The Infertility Journey
Atlanta Infertility Treatments
This is a journey that no one intends to start, and no one can be sure
how it will end. The first step is the recognition that there may be a
problem. The formal definition of infertility is failure to conceive after
one year of exposure to pregnancy ("unprotected intercourse")
in women under age 35, or after 6 months in women 35 years of age or more.
Conception usually occurs within the first 6 months of trying.
The Way Journeys Often Start...
Most couples start on this journey at the office of the patient’s
gynecologist. During a routine exam, she may mention that she stopped
using contraception some time ago and nothing is happening.
The initial evaluation will typically be simple. Most gynecologists will
initially recommend that the patient monitor her cycles with temperature
charts or over-the-counter ovulation predictor kits to assess whether
ovulation is taking place. These monitoring exercises also serve the very
important function of verifying whether the couple is having intercourse
at the right time of the month. After this initial step, there is great
variability as to how gynecologists will manage their patients who are
trying to conceive.
Some GYNs will immediately give the patient some treatment, including:
- Clomiphene citrate (Clomid or Serophene) or Letrozole (Femara) tablets
which will enhance or establish ovulation
- A series of diagnostic tests in an attempt to establish the cause of the
infertility
- Male fertility tests (semen analysis)
- Examination of the fallopian tubes (hysterosalpingogram or FemVue)
- Hormonal assessments (blood tests)
Some GYNs will immediately refer patients to infertility specialists once
the diagnosis has been made. It is certainly reasonable for a GYN to carry
out an initial evaluation and even initial treatment but typically if
there hasn't been success within 6-12 months, it is appropriate to
see a specialist. It is recommended you consult with a specialist sometime
before your 35th birthday as the chances of conception drop after this point.
Taking the Next Step
If a couple hasn't conceived under the care of the GYN, they will generally
end up under the care of an Infertility Specialist. Usually the GYN will
make the referral, but sometimes the patient will seek out this specialized
care directly or under the advice of others who have already gone through
this type of evaluation.
Upon meeting with your fertility team, the first step will be to review
the treatment and tests you have already received. Further
diagnostic testing may be required. Once a diagnosis is established, directed therapy can
be implemented. This may include ovulation induction for the woman or
sperm preparation for the man. These therapies often prove effective,
and typically a couple will be pregnant within 3 cycles of a given treatment.
If these treatments do not work, your fertility team should start discussing
alternative treatments.
What If You Can’t Make a Diagnosis?
In some cases, all testing is normal and we cannot find the "reason"
for the couple's infertility. This is the case about 15% of the time.
Even though this may be an emotionally difficult diagnosis to deal with,
the good news is that couples with unexplained infertility have an excellent
prognosis for success with treatment.
Fertility research is always evolving. Over time, it may be appropriate
to reevaluate a patient’s situation with the newest developments
and treatments in mind. You and your doctor should work as a team during
this process, discussing new options for treatment and how circumstances
may change over time.
It Still Hasn't Happened
If simpler forms of therapy prove ineffective, it’s time to start
exploring more advanced treatments. The "big guns" of infertility
treatments are known as Advanced Reproductive Techniques (ART). There
have been many different techniques described over the years, usually
alluded to by their abbreviations such as IVF, GIFT, ICSI, TET, ZIFT etc.
Today, the dominant procedure is still the first developed—
IVF or In Vitro Fertilization.
IVF is a very powerful tool in that it bypasses non-functioning tubes,
it can minimize the impact of endometriosis, and it can bypass male factors.
The biggest change in the treatment of infertility in the last 15 years
has been the growth of IVF. As recently as 10 years ago, the best IVF
programs in the country had "take home baby rates" of 20%. The
best programs today have rates that are much higher than that.
IVF is now being recommended earlier and earlier in the treatment process.
This is not only because it is the most successful therapy option we have
available today, but also because it will treat just about all problems
which may be preventing pregnancy. As the success rates continue to rise
and as we continue to reduce the likelihood of multiple pregnancy, it
is only a matter of time before IVF becomes the procedure of choice for
the treatment of infertility.
Can I Go On This Journey If I'm Older?
Age does play a factor in the chances of creating a successful pregnancy.
The difficult part is to determine when a given woman has undergone the
transition from having "good" eggs to "bad" eggs.
Typically, egg quality diminishes between age 35 and 45, but it can occur
at any age.
Furthermore, this transition is not necessarily related to timing of menopause,
so a woman will not have any hints or symptoms that her eggs may be decreasing
in quality. By the time symptoms such as irregular cycles, hot flashes
etc. appear, it may be too late. It is imperative that a physician factors
in both the egg quality and supply when developing a treatment plan.
We carefully evaluate the situation for each and every patient and work
with them to determine whether or not proceeding with treatment is the
right option. If a woman over 35 has normal ovarian reserve, she deserves
aggressive efficient therapy. Time is of the essence and the couple should
proceed quickly through the options.
Exploring All the Options
Sometimes the couple won't be able to establish a pregnancy because
of egg quality issues. The traditional options for these couples have
been to remain as they are as a family or to pursue adoption.
Those are still the right options for many couples. For others however,
these are not the right choices. By using in vitro fertilization techniques,
we can establish pregnancies using eggs donated by another woman. This
is analogous to the situations where the husband is sterile and a sperm
donor is used. In the process of egg donation, healthy eggs are retrieved
from an egg donor and inseminated with sperm from either a partner or
donor through IVF. The resulting embryos are transferred back into the
uterus of the egg recipient. Generally, the process is fairly straightforward
and these are highly successful IVF procedures. Emotionally, however,
this may not be the right option for all couples. This is a very personal
decision and all couples should undergo extensive evaluation and counseling
to ensure that this is the right path for them on their journey to create
the family they envision.
What if Treatment Fails?
Sometimes our treatments don't work. The vast majority of couples presenting
for the treatment of infertility will be successful and will do so in
a short amount of time. Most don't need complex, expensive therapy,
such as IVF, and will conceive with more conservative treatments. Unfortunately,
some couples will not conceive.
Infertility is a loss, and one that can be very hard on the couple. Though
this is difficult, there are support groups and other resources that can
help you come to terms with the situation. It is not an easy or pleasant
process but it is a necessary one, and our staff will direct you to any
services that may help you through this difficult time.
After couples have resolved their situation, different choices will be
available. If the lack of success is due to poor quality eggs, donor eggs
have enabled these couples to be parents. Adoption is another possible
option. While treating infertile couples, we have found that the process
is as important as the outcome. We are honest and forthright with our
patients, providing them with realistic expectations from the moment they
begin discussing treatment with us. We would never advise a couple to
proceed with treatment if we believed there was little chance of a positive outcome.