March 2011 eNews
Infertility Myths: Setting the Record Straight
by Sunita Kulshrestha, MD, FACOG, Board Certified Reproductive Endocrinologist
National Infertility Awareness Week (NIAW) is April 24-30, 2011. Hosted by RESOLVE: The National Infertility Association, NIAW seeks to raise awareness and educate the public about infertility.
With so many well intentioned friends and family and a plethora of information on the web, it is likely that at some point in time, a patient will come across myths, misconceptions, or old wives tales about fertility. In the spirit of this year's NIAW theme, "Busting the Myths of Infertility," we're setting the record straight on several infertility myths we hear quite often.
- Myth: Infertility is uncommon.
Fact: Infertility is one of the most common medical problems affecting men and women of reproductive age. It affects over 7 million people in the U.S. and in the younger population affects 10-15% of all couples and among women over age 35, can affect 1/3 of patients. It is prevalent at a much higher rate in women over the age of 40.
- Myth: Infertility is usually a female problem.
Fact: On average, both women and men have an equal chance of contributing to infertility with about 1/3 of cases being due to a male factor, 1/3 being due to a female factor, and 1/3 being a combination of male and female factors or unexplained infertility.
Causes of male factor infertility include problems involving sperm count, sperm motility (swimming ability), or sperm morphology (shape of the sperm). Erectile dysfunction, ejaculatory problems, and obstructed ducts (like the vas deferens) interfere with the delivery of sperm from the male to the female.
Female factors include ovulation disorders, compromised egg quality, tubal disease, pelvic adhesions (scarring in the pelvis), endometriosis, and uterine abnormalities. Some couples have no known abnormality on testing and therefore have "unexplained infertility."
- Myth: Boxers are better for men than briefs.
Fact: There is no difference between boxers and briefs in terms of male fertility potential.
This tale was probably initially told in relation to the concern about the documented adverse effect of increased heat on the testes. It is true that extremes of heat can negatively affect spermatogenesis (the process of sperm production in the testes). Such extremes of heat can be seen with high fevers, and use of hot tubs, saunas, and Jacuzzis. However, seasonal and local weather variations, clothing use, and use of laptops are not thought to have the same effect.
- Myth: For women in 2011, age 45 is the new 35.
Fact: Advancing age does negatively affect a woman’s fertility. Even though a woman may look great and be more active, healthy, and fit than her 35 year old neighbor, ovarian health and pregnancy rates unfortunately continue to decline with age.
Women reach their peak fertility between the ages of 19 and 32. Fertility then starts declining and this decline becomes more rapid as she reaches her mid to late thirties. This age-related decline in fertility is due to a decrease in the quality and number of the eggs and an increase in the chromosomal abnormalities affecting the eggs.
These biological changes can be seen in practice. Looking at average national data from 2007 (last reported CDC/SART Report), a 35 year old woman’s chance of having a live birth in an IVF cycle was 33% whereas the national average for a 44 year old was one tenth of that at a rate of 3.3%.
Patients often see celebrities in the news achieving pregnancy in their mid to late 40s and 50s and use that as a model. Although occasional pregnancies do occur in the perimenopausal years, the vast majority of these pregnancies are from the use of a donor egg.
- Myth: Men and women with severe fertility problems will be unable to become parents.
Fact: Infertility conditions that at one time were deemed untreatable now have solutions or strategies to bypass the problem. Every fertility problem can now be treated or bypassed. In vitro fertilization has revolutionized the field of reproductive endocrinology and infertility. IVF can bypass female tubal disease, pelvic disease (adhesions or endometriosis), and ovulation disorders. And, as long as the testes produce a few sperm (rather than the typical millions), intracytoplasmic sperm injection (ICSI) can be used to treat this condition.
For situations in which a man does not produce any sperm at all, donor sperm can be used. For women who have poor quality eggs or missing ovaries, donor egg can be used. For women who have a uterine abnormality or are medically unable to carry the pregnancy, a gestational carrier can be used. These technologies have helped millions of patients worldwide build healthy and loving families.
- Myth: Fertility medications and IVF in particular will cause you to end up with a high order multiple pregnancy (triplets or more).
Fact: Ovulation induction medications do increase the risk of a multiple pregnancy. However, the overall risk of a multiple pregnancy is low if a patient is treated responsibly. Although the multiple pregnancy risk related to IVF has been publicized in the recent years due to the "octomom" story, the fact is that IVF allows patients to have the most control over the risk of a multiple pregnancy.
Apart from any social or economic effects, a multiple pregnancy (twins, triplets, or more) is more complicated for both babies and mom. Multiple pregnancy is often associated with early labor (preterm labor) and serious health consequences for the babies, including at times concerns regarding their survival.
