April 2012 eNews
Ten Common Misconceptions about Fertility
by Laurence C. Udoff, MD, FACOG
As a Reproductive Endocrinologist, most patients come to me because they want to conceive. In a typical initial consultation a significant amount of time is spent on education about the process of natural conception as well as about assisted reproductive technologies (ART). I encourage patients to ask questions because I think it is critical they have a good understanding of the issues. During these discussions, I commonly encounter misconceptions about fertility and infertility treatment. In my nearly eighteen years of practice, the following is a list of commonly encountered myths:
- "Infertility is a woman's problem."
Though estimates vary, approximately 25-30% of infertility is due to male factors. This also is true for secondary infertility (when a patient has had a child before, but now is having difficulty conceiving.)
- "To have the best chance of conceiving naturally, a couple should plan to have intercourse on the day of ovulation."
Multiple studies have shown that the best chances for pregnancy are when intercourse occurred within three days before ovulation. After ovulation, pregnancy rates decreased dramatically. This is probably due to several factors: it is difficult to exactly pinpoint the timing of intercourse; after ovulation the window for fertilization is relatively small and; sperm can live in the genital tract for days. If you have intercourse a day or two before actual ovulation occurs, there should be plenty of sperm available when the egg is at its peak potential for fertilization.
- "After intercourse, all the sperm leaks out, so I guess that is why I am not getting pregnant. I should try to put a pillow under my hips and lay in bed for a few hours after intercourse."
There is no evidence that positioning affects pregnancy rates. In fact, studies suggest that sperm travel from the vagina into the cervix within seconds and up into the uterus and Fallopian tubes within minutes of ejaculation. Additionally, since a normal ejaculate contains tens of millions of sperm, even if leakage occurs, an adequate number of motile sperm should get to where they have to go. (Optimizing natural fertility. Fertil Steril committee opinion Nov. 2008.)
- "Since my partner has a low sperm count, he should abstain from ejaculation longer, prior to ovulation, so he can save up sperm."
Actually, studies have shown that with abstinence intervals of ten days or more, semen quality worsens. In general, the ideal abstinence interval is thought to be two to five days. However, there are studies that have shown that even men with low sperm counts may have good semen analysis results with daily ejaculation (Optimizing natural fertility. Fertil Steril Committee Opinon Nov. 2008)
- "All my friends got pregnant after trying for only a month or two, so I assume the chance for conception for a normal couple must be 50% or more each month."
Actually, for a normal, young (under age 35) couple, the chance for a conception each month (fecundability) is only 25-30% in natural cycles. (Guttmacher, AF. J Am Med Assoc 1956, Zinaman, M et al. Fertil Steril 1996). It is estimated that the cumulative chance for conception over 12 months, in a normal couple, is 80-90%. An additional 15% of couples will conceive if they continue natural conception attempts for another 12 month period. Therefore, approximately 95% of couples will have conceived after 24 months of attempts. The American Society for Reproductive Medicine defines infertility as the failure to achieve pregnancy after 12 months or more of regular unprotected intercourse. Women over 35 years old or who have a medical history that indicates irregular menstrual cycles or other special circumstances should be evaluated after 6 months of attempting to become pregnant.
- "I exercise, eat right, and am in general good health. I should have no problems conceiving."
Obviously, being in overall good health before trying to conceive is important, however, age is the single best predictor of pregnancy rates. I have met many very healthy 45 year old women who are shocked to learn that it will be very difficult for them to conceive using their own eggs. A decline in pregnancy rates with age is just a part of natural physiology.
- "I get my period regularly, so that must mean that I ovulate and that I am fertile."
Patients who report regular and predictable menstrual cycles (21-35 day intervals) are more likely to be ovulating than women who report irregular and unpredictable cycles. However, 10-15% of women who report regular cycles may actually be found to be anovulatory when evaluated by blood tests or ultrasounds. For this reason, I recommend documentation of ovulation by blood tests even in patients who report regular cycles. Additionally, ovulation in and of itself, is only part of the story as egg quality is a major determining factor of success in natural or assisted cycles.
- "If I just relaxed, everything would be fine."
Though stress can contribute to ovulation problems, it is very rarely the sole cause of infertility. Infertility is a disease and requires evaluation and treatment by qualified medical personnel such as a board-certified reproductive endocrinologist.
