When Heather Patterson hadn’t conceived after trying 18 months for a second child, she consulted her physician. At 32, she dropped her jaw when he told her she had begun early menopause. “I cry a lot now,” she said. “Especially when I receive baby shower invitations.”
In longing for a child, Heather has plenty of company, as researchers estimate that one in six couples of childbearing age experience infertility. Infertility is defined as the inability to conceive after a year of unprotected intercourse or to carry a child to term.
Of those seeking treatment, roughly half eventually conceive. For those who seek no medical intervention, only about 5 percent achieve pregnancy. So for many patients, the advice to “take a vacation” serves as an irritant.
“Most patients describe infertility as a roller coaster of up-and-down emotions,” says Susan Claerhout of RESOLVE, a national infertility support organization. Susan experienced a miscarriage followed by years of trying to conceive. “Miscarriage is a compressed loss; failure to conceive is a drawn-out loss. You have hope during treatment followed by that monthly reminder that you’ve failed. You give up your privacy as you endure poking and prodding; you experience “love by the calendar,” which can destroy the greatest of romances; you loathe Mother’s Day; and with most couples, one partner feels more of a longing to have children. ‘Being at different places’ can be agonizing. People think stress causes infertility; actually, most of the time, infertility causes stress.”
Infertility rates sixth among 43 major life stresses, according to some psychologists who study infertility. “Yet the rest of the world doesn’t even acknowledge it,” says one of the Rutgers researchers who conducted the study.
Patients typically experience a “grief cycle” in which mentally healthy patients move from denial to sadness, anger and depression and then eventually to resolution. “Infertility was a grief cycle within a grief cycle for me,” says Mary McLaughlin, a patient treated for unexplained infertility. “The monthly cycle of despair followed by hope fell within the larger grief cycle, leaving me wondering if I’d ever be free.”
Mary eventually adopted. Afterward, her doctor discovered a minor infection that she and her husband kept giving each other. Following a round of antibiotics, she conceived. “I understand that only 5 percent of women conceive after adopting. That’s the same percentage as those who seek no treatment,” she says. “But I’m amazed at how many times people assume my adopted child served as a placebo. They used to say, ‘Adopt and then you’ll get pregnant.’ Part of me hurt that my story gave people ammunition for hurting my infertile friends.”
Even though modern technologies have improved the chances of having a baby, nearly half of those who undergo treatment remain childless. These couples ultimately face the question of when to stop.
“Often people accuse patients of ‘baby craving,’ as though couples believe their genetics are superior. They don’t understand the longing that drives couples to stay in treatment. How can you place a value on creating a child together?” says Susan, who stopped trying several years ago. “Nevertheless, it’s time to stop when it hurts more to go on than it does to quit.”
Causes of infertility include immunological abnormalities, delayed childbearing, failure to ovulate, structural damage to the reproductive tract, low sperm count, and sexually transmitted diseases, to name a few.
Though many consider it a “women’s health issue,” men and women actually share medical diagnoses equally: roughly 30% of infertility’s causes are in the female, 30% in the male, 30% are shared by both partners, and 10% of cases remain unexplained. Uterine infection or scarring following childbirth can also create problems, and the odds of conceiving her cycle drop drastically in the upper 30s. So couples “trying again” may face increased difficulty.
Physicians encourage women under 30 to try for a year before seeking help. Those approaching their mid- to upper-30s may want to cut that time to six months. And though couples with multiple losses still have good odds of having a baby, after two or three miscarriages, they should seek medical evaluation.
Few health plans cover treatment unless doctors list specific diagnoses. For example, companies may cover tests for “endometriosis” or “polycystic ovarian disease,” but not “infertility.” Many insurance plans label infertility “elective,” lumping it in the same category as cosmetic surgery. One patient gave up a career in public relations with a company whose plan excluded infertility for a minimum-wage job with an organization offering the benefits she needed.
