What To Expect When You’re Not Expecting

 Thanks to modern technology, couples dealing with infertility can get a second chance at parenthood

Scan the mall and you’re likely to see clothes, cash and kids. For Tallahassee resident Meri Rosenbaum, the last item on the list was the problem. She and her husband, Brick, had tried to have children, but to no avail.

“When we first moved to Tallahassee, I simply could not go to the mall because there were so many babies, or somebody was pregnant,” Rosenbaum said. “It was extremely discouraging.”

Rosenbaum is one of 7.3 million women in the United States who have difficulty getting pregnant or carrying a baby to term. According to the National Center for Health Statistics of the Centers for Disease Control and Prevention, about 12 percent of women in the United States between the ages of 15 and 44 struggled with infertility in 2002.

But Dr. David O’Bryan, a partner at North Florida Women’s Care in Tallahassee, is quick to point out that infertility is not just a challenge to women.

“It is important to realize that infertility is a ‘couples’ problem and not just a woman’s issue,” O’Bryan said. “In evaluating infertility, approximately one-third of infertility can be attributed to the female partner, another one-third attributed to the male partner, and in the other one-third, both partners have an underlying condition affecting fertility.

The symptoms a woman should become concerned about are irregular or absence of periods (menses) and/or very painful menses. Male partners are generally without symptoms, though erectile dysfunction can be an issue.

Most experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have repeat miscarriages also are said to be infertile. Pregnancy is the result of a complex chain of events. In order to get pregnant:

  • • A woman’s ovaries must release an egg (ovulation).
  • • The egg must go through a fallopian tube toward the uterus (womb).
  • • A man’s sperm must join with (fertilize) the egg along the way.
  • • The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can result from problems that interfere with any of these steps.

If you suspect you might be struggling with infertility, an extensive medical history must be obtained from both partners.

“Many times, the history alone points toward the problem,” O’Bryan said. “A physical examination is also important looking for weight, body habitus (condition), abnormal hair distribution, thyroid enlargement, and abnormal findings on the pelvic exam in the female. Then, based on these findings, testing is tailored to evaluate the possible underlying cause. Blood tests to look for certain hormonal problems may be ordered and are generally done at particular times during the menstrual cycle. For men, a semen analysis is ordered. If there are concerns regarding the woman’s fallopian tubes, a hysterosalpingogram (X-ray dye test) to assess for tubal patency (‘blocked tubes’) will be done. A diagnostic laparoscopy is sometimes suggested.”

Infertility can be treated with medicine, surgery, artificial insemination or assisted reproductive technology. Many times, these treatments are combined. About two-thirds of couples treated for infertility eventually are able to have a baby. In most cases, infertility is treated with drugs or surgery.

Most local gynecologists can provide initial evaluation and basic treatments for infertility. Those who need advanced reproductive technologies such as in vitro fertilization and letrozole treatment usually are referred to the Florida Institute for Reproductive Medicine (FIRM), a highly rated infertility clinic based in Jacksonville. Patients are seen here in Tallahassee at North Florida Women’s Care twice a month. Otherwise, the closest infertility specialists (professionally known as reproductive endocrinologists) are at the Magnolia Park Clinic in Gainesville.

In the Rosenbaums’ case, after two years of trying to conceive, they were tested and referred to a reproductive endocrinologist. It was determined that they might be successful using in vitro fertilization (IVF).

IVF means fertilization outside of the body. It is the most effective assisted reproductive technology, and often is used when a woman’s fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman.

They are put in a dish in the lab along with the man’s sperm for fertilization. After three to five days, healthy embryos are implanted in the woman’s uterus.

Meri Rosenbaum marvels at the technology.

“It was an amazing process,” she said.

She remembers the day she waited for the phone call to find out if the procedure was successful.

“I was waiting for the nurse to call me and tell me either way,” Rosenbaum said. “I was already on the phone getting the news when my husband walked in the door and saw me crying. He thought it didn’t work.” But the opposite was true. She was pregnant.

The procedure was such a positive experience for the Rosenbaums that they decided to try again three and a half years later – and once again it worked. Their daughter now is 11 and their son is 8.

“I can’t imagine life without them,” Meri Rosenbaum said.

How often is assisted reproductive technology successful?

Success rates vary and depend on many factors. Some factors that affect the success rate include:

  • • The age of the partners
    • The reason for infertility
    • The clinic used
    • The type of assisted reproductive technology employed
    • Whether the egg is fresh or frozen
    • Whether the embryo is fresh or frozen

The U.S. Centers for Disease Control and Prevention (CDC) collects success rates on assisted reproductive technology for some fertility clinics. According to the 2003 CDC report on assisted reproductive technology, the average percentage of treatment cycles that led to a healthy baby were as high as 37.3 percent in women under the age of 35 and as low as 11 percent in women between the ages of 41 and 42.

Assisted reproductive technology can be expensive and time-consuming. But it has allowed many couples to have children who otherwise would not have been conceived.

The most common complication of assisted reproductive technology is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

Costs for infertility treatment are based on the underlying cause and treatments needed vary from hundreds of dollars to $15,000 and upward. Unfortunately, most medical insurance policies do not cover such treatments.

With more and more couples waiting longer and longer to have children, when should they focus on fertility? Women in their 30s who have been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman’s chances of having a baby decrease rapidly every year after the age of 30.

But no matter how old you are, it always is a good idea to talk to a doctor before you start trying to get pregnant. Doctors can help you prepare your body for a healthy baby.

They also can answer questions on fertility and give tips on conceiving.

O’Bryan said couples who have had difficulty should not get discouraged.

“In this day and age, especially with development of advanced reproductive technologies, there is hope for nearly all couples,” he said.

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