Conceiving with a little Push from Technology

When most couples decide they want a baby they think about it being a girl or a boy, names they want and how many they want, but seldom does it cross their mind that they may not be able to have a baby or that they will have to take great measures to do so.

According to the CDC, 7.3 million women ages 15-44 in the U.S. have an impaired ability to have children; that is 11.8 percent of all women in the U.S. Since infertility can also be caused by a man’s impaired ability, which makes up 30 percent of all the rest of infertility cases, the chances of having a child are made that much more difficult.

Luckily with so much advanced technology a lot of couples with fertility problems can be helped and, with persistence, care and the proper procedures, that desired baby can become a possibility.

However, first and foremost it is recommended to see a doctor even before trying to conceive so that the doctor can run regular exams and make sure the parents are at their healthiest for a better outcome. If the woman is on the pill or using any other type of contraceptive, like the Depo Provera shot, fertility specialist Dr. Eva Littman from the Red Rock Fertility Center says the woman will most likely be fertile and ready to try after the first regular menstrual period after dropping the pill.

“Some people think it is three months or four but you really just need to wait until you start ovulating,” said Dr. Littman.

If the women isn’t ovulating it may be due to a condition called cystic ovarian syndrome ,which is not caused by the pill but perhaps was not known because the pill caused the woman to have regular menstrual periods. If this is the case some intervention might be required to be able to conceive.

Prior to trying any procedures, Dr. Littman says the problem needs to be identified and because so many times the fertility problem can be caused by age, she recommends seeing a fertility specialist only three months after trying if the woman is over age 35. If the woman is less than 35 years old, Dr. Littman suggests seeing a fertility specialist after six months.

Age can play a huge part in a couple trying to conceive, which is why Dr. Littman recommends a couple trying to have a baby do so when the woman is between ages 24 to 34 which is what she calls the “grand reproductive age.”

“Once you get past that window you have a higher risk of Down syndrome and trouble producing and other issues,” said Dr. Littman.

Although couples typically are waiting longer to have children when they are more financially stable and have settled to that point in their life, the biological clock does not always cooperate with the plans.

Even so, according to the U.S. Department of Health & Human Services, 20 percent of women in the U.S. are now having their first child after age 35.

However, age decreases the woman’s chances of having a baby because her ovaries becomes less able to release eggs and she has a small number of eggs left at the point, her eggs are not as healthy and she is more likely to have health conditions that can cause fertility problems, according the Department of Health and Human Services.

Another problem that may cause the woman to have problems conceiving is a disease called endometriosis where endometrial tissue grows in places outside the uterus such as the fallopian tubes and ovaries and is thought to be the cause of 30 percent of infertility cases in women, according to the National Institutes of Health. According to the Mayo Clinic some women with endometriosis, which can also be a hereditary disease, can still conceive but doctors recommend the women not wait too long because the condition tends to worsen over time.

Other factors that can cause infertility in women can be too much weight or being underweight, or severe health conditions such as cancer.

Women can also have secondary infertility, according to Dr. Littman which occurs after a woman has successfully given birth to a child. This is usually caused by weight gain or some big event happening between the two periods or something happening during the pregnancy that could cause fertility issues.

However, as the saying goes, “It takes two, baby,” and the man also plays a key role in having a child and just as well can play a key role in problems conceiving. While the man’s biological clock may not be ticking as loudly as the woman’s, studies have shown that babies who are fathered by men older than 50 have a higher risk for autism and other development problems, according to an article in the Washington Post.

Dr. Tillman says 30 percent of cases of infertility are caused by a problem with the man. To determine if there is an issue with the man’s ability to conceive, a fertility specialist will do a semen analysis to check on the health of the sperm. If there is an issue, the man will be need to be referred to a urologist for treatment.

These problems are treatable. If a woman is not ovulating, there are medicines that she can take which can help her ovulate. The problem with fertility drugs is that they increase a woman’s chances of having twins, triplets or multiple babies, which can cause problems during the pregnancy.

Another popular procedure is intrauterine insemination (IUI), many times referred to as artificial insemination. This process can treat the male’s factor in infertility, such as slow mobility, and women who have problems with their cervical mucus. In this procedure, the sperm is washed and the concentrate it is and put it into a uterine cavity to implant it in the woman.

Another popular procedure is assisted reproductive technology, which is a group of different methods used to help infertile couples. Typically in these procedures eggs are removed from a woman’s body and mixed with sperm to make embryos which are then put back into the woman’s body. In vitro fertilization (IVF) is one of the most popular procedures which is often used when a woman’s fallopian tubes are blocked or a man does not produce enough sperm. In these procedures the doctor removes the eggs from the women and put them in a Petri dish in the lab along with the man’s sperm for fertilization and after three to five days the embryos are implanted into the woman’s uterus. Ovarian hyperstimulation is also a procedure that is used to make eggs grow if that happens to be the factor.

Bruce Shapiro, M.D., Ph.D., who is subspecialty certified in reproductive endocrinology and infertility, says the process of blastocyst transfer has been refined over the years and now presents a much lower risk of multiple pregnancies.

“One or two embryos are now placed back in the uterus,” Dr. Shapiro said.

In addition, Dr. Shapiro says research has made it possible to determine whether the uterus is receptive to the implantation of an embryo, further increasing the likelihood of success.

If after trying these procedures there is no success, a couple can use donor eggs, donor sperm or previously frozen embryos.

“Egg donation is a good alternative because 70 percent of the time it’s the egg issue and the baby can still have half the genetics and the woman can still carry the pregnancy,” said Dr. Littman.

Many times parents can go to fertility clinics and look at pictures to pick an egg donor or sperm donor that most likely resembles them so that the baby has higher chances of looking like the parents.

This procedure can be costly according to Dr. Littman as it can range anywhere from $20,000 to $25,000 depending on how much the egg donors ask to be reimbursed.

Another option is a surrogate mothers, which is a good option for women with no eggs or unhealthy eggs. A surrogate woman agrees to become pregnant using the male’s sperm and her own egg. The child will be genetically related to the father and, once born, the surrogate mother will give up the baby for adoption to the parents.

If a woman has ovaries but no uterus or it is expected that she would have a high-risk pregnancy the couple  can also have a gestational carrier. This is a procedure where a woman’s ovaries and a male’s sperm is turned into an embryo and implanted in the carrier’s uterus.

While all these procedures are good alternatives to spontaneous  conception they can also be very costly as the couple might need several cycles of treatment.

According to Dr. Littman, ovarian hyperstimulation only has a 15 to 20 percent success rate and IVF has a 40 percent success rate so several cycles might need to be done and it is very costly; furthermore many insurances don’t cover fertility treatment.

“It’s very financially draining,” Dr. Littman said. “IVF cycles can cost around $10,000 and IUI treatment can cost an average of $2,000 to $4,000  and the financial stress can cause a lot of issue with the couples health.”

Because of all the stress of keeping up with treatment and procedure and the cost of everything Dr. Littman says the whole process can cause a strain on a marriage.

“There is a higher rate of divorces and marital problems. That’s why we try to work on not having the emotional part be so stressful and we encourage the patients to be persistent with their fertility care to have the best outcomes,” said Dr. Littman.

Once a couple finally becomes pregnant Dr. Littman follows them until they are 10 weeks pregnant and then refers them to an obstetrician.

“Usually they are on progesterone supplementation and ob/gyn’s don’t know how to do that so I follow them until they’re using their own progesterone,” said Dr. Littman.