MAX HEALTH

A Private
Heartache:
Facing
Infertility
BY LINDA HEPLER, BSN, RN

Remember that birds and

bees talk when you were
an adolescent? Invariably, it
included a caution against
unprotected sex because it
only takes once to conceive
a baby. But for those couples
experiencing infertility,
conception is not that easy.

Infertility or the inability to conceive

after one year of regular, unprotected
intercourse affects more couples than
you may think, said David Adamson, MD,
founder and CEO of ARC fertility. Over
their lifetime, about one couple in six will
have diffculty getting pregnant when
they want to, he explained.
According to Dr. Adamson, the
underlying cause of infertility can be
determined to be a problem with the
females reproductive system in about
50 percent of cases, and with the males
reproductive system in about 25 percent
of cases. In some instances, the problem
is a combination of both female and
male issues, and in fewer situations, a
cause of infertility cant be found. This
is called unexplained infertility, he said.
This condition is probably caused by
as-yet-unknown egg, sperm, genetic,
immunological, and other conditions.

Conception 101

If you remember back to your 7th grade

sex education class, there are a number
of events (other than intercourse) that
must occur harmoniously in order to
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make a baby. First, during the beginning

phase of the womans menstrual cycle,
the hormones FSH and LH are released
from the brain, where they travel to the
ovaries, stimulating the growth of some of
her immature eggs in their shells (follicles).
These hormones also stimulate the
production of the hormone estrogen, which
eventually causes FSH to turn off limiting
the number of maturing follicles. During this
time, one of the maturing eggs becomes
dominant, and continues to produce
estrogen, while the remaining follicles die
off.
The rise in estrogen triggers a surge in
LH, which stimulates the dominant follicle
to release its egg, causing ovulation.
The egg is then captured by the fmbriae
(projections on the end of the fallopian
tubes) and swept into the tube, where it
awaits fertilization.
Once the follicle has released its egg, it
develops into the corpus luteum, a structure
that secretes yet another hormone
progesterone which prepares the uterus
for a fertilized egg to implant. Prior to this,
the womans cervix has begun to increase
the amount and thickness of mucus
production, so that if intercourse occurs,
it can capture the sperm and help guide it
toward the egg for fertilization.
If all goes as planned, the sperm will
travel to and fertilize the egg (conception),
and then the newly developed embryo will
travel down through the fallopian tube and
implant successfully into the wall of the
uterus. But there are many things that
can go wrong in this process.

Conception Challenges

In the womans body, abnormal levels of the

hormones needed to orchestrate ovulation
and implantation, a blockage of the fallopian
tubes, fbroids or polyps in the uterus, or
even abnormal cervical mucus can cause
a pregnancy to fail, said Dr. Adamson.
Common male problems that contribute to
infertility include decreased sperm count
or motility (movement), abnormal shape
of sperm, as well as varicoceles (a vein
abnormality in the scrotum).
And a womans age is a very important
factor affecting fertility, said Jane Frederick,
MD, medical director of HRC Fertility in
Newport Beach, California. According to
Dr. Frederick, a woman is born with a fnite
number of eggs. Throughout her life, the
majority of these immature eggs will die,
many prior to puberty, then more with each
menstrual cycle. About 10 years prior to
menopause (approximately at age 40), few
follicles remain. This means that fertility
declines rapidly as we approach that age.

That biological clock is a very real thing,

she claimed.
The good news is that for many couples,
there is an easy enough fx. There are
easy tests that can be done when a couple
comes in for a fertility consultation, Dr.
Frederick explained. In addition to a
physical examination, these include blood
work to determine levels of reproductive
hormones, and ultrasound testing to
measure the follicle count in the ovaries
and to rule out polyps, fbroids, and uterus
abnormalities. A hysterosalpingogram
(HSG, an x-ray procedure) will determine
if the fallopian tubes are blocked. For
males, a semen analysis can be done as
well as a scrotal ultrasound if needed, to
detect a possible varicocele. Following the
results of the testing, the vast majority of
couples can be helped with medications (to
treat hormone imbalances and stimulate
ovulation), or simple procedures to correct
problems such as fallopian tube blockage
or varicoceles. Only about two percent
of infertile couples need high technology
treatments such as in-vitro fertilization
(IVF), said Dr. Frederick.
When to see a fertility specialist?
Women younger than age 35 who
are having regular intercourse without
contraception who are not pregnant after
one year should see a fertility specialist,
said Dr. Adamson. For those aged 35-40,
seek help after six months, and if 40 or
older, after three months.

