try IVF, right? Not without understanding what actually goes into the treatment of infertility.
If you’re having trouble conceiving, you’re not alone. More than seven million people in the U.S. have experienced infertility, with 13 percent seeking assistance from fertility specialists, and 85 to 90 percent benefitting from the help and bringing home a baby. However, fewer than 5 percent of infertility cases are treated with IVF, as specialists examine every aspect of a woman’s and man’s body to determine what could be delaying the process.
“Sometimes I don’t think people are prepared to hear their egg storage is depleted or their sperm count is low. Patients come in thinking they will have IVF and then have a baby, but it’s not that simple,” said Debbra Keegan, M.D., OB/GYN in private practice at IVF Florida, Margate, Fla.
Patients seeking fertility assistance can expect to undergo a series of tests, taking two weeks to up to six months, as doctors attempt to pinpoint the problem and determine whether or not a couple will benefit from medical intervention.
“When a couple visits our practice we begin by reviewing any records of any fertility treatments they may have done, but we look at the whole person and not just the procedures,” said Carolyn Kaplan, M.D., director of in vitro fertilization, Georgia Reproductive Specialists, Atlanta. “A lot of times our patients will get pregnant with no intervention but just by treating metabolic problems. Couples need to look at their overall health — are they maximizing it with a good diet, exercise and no smoking, for example. From there, they need to recognize that there are a lot of options available for treatment depending on their health and how aggressive they want the treatments to be. And a lot of treatments are empiric, meaning we don’t know where a problem lives but we know how to increase fertility.”
Still, not every patient will discover small changes that will make a difference, and thus seek more aggressive fertility treatments like IVF, which even in the best centers around the country carries only a 50 percent success rate.
“Women come to me at 43 and I say, ‘you know age is a factor,’ and they always say they know, yet they waited for the time to be right and before they knew it, time ran out on them,” said Nicole Noyes, M.D., associate professor and director of reproductive surgery, NYU School of Medicine and NYU Fertility Center. “I tell patients two-thirds of fertility is lost to women between 35 and 40 years of age. If she’s 32 and she needs one more year before she starts, okay, but if she’s 36 and she waits another year, she’s playing Russian roulette.”
For her patients who have are not quick to get pregnant, Dr. Noyes warns them up front of the multitude of tests they will have to undergo, including testing for sexually transmitted diseases, endometriosis, low sperm count, as well as examinations of fallopian tubes and ovaries, agreeing with Dr. Kaplan that many fertility problems can be fixed without undergoing IVF.
Couples seeking fertility help, especially IVF, are often not prepared for the challenges ahead. “It varies by couple, of course, but on average a couple can expect to spend months undergoing testing before they can even get pregnant. If in vitro is the route taken, a woman has to have shots every day for six weeks, and she may have to go see her doctor up to four days a week; it takes over your schedule and it can be emotionally draining,” said Dr. Noyes.
Added Dr. Kaplan, “Patients need to recognize that sometimes it won’t be simple, that there are different stages of treatment when you get into IVF and that there are more visits required and it’s more stressful. Stress has been shown to impact implantation, so we want our patients to be prepared and understand the medications, and feel as if they are partners with their doctors, as well as their spouse.”
Even after months of testing and lifestyle changes, some couples will not be candidates for IVF. “Someone who has had multiple failed cycles, premature ovarian failure, pre-menopausal and menopausal women in their late 40s — these are women who are not candidates for IVF,” said Dr. Keegan. “That’s why you begin the process by talking to your doctor, being very open, and undergoing so many tests. You wouldn’t want to take anyone through the stress of IVF who doesn’t have a good chance of conceiving.”
For women who are candidates for IVF, the stress continues when after months of doing everything right, conception doesn’t occur. While doctors all remind patients that most IVF treatments do not “take” the first time, the disappointment and lack of control over one’s body creates an emotional roller coaster, said Dr. Keegan.
Many couples seeking fertility treatments are often surprised, and rightfully devastated, by another common occurrence: miscarriage. “Miscarriage is common in any pregnant population, whether it’s a couple who conceived on the first try or one who sought help. In fact, up to 20 percent of all pregnancies end in miscarriage,” said Lynn Westphal, M.D., associate professor of Women’s Health, Stanford School of Medicine, Stanford, Calif.
Added Dr. Noyes, 50 percent of women over 40 experience miscarriages, and it’s 20 to 25 percent for women who are 35. Although common and emotionally difficult, doctors encourage couples to try again, but they must wait three months. “If you have a miscarriage and have to wait three months, that’s a quarter of a year. If you have two, there goes your year and conception gets harder with age,” said Dr. Noyes. “Women need to understand how important it is to start early.”
While doctors want couples seeking fertility assistance to have a better understanding about the physical, emotional and even financial toll involved, they agree seeking help early is a key to conception. Says Dr. Kaplan, “It’s important for patients to be their own advocates. Any woman over 35 who has been trying for six months deserves to have a complete evaluation from a reproductive endocrinologist because they specialize in treating infertility and time is of the essence.”