Finding the Infertility Treatment That is Best for You
Getting pregnant may not always be as simple as people expect.
More than six million couples in the U.S. struggle with problems conceiving. It can be confusing, embarrassing, intimidating and even overwhelming for couples to decide just what to do about it.
To help, UW Health's Generations Fertility Care specialists held a Community Talk to help couples understand what approaches might work best for their situation.
Doctors recognize there aren't unlimited resources, so they look for how to maximize a couple's chances of conception.
The best candidates for natural conception usually include couples where:
- The woman is younger than 35, has good ovarian reserve, and has open and mobile fallopian tubes
- The man has good sperm
- A gradual approach to conception will not cause undue stress for the couple.
For couples who fit those criteria, there are ways to stack the deck in their favor, including:
- Avoiding spermicidal lubricants
- Minimizing NSAIDS (Motrin, Alleve, and other non-acetaminophen (Tylenol) pain relievers) around the time of ovulation (for women taking higher doses for chronic issues such as migraines)
- Stopping smoking and minimizing alcohol consumption
- Undergoing a preliminary evaluation by a health professional
- Having opportunities for conception to occur
When a couple decides to start trying to conceive, it is recommended they see a health professional, whether it is a couples' primary physician, nurse practitioner or even a fertility specialist.
Assisted Reproductive Techniques
For couples for whom assisted reproductive techniques become necessary, generally there is a stepwise approach to determining where to start treatments:
- Natural conception
- Intrauterine insemination (IUI) with oral medication
- Intrauterine insemination with injectible medication
- In vitro fertilization (IVF)
Dan Lebovic, MD, medical director of Generations Fertility Care, explained that there are three issues that are taken into consideration when deciding where to begin treatments:
- Ensuring everyone is comfortable and agrees on the level of treatment
- Expectations of results
A couple may not be willing to take particular risks associated with a treatment, and it's important that they have realistic expectations of the results.
"Normal fecundity for a couple with no problems is around 20 percent," explained Dr. Lebovic. "That is the chance of conceiving each month. Over a year's time, there is a 85 percent chance of conceiving."
The rate drops to around 1 to 4 percent per month for couples experiencing unexplained subfertility, a condition where there is no known cause for infertility.
Using unexplained infertility as an example, Dr. Lebovic explained that by undergoing treatment a couple's chances of conceiving could range from 4 percent using IUI alone to as greater than 30 percent using IVF (and as high as 40-50 percent). In helping a couple, it is a matter of fine tuning.
"Each couple is different in determining how long to stay on each step," commented Lebovic.
There are potential side effects with fertility medications and the cost can be significant. Often, it is the financial aspect that determines couple's willingness to stay with a treatment. In Wisconsin, most fertility treatments are not covered by insurance, although Generations Fertility Care offers numerous financial options to assist couples receiving care.
In undergoing fertility treatments, it is critical that men undergo a routine evaluation as well, although frequently they don't.
There is a notion in the general public and the medical community that the problem is due to the woman, and not the man. Yet, in approximately 50 percent of infertility cases, men are part of the cause.
- Access to care - couples may not have access to a urologist specially trained in male infertility
- Perception - both the general public and the medical community frequently perceive infertility as strictly a female problem
- Success of fertility treatments - because assisted reproductive techniques are so successful, often the male side is overlooked
"The goal of a male factor evaluation is to identify potentially correctable conditions that, once corrected, could allow for natural conception," explained Williams.
Through an evaluation, doctors can also determine whether there are irreversible conditions and conditions not amenable to assisted reproductive techniques.
"We can spare couples the stress of attempting ineffective therapies if we know the underlying cause," commented Dr. Williams.
An evaluation also extends beyond fertility issues as well. Through an examination, doctors can identify any potentially life- or health-threatening conditions.
Yet even after a thorough evaluation, it may not be possible to determine the cause of a man's fertility problem.
"While varicocele is the leading cause of infertility in men, the second is idiopathic, which means we don't actually know why there are difficulties," said Dr. Williams.
Despite that, there are infertility treatments that may make conception possible.
Charles Bormann, PhD, Generations IVF/Andrology lab supervisor, explained that even when there is no sperm, there are retrieval techniques that can procure enough for a couple to undergo treatment. The key is that the sperm are healthy.
"There are a lot of parameters that indicate healthy sperm," said Dr. Bormann. "It's not just about the number."
Even when the sperm aren't entirely healthy, there are options available to couples including IVF with ICSI that can improve the chances of conception. Even then, IVF isn't a guarantee.
Emotional Aspects of Infertility
"Sometimes the treatments are as hard as the condition," comments Julianne Zweifel, PhD, the clinical psychologist at Generations. Her role is to help couples maintain a quality of life while they're experiencing infertility.
When a couple first decides to try and conceive, they are filled with tremendous excitement. But that can give way to uncertainty when it is more difficult than anticipated. Couples are left wondering how long to continue trying and unsure of what the problem is.
"When couples experience infertility, they often have feelings of unfairness, worry about the long term, concerns about being judged and a sense of isolation," said Dr. Zweifel.
Dr. Zweifel is available for both couples and individual counseling and in some cases, such as when a couple is undergoing an IVF. Though not mandatory, seeing her often helps alleviate many stressors and barriersin the process.
"A lot of people are mystified about seeing a psychologist," commented Dr. Zweifel. "In reality, it's a focused discussion to get out the different emotions, thoughts and worries. Get a little sunshine on the issues."
While a wide range of topics is usually discussed, everything from treatment options to personal beliefs, the end result is to help the couple come back together and resolve the emotional strain.
"It's to help couples have the sense of quality of life and emotional strength as they get through their treatments," concluded Dr. Zweifel.
Date Published: 12/02/2009