The facts of fertility
Nearly one in eight women struggles with conception
May, 2018 | Northside Woman | NorthsideWoman.com | By Candy Waylock
Lost in the celebration of all things motherhood in May, is the reality that the natural process of reproduction eludes many women who struggle with issues of infertility.In the United States, difficulties in conceiving occur in about one in every eight couples, or 12 percent of married women, according to the Centers for Disease Control and Prevention (CDC).
While breakthroughs in infertility treatment have made the option of having children a greater likelihood than in the past, the root causes of infertility remain unchanged, and often unknown.
"Infertility treatments have advanced and improved outcomes over the years, but the basic concepts of treating infertility has stayed generally the same," said Dr. Ingrid Reyes, co-founder along with her husband, Dr. John Reyes, of Modern Obstetrics and Gynecology of North Atlanta. "There are certain specific factors that affect a couple's fertility."
She noted the causes of fertility are so varied it is hard to pinpoint whether it’s primarily linked to genetics or lifestyle, or personal or family history. And so often, a women with no known risk factors, no environmental exposures, negative medical history, or other apparent reasons ends up simply with "unexplained infertility."
"It's often things that women or their partners have no control over," said Dr. Reyes, who is Board Certified and a Diplomate of the American Board of Obstetrics and Gynecology. "And I think that's one of the things we women do too much -- put so much burden on ourselves."
She says when a woman struggles with infertility they invariably think "what did I do?", or "how could I have caused this?"
Most women are unaware of their infertility issues until the point they decide to start their family.
"In our lifetimes [women] are either trying to prevent pregnancy or trying to get pregnant," said Dr. Reyes. "Most women at some point wonder if they will have any trouble conceiving. And you rarely know if you will have any trouble having children until you start trying."
She noted healthy women under 35 should try having unprotected intercourse for at least one year before seeking medical advice. Women older than 35 may want to seek medical advice after six months of trying to conceive.
Treatments for infertility begin with testing to rule out, or rule in, any factors that prevent pregnancy (for both men and women), including a physical exam, bloodwork testing, ultrasound testing, tubal patency evaluation, and/or semen analysis. At that point, your doctor will develop the most appropriate plan. [see sidebar of treatments]
Age and medical histories determine a lot of the next steps, with the age of the mother the most important determinant in female infertility.
"Egg quality and quantity are directly linked to female age,” said Dr. Reyes. “At the age of 30, 7% of [women] are infertile; that slowly increases to 11% by age 35."
Beyond that, there is a rapid increase of infertility, with one in three [women] infertile by age 40 and nearly 90 percent by age 45. At that point, conception plans may need to include a donor egg.
Although there are cases of women over 50 having babies, Dr. Reyes said it is extremely rare for anyone to spontaneously conceive beyond the age of 44. These women most likely went through either years of infertility management, had their eggs frozen at a younger age, used donor eggs, or some other combination of things.
"While a healthy, fit woman can carry a pregnancy in her 50s (and beyond) I think it sets an unfair expectation. [Conception] didn’t happen just by chance….but they don’t always speak openly about what struggles they might have gone through to do that."
But for women of childbearing age, the good news is it is possible for most women to have children of their own.
Treatment Options for Infertility
The most common interventions for infertility are ovulation induction with oral or injectable medications, intrauterine insemination, and in vitro fertilization (IVF).
Sometimes patients will need more specific care including egg donation, surgical management for fibroids or endometriosis, egg and embryo freezing, or preimplantation genetic testing.
"In-vitro fertilization is the most preferred option because of the highest chance of success in a shorter window of time. [However] there are many options before needing to move forward with IVF," said Dr. Reyes.
The basic components of the IVF process include stimulation of the ovaries to produce multiple eggs at a time, removal of the eggs from the ovary (egg retrieval), fertilization of the eggs in the laboratory, and subsequent placement of the resulting embryos into the uterus (embryo transfer).
In 2015, about two percent of all babies born in the United States were a result of successful IVF, according to the CDC. In 40 percent of those cases, IVF resulted in multiple births (primarily twins) because of the practice of implanting more than one embryo to increase the chances of success.
"There are many, many options for infertility management so I usually try to counsel my patients that it may be very quick and successful, but it can sometimes take years to find success [using] multiple different interventions," said Dr. Reyes.
She said she encourages her patients to not give up, even after years of trying, although they may need to take breaks from the treatments.
Looking ahead, Dr. Reyes said advances in fertility treatments are promising, especially in the success rates of IVF. In fact, the process has become so successful that most women are being advised to only implant one egg.
One promising technique is preimplantation genetic testing where an embryo can be tested for specific genetic traits to preclude passing on debilitating disease.
"While this is an incredibly deep ethical issue, it also is a powerful opportunity for the women to [choose not to have a child] who will inevitably have a very difficult life. But there are always concerns about how far should/will this go," said Dr. Reyes.
Egg freezing/egg banking is also an option for women who want to defer their child-bearing. It has been used for women undergoing medical treatments that could impact fertility, and also for women who want to wait to have kids until they've established a career, find a partner, or for other reasons.
"Again, the field of infertility management has its own ethical dilemmas, but these are powerful options that women can take advantage of," said Dr. Reyes.