This is a complex and emotional topic.
Every woman I know walks the path of motherhood in some fashion. We are preventing pregnancy, planning for pregnancy and praying that when we are ready, our body will cooperate. The American Society For Reproductive Medicine states that “11% of women in the US (about 6.7 million)” struggle with infertility. You are not alone.
Rebecca Usadi, MD, of Carolinas Healthcare System Reproductive Medicine and Infertility took the time to answer our questions about infertility,offering a foundation of information and connecting us to resources should we choose to delve further.
1. At what point should I consider seeing a doctor if I am unable to get pregnant? After six months? A year?
If you are over 35, or have irregular menstrual cycles or existing medical conditions (PCOS, endometriosis, thyroid disease), six months is enough time to wait. Conversely, if you are under 35, and have regular menstrual periods and no pre-existing medical conditions, practitioners suggest trying to conceive for a year before seeking infertility advice.
And your OB/GYN can even do the initial testing and referral to a fertility specialist if necessary.
2. What is infertility exactly? What are the causes? Risk factors?
Infertility is defined as not being able to get pregnant after having a year of unprotected intercourse. The most common cause is age, however there can be a number of factors playing a role including: ovulation problems, blocked Fallopian tubes, low semen count, endometriosis and thyroid conditions. About 15 percent will have what is referred to as “unexplained infertility.â€
While some of the medical conditions (polycystic ovarian syndrome-PCOS, thyroid) are hereditary, the two other risk factors for infertility are smoking and weight (being overweight or underweight). In our practice, we have a seminar called “fertility fitness†that helps patients focus on achieving a healthy weight range for conception.
3. Are there signs or symptoms of infertility?
Most couples don’t know they have a fertility problem until they stop using birth control. So, typically, there are no symptoms.
4. This isn’t just a female issue. Can you discuss male infertility? Causes, signs
This is definitely not just a woman’s issue – 20 to 30 percent is caused by male infertility. Your gynecologist can recommend a semen analysis, which would be done by a fertility specialist. Low sperm count is relatively easy to treat. Again, there are usually no signs or symptoms, so the only way to know is through diagnostics.
5. Tell me about the diagnostic process for myself and my partner.
The basic evaluation can be done by an OB/GYN who will then make a recommendation regarding further diagnostics. The evaluation will consist of:
- An ovulation test
- A semen analysis
- An analysis of fallopian tubes, uterus and ovaries by ultrasound
- A blood panel
A fertility specialist will look at these tests and recommend a course of treatment based on each couple’s needs. The treatments will vary, but the good news is most causes of infertility are treatable.
6. Women are waiting longer to start families. Give me the honest doctor’s opinion on age and infertility.
Age does play a role in infertility. The truth is, delaying having children can make it difficult to conceive. Natural fertility begins to decline at age 30. Women are born with a certain number of eggs. By age 40, you have a lower number of eggs and the quality of those eggs can make it difficult for them to fertilize and implant. The time to discuss family planning is in your 30s. I recommend talking honestly with your partner about timing.
If there is no partner…yet, consider egg banking – a revolutionary process of capturing a woman’s healthy “young†eggs and preserving them for future use. Egg banking is more successful when done before 35. So, again, don’t delay.
7. What are the treatment options for infertility?
Every couple will need to be evaluated and receive a treatment protocol based on their needs. With that in mind, here are the basic forms of treatment:
- Ovulation induction pills which are easy to take, relatively inexpensive but do have some side effects. The most well-known is Clomid. The pills help a woman ovulate and can be used with IUI and IVF or alone to achieve pregnancy.
- Intrauterine insemination (IUI) is a procedure that involves placing sperm inside a woman’s uterus to facilitate fertilization. This is done in the office and timed with ovulation.
- Injectable hormones which carries significant risk of multiple births is used generally as a last resort.
- In Vitro Fertilization (IVF) is the process of fertilization by combining an egg and sperm in a laboratory and then transferring the egg into the uterus.
8. IVF is the most talked about treatment. Can you tell me exactly what IVF is?
This procedure is done in the office over a few days and requires a series of steps:
- Monitor and stimulate the development of healthy egg(s) in the ovaries.
- Collect the eggs.
- Secure the sperm.
- Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
- Transfer embryos into the uterus.
9. Once I am diagnosed and have gone through the treatment process, how long will it be before I conceive?
I can’t predict. I wish I could because this is the answer that every patient wants to know. Once you and your partner have been diagnosed, I will recommend a given protocol for three cycles. If there is no success, then I will change the protocol. My goal is to help you conceive in the safest, most effective way.
10. Does insurance cover the diagnostic and treatment of infertility?
Many insurance companies will cover the screening and monitoring process. I recommend calling your insurer to verify benefits. Sometimes patients are surprised by what is actually covered.
11. I feel like this could be stressful on my relationship. Are there counseling services available for couples going through infertility?
Absolutely. Infertility can be stressful for both partners. There are excellent therapists specializing in infertility issues. I refer my patients and encourage them to take advantage of this resource. I also recommend acupuncture to my patients to reduce stress levels.
12. Can you recommend a book/website?
The book I recommend to all my patients is Conquering Infertility: Dr. Alice Domar’s Mind/Body Guide to Enhancing Fertility and Coping with Infertility.
The website I recommend is: American Society of Reproductive Medicine. Its is a wonderful source of current information.
To further discuss evaluation/diagnosis and treatment options, make an appointment with a specialist at Carolinas HeathCare System Reproductive Medicine and Infertility. Knowledge of your situation and the guidance of a professional can be the best tools for tackling infertility.
Rebecca S. Usadi, MD
Dr. Rebecca Usadi is the associate director of Carolinas HealthCare System’s Reproductive Medicine and Infertility team in Charlotte, North Carolina. She received her medical degree from Duke University School of Medicine and has been in practice for 19 years.
Carolinas HealthCare System Reproductive Medicine and Infertility
Morehead Medical Plaza
1025 Morehead Medical Drive, Suite 500
Charlotte, NC 28204
To schedule an appointments, call 704-355-3149.