High-Tech Treatments

When a simple fx for infertility isnt

possible, fertility experts have several more
advanced treatment options available,
said Rashmi Kudesia, MD, assistant clinical
professor of reproductive medicine at the
Icahn School of Medicine at Mount Sinai
and reproductive endocrinologist and
infertility specialist at RMA of New York.
Two of the most widely used treatments are
intrauterine insemination (IUI) and in-vitro
fertilization (IVF).
IUI is a procedure where processed
sperm (sperm that have been washed to
concentrate the hardiest specimens into a
small amount of fuid) are inserted through
a small tube (catheter) into the uterus. IUI
may be combined with fertility medications,
which are used both to induce ovulation and
to stimulate the ovaries to produce more
than one mature egg. The goal of IUI is to
increase the number of sperm that reach
the fallopian tubes to better the chances
of conception. It is a frst-line treatment
used in situations of unexplained fertility,
low sperm count or motility, problems with
ejaculation, or cervical problems such as
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scarring (which may hinder the sperms

ability to enter the uterus). It is also
used for those requesting donor sperm
insemination. Couples may require more
than one cycle (round of treatment) in
order to conceive.
Although far less expensive than IVF,
IUI is also less effective, with success
rates highest in women under age 35.
In the best prognosis patients, said Dr.
Kudesia, IUIs have a success rate per
cycle of approximately 20-25 percent.
Another disadvantage of IUI, he added,
is that when this treatment is combined
with fertility medications, there is an
increased risk of multiple births.
IVF is a procedure in which the
ovaries are stimulated with fertility drugs
to produce multiple mature eggs, then
the eggs are retrieved from the ovaries
via a minor surgical procedure, examined
for maturity and quality, and sometimes
screened for chromosomal abnormalities.
The best quality eggs are placed
together with sperm in a culture medium
and incubated overnight. In some cases,
intracytoplasmic sperm injection (ICSI)
may be used to directly inject a single
sperm into each mature egg. After
confrming that the eggs have been
fertilized, they are allowed to develop
for as long as six days, then one or
more embryos (a maximum of three) are
transferred to the womans uterus via a
catheter. IVF is used when IUI has failed,
in situations of very low sperm count,
when the fallopian tubes are blocked or
damaged, or when donor eggs are being
used. It is often the frst-line treatment
for older women who want the highest
possibility of conception without delay.
According to Dr. Kudesia, IVF has been
used since the late 1970s, but success
rates have improved exponentially.

Current trends in IVF are moving

toward the transfer of a single embryo to
decrease the risk of multiple births. And
when the embryo has been screened for
chromosomal abnormalities, the success
rate with a single embryo transfer can be
quite high, approaching 50 percent in
the youngest patients, he added.

Cost of Treatments

While many insurance companies pay

for infertility testing such as blood
work, ultrasounds and x-rays as well as
surgical procedures or medications to
correct reproductive problems, few pay
for fertility treatments such as IUI and
IVF, making these procedures too costly
for many couples to consider. According
to RESOLVE, the National Infertility
Association, the national average cost
for one cycle of IUI, using your partners
sperm, is $900. IVF is even pricier with
an average cost of $11-12,000 per cycle,
more than double this fgure if using
donor eggs.

Planning for the Future

Young adults should plan their

reproductive life just as they plan their
education and employment, said Dr.
Adamson. For a young woman who
wishes to delay childbearing until her
mid-30s or beyond, elective egg freezing
may provide an insurance policy against
ovarian aging.
Egg freezing is becoming popular
these days, since studies have shown
that using frozen eggs for IVF is
comparable in success with using fresh
ones. But theres a hefty price tag
attached: Egg harvesting costs about
$10,000, storing the frozen eggs about
$1,000 per year, and using them an
additional $5,000. MS&F

Boost Your
Baby-Making
Potential

According to the fertility experts,

there are some things all couples
can do to optimize the chances
for pregnancy:
FOR BOTH WOMEN AND MEN

Maintain a healthy weight. Both

being overweight and being underweight
can interfere with male and female
reproductive hormones.
Eat a healthy diet, with plenty of fruits
and veggies.
Exercise, but not too much. Excessive
exercise can throw of your hormone
levels.
Dont smoke or use recreational
drugs, and limit alcohol use.
Avoid environmental toxins, such as
household, lawn and garden chemicals,
heavily sprayed foods, and plastics.
These are endocrine disruptors that
can interfere with the reproductive
system.
Make sure any chronic illnesses, such
as diabetes or thyroid issues, are wellcontrolled. Some chronic illnesses can
cause ejaculatory problems or difculties
with ovulation.
See a doc if you suspect a
reproductive infection. STDs such as
Gonorrhea and Chlamydia can scar
or block fallopian tubes and cause
problems with sperm quality.

FOR THE LADIES

See your gyno regularly, especially
if youre experiencing pelvic issues.
Problems such as uterine fbroids,
hormonal imbalances, and endometriosis
can lower pregnancy potential.

FOR THE GUYS

"Since its intoductio

in the U.S. in 1981,
IVF and othe simila
techniques have
resulted in moe than
200,000 babies."
Source: WebMD.com

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Keep things cool down there

by avoiding hot tubs, prolonged
sitting, or laptops on the lap. Heat
causes decreased sperm motility and
production.
Get regular action. Of course its
important to have sex during your
partners ovulation. But recent research
indicates that sperm are healthiest with
no more than a few days of abstinence
at a time.
Ditch the soy. Tofu may be great for
your heart but it may adversely impact
sperm health.