Treading Infertile Grounds
I’ve seen it a dozen times: a bride and her new husband walk down the aisle to join their guests at the reception and are accosted by an elderly relative with the question: “So, when are you going to start having kids?” The question assumes that every couple has a proverbial biological clock that begins ticking the moment after the wedding cake is served. But it also assumes that the option to start a family whenever the mood strikes is a guarantee. However, the harsh reality for nearly 15 percent of couples is that when, or if, they start a family is not within their control. Thanks to the miracles of modern medicine, couples suffering from fertility issues have several options.
Infertility is not a “women’s” issue – it affects both men and women equally. Therefore, the first essential step in treating infertility is to test both the man and woman. Doctors will usually test for infertility after a couple has tried to conceive for one year, although testing may occur in as little as six months if the woman is over 35. Because treatments may last for months or even years, and the success rates decrease as a woman ages, it is important not to delay testing. Whether you are suffering from primary infertility (never been able to get pregnant) or secondary infertility (been able to conceive in the past, but now have a problem), the key is to find the cause and then cater treatments to your specific condition and age.
Reproductive Medicine Associates of Pennsylvania (RMA) offers various treatments including fertility surgery as well as in-vitro fertilization (IVF). IVF, a successful but expensive procedure that has been around since 1978, involves removing mature eggs from the woman’s ovaries, fertilizing the eggs with sperm in a test tube and then implanting embryos into the uterus. RMA is also embarking on a new procedure called comprehensive chromosomal screening, which involves testing embryos for chromosomal abnormalities before implanting them into the uterus. The goal is that screening before implantation will improve pregnancy success rates by avoiding implanting eggs that are likely to miscarry because of anomalies.
No matter the procedure, the process of treating infertility can be an emotional roller coaster ride. “I had to take pills, my husband had to inject me every day with hormones, and then I had to go through surgery to remove eggs,” says Emily*, a woman who went through five cycles of IVF treatments. “The hormones left me feeling emotional and weepy, and there was this underlying stress of knowing how much this was costing us and the realization that it might fail.”
Unfortunately, failure is always a possibility and the psychological toll of waiting for pregnancy results can be intense. “After my embryo was implanted, all I could do was wait,” says Emily. “And all I could think about while I was waiting is that ‘it has to work because I can’t go through IVF again’.” Dealing with the expense, the hormones and the knowledge that there are no guarantees of success means that stress management is an important component of treatment. “I encourage patients to try yoga and acupuncture, and we have a [massage therapist] that comes into the office on Fridays,” says Wendy Shillings, M.D., an infertility specialist with RMA. “On a daily basis we are going from room to room doing ultrasounds, some with happy results, while [for] others it’s unhappy. I have patients who feel like ‘I’m young and healthy I shouldn’t have to go through all this’. It can be a difficult process.” Shillings emphasizes that one-on-one patient care is extremely important.
The pain, the expense, the stress – one might wonder why people go through all of this when they could adopt. “I think it’s the desire to give the child the best start,” says Bruce Rose, M.D. Ph.D., a reproductive endocrinologist with Infertility Solutions. “To know the child is well cared for from the very beginning.” Emily agreed and also added that the perception of numerous unwanted children lined up waiting for a family to take them in is false. “It’s very difficult to adopt; we were told that we may never get a child and even if we did, [the process] would be extremely expensive.”
Before seeking treatments, educate yourself about your options and build a support network to help you get through it. “When I was going through IVF I felt isolated,” Emily says. “It was on my mind all the time but I couldn’t talk about it because I was afraid how people would react. People have such a negative perception of it, like it’s selfish to do this.” But in the end, both Emily and her husband agree that the ends justified the means. “Once we had our child, everything was forgotten,” she says. “Once I held my baby I knew it was all worth it.”
*Name has been changed to protect privacy.
Dr. Bruce Rose, M.D. Ph.D., reproductive endocrinologist
1275 South Cedar Crest Boulevard Suite #3
Allentown, PA 18103
Dr. Wendy Shillings, MD, infertility specialist
Reproductive Medicine Associates of Pennsylvania
1401 North Cedar Crest Blvd, Suite 200, Allentown
To check for success rates at infertility clinics: www.sart.org