Monday Medical: Options for infertility
March 19, 2018
If you're struggling with infertility, you're not alone. In the United States, about 6 percent of married women up to age 44 are unable to get pregnant after a year of trying while 12 percent of women up to age 44 have used infertility services.
But even with a diagnosis of infertility, pregnancy may be possible.
"It's something that needs to be evaluated, and then you can see if there's a treatment," said Dr. Jeff Chamberlain, an OB-GYN with UCHealth Women's Care Clinics in Steamboat Springs and Craig. Below, Chamberlain outlines things to consider if you're dealing with infertility.
Reasons often aren't clear
There are numerous known causes of infertility, including issues with ovulation, hormones or the reproductive tract. Lifestyle issues such as diet, a low body mass index or use of alcohol, tobacco or marijuana can also play a role.
But in many cases, the reason for infertility isn't clear.
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"Sometimes, it's obvious, and you can zone in on an issue," Chamberlain said. "But it's pretty common to not have a known cause by the end of all of it."
The older a woman is the more difficult it is to get pregnant.
"After around age 35, women begin to ovulate with poorer quality of eggs and often less frequently than at a younger age," Chamberlain said. "That's even more true at age 40. If you're over 40, the chance of getting pregnant during a menstrual cycle is 10 percent or less. If you are 20 to 30-something, that percentage is in the 25 to 35 percent range."
For women as old as age 35, infertility is defined as not becoming pregnant after a year of regular sexual intercourse without the use of any birth control. For women older than 35, the diagnosis is made after six months. Women who are 40 or older or who have irregular menstrual cycles may consider immediate infertility evaluation.
"Be open to discussing any concerns of infertility with your primary care provider or OB-GYN," Chamberlain said. "The sooner you bring it up, the sooner we can see if it's even a concern you need to have."
An infertility evaluation is the best first step
Infertility testing is very personalized and based on factors such as a patient's medical history, family history and lifestyle. Typically, tests for women include blood work, a review of ovulation patterns and an ultrasound of the pelvis while men undergo a semen analysis.
An OB-GYN doctor is a good place to begin, but patients may ultimately be referred to a fertility specialist, also known as a reproductive endocrinologist.
Before starting an infertility evaluation, it's a good idea to call insurance and understand your benefits.
"It is a big question that almost every patient has, and it's an easy phone call to make to double check," Chamberlain said.
Infertility treatments are available
Options include hormone treatments to encourage regular ovulation, lifestyle changes such as maintaining a healthy body mass index and limiting use of alcohol and drugs or even surgery to treat endometriosis, fix a blocked fallopian tube or remove polyps or fibroids.
Another option is in vitro fertilization, in which eggs and sperm are combined in a laboratory, and then an embryo is transferred to the uterus.
"Whether or not a couple needs to go down the IVF road is a very personalized decision based on the couple's age, what they've tried before, resources available and what they're willing to go through," Chamberlain said.
At the end of the day, Chamberlain encourages couples to do their best to practice patience and stay optimistic through what is often a difficult, heart-wrenching process.
"Being optimistic is hard, but we have lots of tools for evaluation and treatment, which helps," Chamberlain said. "It takes a big commitment from both partners."
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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