First Steps to a Family
Getting Started With Fertility Treatment
You’ve tried to get pregnant for many months or even years, and it just hasn’t happened. It’s dawning on you that something could be wrong, and maybe it’s time to talk to a fertility specialist. Doctors generally recommend that couples under the age of 35 try to conceive on their own for one year before seeing a specialist. However, if you’re 35 years or older, you should seek help sooner, perhaps after six months of trying to conceive.
It’s tough to admit you might need medical help to conceive, but it’s a big step towards realizing your dream of having a child. More than half the couples who seek treatment will become pregnant. Success rates are improving, in part, thanks to new technologies like recombinant fertility medications. The more you know about infertility and its treatments and the sooner you get started, the better your chances of becoming pregnant.
After you go for the first blood test, your partner should be tested. Sometimes it’s harder for a man to admit he may be experiencing fertility problems. But before putting yourself through a long and sometimes expensive testing process, have your partner undergo a simple semen analysis test to eliminate that as a factor. Men and women contribute about equally to the causes of infertility.
Finding Dr. Right
Your own Ob/Gyn may want to help you with the basic diagnosis and treatment of infertility. But it’s best to see a Reproductive Endocrinologist (RE), a fertility specialist, who can provide you with a range of options, cutting-edge therapies, and direct access to services through the office or center that will be needed throughout treatment. You may feel uncomfortable or disloyal about asking for a second opinion or a referral, but your doctor will appreciate your desire to work with a physician who has additional training and education in reproductive medicine. Please refer to the American Society for Reproductive Medicine’s (ASRM) Web site, http://www.asrm.org, for more information about finding a certified RE near you.
When looking for an RE, try to find one practicing at a comprehensive fertility clinic that offers assisted reproductive technology. The clinic you choose should be a member of the Society for Assisted Reproductive Technology (SART); ask the clinic when scheduling your appointment. SART holds its members accountable to strict guidelines for data collecting and reporting, resulting in information that is accurate and understandable. To identify member practices or physicians in your area, visit the SART Web site at http://www.SART.org. In addition, you can compare U.S. fertility clinic success rates at http://www.cdc.gov/nccdphp/drh/art.htm. And as always, you can contact AFA for a referral by calling our toll-free number, 888-917-3777, or visiting our Web site, http://www.americaninfertility.org.
Tests You Can Expect
Once you’ve met with a fertility specialist and completed a medical history and physical exam, your doctor will proceed with a series of basic tests. Since men and women contribute to infertility problems equally, both members of the couple will undergo testing, in the following order.
Here are a few tests your doctor may perform to help determine the best course of treatment:
- Blood test – a woman’s blood is drawn and tested to determine levels of follicle stimulating hormone (FSH) and lutenizing hormone (LH), both key to development and quality of eggs.
- Semen analysis – a sperm sample is evaluated under a microscope for sperm count, mobility, and shape, among other factors.
- Cervical mucus/post-coital test – after intercourse, a sample of cervical mucus is obtained and viewed under a microscope to see if sperm can penetrate and survive in the mucus.
- Ultrasound –a transvaginal ultrasound exam is done to assess the lining of the uterus, monitor follicle development and assess condition of the uterus and ovaries.
- Hysterosalpinogram (HSG) –a radiologist injects a special dye through the cervix and into the uterus and fallopian tubes and uses an X-ray machine to view any tumors or blockages.
- Laparoscopy – a surgeon inserts a small fiber optic telescope into a woman’s abdomen to view the uterus, fallopian tubes and ovaries, and to determine the presence of endometriosis or pelvic adhesions.
- Endometrial biopsy – a small amount of tissue is scraped from the lining of the uterus and viewed under a microscope to determine if the woman has a hormone imbalance, which prevents her from sustaining a pregnancy.
Time for Treatment
Though there are high-tech procedures available, most infertility patients are successfully treated with low-tech therapies. Depending on your diagnosis, your doctor might prescribe medicines to control or regulate ovulation, or do surgery to repair reproductive organs. Another option is to use ovulation medicines, either in pill or injectable form, in conjunction with artificial insemination to increase chances of pregnancy.
New Technology, New Hope: IVF and Recombinant Medicines
If you’ve exhausted low-tech therapies and you’re still not pregnant, it may be time to turn to assisted reproductive technologies such as in vitro fertilization (IVF). Doctors may recommend that some patients move directly to IVF. Women over age 35 (due to the decline in fertility rate with age) and women with blocked fallopian tubes are examples.
In IVF, a man’s sperm and a woman’s eggs are combined in a laboratory dish, where fertilization occurs. Some of the resulting embryos are transferred into the woman’s uterus to develop naturally. One advantage of using IVF over artificial insemination is that the doctor can select the embryos with the best chances of implantation and control the number of embryos transferred to reduce the risk of multiple births.
To prepare for IVF, the woman undergoes a series of daily injections with follicle-stimulating hormone (FSH) that is sometimes used in combination with human menopausal gonadotropin (hMG) to stimulate growth of follicles within her ovaries and maturation of eggs. In order for ovulation to occur at the right time, a hormone medication known as human chorionic gonadatropin (hCG) is usually given. HCG causes the final maturation and release of mature eggs.
Newer medicines, such as recombinant FSH, are now readily available. Because of this breakthrough in 21st century technology, these recombinant products provide consistent drug amount from one vial to the next and a steady supply of drug because there is no dependence on urine collection or donor availability. Recombinant FSH is greater than 99 percent pure. It is free from potential urinary proteins. Talk to your doctor about which fertility medications are right for your situation.
Studies have shown that recombinant FSH is efficient, requiring less medicine and fewer days of treatment to reach the point that eggs can be retrieved for fertilization. This means that women need fewer injections – which can be a real benefit for women undergoing numerous, daily self-injections. In addition, some doctors believe that recombinant FSH allows them to collect more eggs per retrieval, which provides more options for choosing which eggs to fertilize and transfer to the uterus. The fertilized eggs not used during a pregnancy attempt may be frozen and saved for future attempts, if necessary.
Take the Next Step
You probably feel overwhelmed by the prospect of undergoing treatment for infertility. The procedures, medications and even the tests appear daunting. No question, making an appointment with a fertility specialist is a big step. But it is the first step toward reaching your heart’s desire — a baby.
There are things you can do to make your journey more productive and even more pleasant. Learn all you can about infertility testing and treatment. Join The AFA and take advantage of online chats, message boards or our newsletter. Or speak with your doctor about support services offered at your IVF center. Many centers offer support groups and access to mental health professionals to help you on your journey. You’ll share your feelings with people who understand, and have access to some of the latest news on fertility treatment.
As one of the most comprehensive infertility resources, the American Fertility Association is a national organization dedicated to assisting women and men facing decisions related to family building and reproductive health. You can find out more about us and other infertility resources on our Web site, http://www.theafa.org, or on the Focus on Fertility Web site, http://www.focusonfertility.org.