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New Approach to Infertility Care

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Couple walking; UW Health's reproductive endocrinology and infertility experts can help couples when they have difficulties conceivingMADISON – Infertility is a silent crisis, one that has profound emotional consequences for the more than 6.1 million couples in the U.S. facing challenges in having children.

Feelings of frustration, sadness, isolation and uncertainty are common when a couple has difficulty conceiving. Yet many couples aren't sure when to consider these challenges a problem, let alone how to deal with it. That's one reason only a fraction of couples actually seek treatment. 
 
UW Health's reproductive endocrinology and infertility specialists recognize the complex issues surrounding fertility challenges. It is fundamental to their philosophy of care.

"It's an ethic of reciprocity," explained Dan Lebovic, MD, MA, medical director of the program. "How would I want to be treated if I were a patient?"
 
Video; UW Health's Reproductive Endocrinology and Infertility Clinic Infertility Care at UW Health

Nearly 80 individuals gathered recently on Nov. 18 in Madison, Wis. to hear Dr. Lebovic and members of UW Health's Reproductive Endocrinology and Infertility Program discuss their philosophy, services and how they hope to help patients who have fertility challenges.
 
Care for a New Generation

To meet the needs of patients, the program is scheduled to open a new clinic in 2010 called Generations Fertility Care on Madison's far west side.

"The name is a little out of the box," said Dr. Lebovic. "But it reflects our commitment to promoting the continuation of your generations, how you want to raise your children based on your path, your ethics, your morals. We are committed to helping you."

In the conveniently located facility, patients will be able to manage every aspect of their fertility care – from lab tests to procedures and even counseling. A healing garden will also be a key element, offering patients a space for contemplation and reflection.

"The couples of Wisconsin deserve to have the best," said Laurel Rice, MD, chair of UW Health's Obstetrics and Gynecology Department. "UW Health is committed to maintaining an outstanding fertility program serving the region and even the country."

UW Health's Reproductive Endocrinology and Infertility Program has consistently been a leader in the field. It was the fifth program in the nation to achieve a live birth through in-vitro fertilization (IVF) and the first in Wisconsin.
 
Not Just a Woman's Problem
 
Infertility is typically defined as the inability to become pregnant after 12 months of unprotected intercourse. For couples in their mid-30s or early 40s, that window of time reduces to six months or fewer. If a couple has any concerns, however, they should speak with their doctor regardless of how long they've been trying.

When a woman is first seen for fertility issues, the doctors will run routine exams to examine the quality of her eggs and uterus and identify any other contributing factors. The test results, as well as the woman's age, will determine which treatments are recommended. There is generally a stepwise approach to fertility treatments, the most extensive of which is in-vitro fertilization. It is also typically the most expensive.

While physiological issues with the woman account for approximately 40 percent of infertility cases, in roughly 30 percent it is the male's issue, and in the remaining 30 percent of cases it is both partners. Because infertility is a couples' issue, regardless of the underlying cause, the program offers a Couples' Clinic. The Couples' Clinic is a unique approach to fertility care.

"Infertility is commonly thought of as a female problem," commented Daniel Williams, MD, urologist with UW Health who specializes in male infertility. "Yet, upwards of 50 percent of the time, something is going on with the male."

He explained that men are often overlooked in initial fertility exams because the perception that it is a woman's issue pervades even the medical community's thinking. Typically, when couples seek treatment, only 20 percent of the time the man's health is evaluated. Other reasons men are not typically evaluated include lack of access to care and the success of assisted reproduction treatments.

"Many urologists have not completed the advanced training for male infertility," explained Dr. Williams, who has received such training. "So there is simply a lack of access to a trained physician."
 
Maintaining Quality of Life
 
Once couples do decide to seek treatment, undergoing exams and tests can compound an already stressful situation. Julianne Zweifel, PhD, clinical psychologist with UW Health's Reproductive Endocrinology and Infertility Program ensures the Clinic helps the couple maintain their quality of life.

"Infertility is an unexpected crisis for many couples," explained Dr. Zweifel. "It's not where they expected to find themselves."

The uncertainty of the situation is one of the reasons why fertility challenges are so difficult to manage emotionally. Is there truly a problem? If there is, how do you proceed? When do you stop? How do you manage the social and emotional issues related to infertility?

"You just don't know what the outcome is going to be," Dr. Zweifel said. "And that's the most difficult part of all of this."

Well-meaning family and friends often offer advice such as "if you just relax, drink a glass of wine, it will happen." Or they relate stories of acquaintances who decided to adopt, and then had a child naturally. The problem is that this only contributes to feelings of isolation.

"Couples frequently feel that those closest to them just don't get it," explained Dr. Zweifel.

There is also sadness and anxiety as many couples who struggle with fertility feel a sense of unfairness – they've done everything right, and yet conception doesn't happen. Or they constantly doubt themselves and wonder if they're not doing enough.

Complicating the issue even further is the cost of fertility treatments. Many of the treatments are not covered by insurance, leaving couples to face the difficult decision of when to conclude treatment. And often, couples themselves don't always agree.

"We see couples able to go through [the challenge of infertility] together," said Dr. Zweifel. "But often, each member of the couple feels like they're going through it alone."

Counseling can help couples identify and discuss the significant emotional issues they face. It can help couples bring up those differing perspectives so they can discover for themselves what directions and treatment options they want to take.

"The hope is to resolve the crisis and help provide more control for couples," concluded Dr. Zweifel.

Currently, the UW Health Reproductive Endocrinology and Infertility Program is seeing patients in the clinic on the sixth floor of UW Hospital. The program offers the latest technology and compassionate, personalized care to assist couples who wish to become parents.
 

Date Published: 05/04/2009

News tag(s):  infertilitydan i lebovicdaniel h williamsjulianne e zweifel

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