Infertility is defined as the inability to conceive after one year of unprotected well-timed intercourse. This does not apply if the woman is over 35 and has been trying unsuccessfully for 6 months or where either partner has a known history of fertility related problems. Please do not feel alone. Difficulty with conception effects more than 10 million people in this country or 1 out of every 6 couples and is shared by women and men. Approximately 50% of the problem can be traced to the woman, 50% to the man, and in up to 35% of the cases, there is more than one reason why the couple cannot conceive. Although this definition is meant to be used as a guideline, rigid adherence to the definition can and is a disservice to any couple who wants to have a baby.
If the woman has known fertility related issues like a previous history of a ruptured appendix, old pelvic inflammatory disease (PID), a procedure on her cervix for an abnormal PAP like cryosurgery, cautery, LEEP or cervical conization, a history of endometriosis, an ovarian cyst, fibroid surgery, or any previous pelvic surgery like a laparoscopy or laparotomy, any previous D&C for irregular bleeding or a termination of a pregnancy, or a history of irregular periods; and in the case of the male, a history of a varicocele, a history of undescended testicles, the use of marijuana or alcohol, a history of infections that effect the testicles (mumps), any trauma and/or surgery to the testicles, and problems with ejaculation or getting an erection, the couple should be evaluated as soon as they plan on starting a family. Valuable time can be lost if evaluation and treatment is delayed. Seeking help is normal and it is nothing to be ashamed about.
Difficulty in conceiving, in almost all circumstances, is related to an underlying medical problem, and like most other medical problems, can be diagnosed and successfully treated. When seeking care, there are 5 things you need to know before starting treatment.
- Make sure that your doctor is an expert and has had specialized training in reproductive endocrinology and infertility. Although gynecologists are excellent physicians, their expertise lies in a different area. Many times, a woman will spend too much time at her GYN's office because she has had a long relationship and "is comfortable", she does not want to hurt their feelings, she is told to "start doing basal body temperature charts" and/or "try for another 6 months", or "not to worry" or "you are too young or too old" to be thinking about having children. Because most OB/GYNs are busy, they do not have the time that is needed and desired to spend with you; and many times they are limited in their treatment options. This can lead to increased stress, frustration, anger and time lost and delay important evaluation and treatment.
- Once you decide to seek treatment, don't necessarily go to the clinic that is bigger or that is closest to where you live or work, but find one that not only has a reputation of excellent results but one that "will listen to you" without bias, be non-judgmental and embraces all patients, regardless of age, martial status and gender preference. Be careful of advertising like "100% money back guarantee" or being the "biggest". Like many things, "bigger is not necessarily better". Arizona Center for Fertility Studies gives all of our patients individual and personalized attention, care that, many times, is not possible in larger clinics. If you are comfortable, talk with friends or acquaintances, to find out about their experience and where that "best clinic" is. Patient referrals are generally the best because they have already had an experience with one or more clinics. It is generally one where you "feel comfortable" and have a sense that "you are in the right place" and the clinic "has your best interests" in mind. One that is more interested in you than in their statistics. Be careful of clinics that make "wild claims" that seem unrealistic to you and sayings like "trusted doctors".
- Make sure that you are given the option to do the entire work-up, including controversial testing. Up to 35% of couples have more than one reason for why they are not conceiving. One of the biggest mistakes that is made, is once a problem is identified, the rest of the work-up is not completed, many times overlooking a less but equally important problem; and therefore possibly preventing treatment of the initial problem to be successful. As an example, many clinics do not test for antiphospholipid antibodies unless you have a history of repeated pregnancy loss, in which case, you may test positive for these antibodies. The argument is that fertile women can also test positive for APA and yet have no problems with conception or carrying a pregnancy to term. This is true, although, almost all programs will not do the test until after you have 2 or more pregnancy losses. Why wait until you have 2 documented pregnancy losses before doing the test? Arizona Center for Fertility Studies believes it is better to be proactive than reactive; not to mention the emotional and physical trauma of losing 2 or more pregnancies that possibly could have been prevented. The other mistake that is made very often is just because a woman is young, she is not taken as seriously, and a complete work-up is not done, let alone offered. Arizona Center for Fertility Studies believes that a complete work-up should be discussed with every patient, regardless of their age or circumstances, and than they should be given the option of whether or not they want to do the entire work-up or only parts of it. It should always be the couple's choice; and by not choosing to do the complete work-up, they are aware of the possible risks of overlooking something that may interfere with their treatment being successful.
- Once the work-up is completed, make sure that the clinic gives you all your treatment options, from conservative to aggressive and it is done unbiasedly. Once you are clear on the pros and cons of each one of your choices than you should choose the option that is best for you, not the clinic. Many times, a woman, who is having difficulty conceiving, as the first step is automatically put on Clomid, which is an ovulatory medication used for irregular cycles, even though her cycles are regular. Clomid can have several side effects, including interfering with cervical mucus production and/or the preparation of the lining of the uterus. So, rather than improving your fertility, it may actually decrease it. Even if you are young, it is your choice to be conservative or aggressive. You need to feel that you are being taken seriously, no matter what your age is. A woman in her 20's has the same feelings and desires as a woman in her 40's, the only difference is that the woman in her 20's has a bit more time. With a woman in her late 30's to early 40's, although conservative treatment could work, it should be her choice as to whether or not she wants to be aggressive. A clinic needs to listen and honor her right to choose.
- From the beginning, a program should be listening to what you want. You should never have a sense that you are being "talked into or out of something." For example, even though you would like to attempt pregnancy using your own eggs, some programs will try to "talk you into" using donor eggs, stating very low statistics based on "your age" or the fact that you have an "elevated FSH" level. Make sure that their motivation is about "you" and not their "statistics". Although, women who are older or who have elevated FSH levels, statistically have a decreased chance of conception, Arizona Center for Fertility Studies and others in the country, have had good success with these patients. As a matter of fact, at Arizona Center for Fertility Studies, we have found very little to no relationship between FSH levels and pregnancy, only between FSH and age. Also, who is to say that an older woman is not "reproductively young" for her age; whereas, a younger woman is "reproductively old" for hers? Arizona Center for Fertility Studies rarely will tell a couple what to do and, is a strong advocate of a woman's right to choose her treatment options, once she is fully informed of all her choices.