- "In an IVF cycle, the more embryos you transfer, the higher the pregnancy rate."
Data from multiple studies as well as the IVF outcome data collected by the CDC have shown that there is a "plateau effect" regarding the relationship between the number of embryos transferred and the pregnancy rate. This graph shows that for a good prognosis patient (under age 35, has extra embryos available for cryopreservation), transferring more than two embryos did not increase the chances for pregnancy. It would however increase the risks for multiple pregnancy. Data have shown that there is a higher pregnancy rate when two embryos are transferred compared to one (approximately 10-15% lower if one embryo transferred). However, the higher pregnancy rate needs to be weighed against the higher risk for multiple pregnancy when two embryos are transferred rather than one. Additionally, a recent study in the prestigious journal Lancet concluded that the live birth rate did not increase with transfer of three embryos regardless of age. (ref: Lawlor D et al. Lancet Jan 2012)
- "With today's modern technology, every infertility problem can be overcome."
The treatment of infertility has seen remarkable advances in the last 30 years. Advances such as intracytoplasmic sperm injection (ICSI), preimplantation genetic diagnosis (PGD), and other laboratory techniques that are now routine provide hope to couples who decades ago had few if any options. However, not every infertility problem can be solved. For example, there is still no reliable treatment to improve egg quality in women that have infertility due to severely diminished ovarian reserve. However, these women do have the very successful option of donor egg IVF using either fresh or frozen donor eggs.
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RESOLVE Advocacy Day 2012
RESOLVE: The National Infertility Association is sponsoring 2012 Advocacy Day on Wednesday, April 25th in Washington, DC. This event is your opportunity to meet with members of Congress and urge them to provide fertility coverage on insurance programs. Learn more about Advocacy Day 2012.
Dr. K on Capitol Hill to Support Advocacy Day
Dr. Sunita Kulshrestha was invited by RESOLVE to speak at the Family Act briefing on Capitol Hill. Dr. K gave a presentation to an audience that included numerous members of Congress and their staffs. This effort is a part of GIVF's ongoing support for reproductive freedom for American families.
GIVF hosts 26th Annual Baby Reunion
The highlight for GIVF staff each year is to host their patients and former patients and their families to celebrate the success of their family building. This is the signature event for GIVF each year attended by over 1,000 people and GIVF founder and chairman, Dr. Joseph D. Schulman. To receive details, send an email to firstname.lastname@example.org.
Advocacy Day: Make Your Voice Heard!
by Jane Castanias
Don't you hate being ignored? One of the most difficult aspects of infertility is the feeling that everyone around you seems to have no trouble getting pregnant, and nobody understands what you're going through. RESOLVE's National Infertility Awareness Week (NIAW) April 22 - 28, and Advocacy Day, April 25 is the perfect time to make your voice heard!
The goal of National Infertility Awareness Week is to raise awareness: to get everyone the information they need to sort through their family building options, to build understanding and general awareness of the disease, and to protect the availability of treatment options nationwide. A special component of National Infertility Awareness Week is Advocacy Day, on April 25, where women and men from across America travel to Washington, DC to ask Congress to support and pass the Family Act, a bill that would create a tax credit for IVF. The Family Act will provide a financial break for couples who need IVF to treat their disease.
How can you be part of this important week? Whatever suits YOU best - post information about RESOLVE National Infertility Awareness Week events on your Facebook page. Even just talking about your infertility experience with a group of friends, you may be surprised to find someone who has been struggling in silence and needs your support. Or join us at Advocacy Day, and tell your legislator how important family building is to you, and that people with infertility matter.
Whatever your participation, your efforts can make a difference and keep infertility patients from being ignored. You can help create a community of support and inspiration to others fighting this disease, you can protect access to infertility treatment nationwide, you can play a part in raising awareness and understanding of the challenges one in eight couples face when trying to build a family. We'll see you there!
Jane Castanias is on the Board of Directors of RESOLVE, the National Infertility Association, a non-profit organization dedicated to educating, protecting, and advocating for family building options. Visit RESOLVE for more information.
The Genetics & IVF Institute (GIVF) regularly publishes an informative newsletter featuring the latest infertility news and developments. The newsletter is sent electronically via email. To subscribe, click here.