Women generally consult their OB-GYNs first. “Many physicians say they are experts in infertility when they are not,” says Theresa Venet Grant, co-founder and public information director for INCIID (International Council on Infertility Information Dissemination, Inc.). Samuel Marynick, M.D., an endocrinologist at the Baylor Center for Reproductive Health suggests that some OB-GYNs understand and can evaluate infertility well; some cannot. Most OB-GYNs know nothing of male infertility. He suggests, “If you have been with a physician six to twelve months and don’t have a diagnosis or a pregnancy, it seems reasonable to pursue another option.”
Reproductive endocrinologists now offer a growing number of treatments.
Fertility drugs. Doctors may prescribe fertility drugs when tests reveal a hormone imbalance in either male or female. And recently the odds of overcoming recurrent pregnancy loss have improved with medicines which treat immune disorders. Unfortunately, some medications come only in injectable form and require constant monitoring. And because some drugs “hyper-stimulate” ovaries to produce many eggs, they increase the risk of multiple pregnancies.
One cycle on the stronger medications can run into thousands of dollars. Some couples lacking insurance go to Mexico or France , where they can purchase medications legally for a fraction of the U.S. cost. Daily consultations, blood tests and sonograms add to the expense of drug treatment.
Some studies associate ovarian cancer with two commonly-used medications. In reality researchers found only one additional case of cancer in every 6,395 women treated for more than one year with Clomid. And many doctors suspect that the condition which caused these women to need drugs may have been the cancer link, rather than the drugs themselves.
Surgery. Diagnostic surgery can uncover hidden causes of infertility. And corrective surgery may not eliminate infertility, but it often helps. Surgeons may correct fallopian tube blockage or endometriosis, which affects the uterine lining. In men, they may repair structural damage and varicose veins in the testicles.
Intrauterine insemination (IUI). In this procedure, the doctor uses a catheter to place specially-prepared sperm directly into a woman’s uterus. Couples using a donor’s sperm run only an extremely low risk of AIDS, according to Gary Ackerman, M.D., a reproductive endocrinologist at UT Southwestern. The most careful programs freeze sperm for six months and then release it only after the donor has been re-tested for the virus. Each cycle of IUI costs several hundred dollars.
In vitro fertilization (IVF). IVF has become more common since the first “test tube baby,” in 1978. Louise Brown’s father’s sperm fertilized her mother’s egg in a tissue culture dish. Within 36 hours scientists transferred the fertilized egg to her mother’s womb, where it grew. This procedure offers hope for women with blocked tubes.
Today assisted reproductive techniques (ARTs) have many variations. For example specialists may mix sperm and eggs in the fallopian tubes to encourage fertilization in its natural environment. Or egg and sperm may “meet” in glass, and then be transferred to a healthy fallopian tube, where an embryo can travel to the uterus as it would in a normalconception. Various micromanipulation procedures are available for overcoming male factor fertility problems.
A woman who produces no eggs but who has an intact uterus can opt to use donor eggs. Because the process of freezing eggs is unperfected, this involves synchronizing her cycle with the donor’s, whose ovaries are stimulated with fertility drugs. Reproduction care givers then retrieve the eggs, expose them to sperm and transfer resulting embryos to the recipient’s uterus.
One relatively new technique involves injecting one sperm directly into the egg. This helps men with low sperm counts or with sperm that are too weak to penetrate the egg. Specialists generally recommend ARTs only after couples have exhausted other reasonable options. It can be expensive ($10,000+), and physicians recommending it for their patients usually point out the high odds of failure.
Surrogacy. This involves using another woman’s uterus and her egg (traditional surrogacy) or the couple’s embryo (gestational surrogacy). One clinic estimates the average cost at $50,000, and the legal headaches dominate media coverage.
Reproductive technologies continue to evolve, creating ethical mine fields while offering new hope.
“I appreciated the sensitivity of my friend who sent a note breaking the news to me that she was finally pregnant,” says Heather. “She wrote, ‘Infertility is so difficult. Call me when you feel like it. Believe me, I understand.’
“I’m glad she got out. I ran to make the call.”
This article first appeared in Dallas Family.