The medication clomiphene citrate (Clomid) and the hormones FSH and LH are used to produce multiple follicles/eggs (superovulation). On average, the chance of twins with the use of Clomid (which usually results in the production of 2 or 3 eggs) is about 7% and the risk of triplets is less than 1%. With FSH injections, more follicles are produced and therefore the risk of a multiple pregnancy is higher and related to the number of follicles that are produced.
Although ovarian stimulation for IVF results in more follicles and eggs than Clomid or FSH, the unique and interesting aspect of IVF is that we have more control and ability to reduce the risk of a multiple pregnancy compared to ovulation induction with Clomid or FSH. The reason for this is that we control how many embryos we transfer back into the uterus and therefore the maximum number of pregnancies achieved. If we transfer a single embryo, the patient should have just one baby (on rare occasions, however, an embryo can split and lead to twins).
The American Society for Reproductive Medicine has guidelines on the recommended numbers of embryos to transfer and GIVF follows those guidelines. The most recent set of published national data on IVF (CDC/SART) showed that in 2007, close to 70% of patients who got pregnant through IVF had a singleton pregnancy. The majority of the multiple pregnancies were twins.
- Myth: People who have successfully conceived in the past should not have an infertility problem.
Fact: Secondary infertility (difficulty conceiving after an initial pregnancy) is common. Although a previous pregnancy suggests that at one point in time ovulation occurred, egg and sperm quality were fine, at least one tube was open and implantation occurred, all of these factors can change.
Sperm quality can decline and is very sensitive to environmental factors, medications, and changes in health. Some men develop varicoceles (dilated veins in the scrotum) or erectile dysfunction with aging. Surgery, trauma, or infection may result in duct obstruction.
In females, egg quality declines with advancing age. Surgeries, pelvic infection, or endometriosis can cause scarring of the pelvis and block the fallopian tubes. Endometrial polyps or uterine fibroids can grow and can affect implantation or physically obstruct the cervix or tubes. Complicated vaginal deliveries or C-sections can cause uterine scarring, as well.
Hormonal imbalances can affect both men and women. Also, patients may enter into new relationships after having had a vasectomy or tubal ligation for contraception in a previous relationship.
- Myth: Use of birth control pills negatively affects fertility.
Fact: The use of oral contraceptives does not adversely affect a woman’s fertility after the pills have been discontinued. In fact, the typical return to fertility after stopping birth control pills is rapid. Oral contraceptives are often used as the first medication in the series of hormones that are used in preparation for IVF.
As far as other contraceptive practices, long lasting progesterone formulations (Depo-Provera, implants) can inhibit ovulation for several months after the last dose. Some patients who use IUD are more likely to have a pelvic infection and that may cause PID/tubal disease. Both vasectomies and tubal ligations can be reversed or bypassed with IVF.
- Myth: Just relax and you’ll get pregnant.
Fact: Stress can adversely affect some aspects of fertility but is usually not a main contributing factor.
For some women, stress (whether it is related to infertility or other life stressors) can definitely affect ovulation. This can prevent natural conception. For men, stress or "performance anxiety" can lead to erectile or ejaculatory dysfunction and adversely affect the number of sperm ejaculated.
For those who ovulate regularly and have normal sexual behavior, the role of stress is less clear. Some studies suggest that stress does in fact lower pregnancy rates and others show minimal or no effect. In either case, it is important to try to lower and manage stress whenever possible for many reasons.
Patients often find that their stress level is immediately lowered simply by seeking medical assistance. Others find group support and stress management techniques such as exercise, meditation, yoga, massage, and prayer to be helpful ways to enhance mood, lower stress, and make the process of infertility treatment much easier and manageable.
- Myth: If you can’t afford IVF, there is no point in seeking treatment.
Fact: Some of the more technologically advanced treatments like IVF/ICSI and Donor Egg IVF can be expensive. However, many insurance plans cover such treatments. At GIVF we offer many financial options such as discounted Multicycle packages, The Delivery Promise℠ (money-back guarantee program), and financing options to assist our patients who do not have insurance coverage for infertility treatment.
IVF is just one of many treatments that are available to treat infertility. Additional strategies to improve fertility and achieve pregnancy include hormonal manipulation with medication (to treat thyroid disease, hyperprolactinemia, polycystic ovary syndrome), lifestyle management (weight loss/gain, discontinuation of alcohol/tobacco, stress reduction), ovulation induction, surgical management (polyps, fibroids, endometriosis, adhesions), and intrauterine insemination (IUI). These treatments are often covered by insurance and are much more affordable and manageable. These approaches are also efficient and yield good success rates.
Spring into Affordability! New Affordable IVF Options
Helping patients afford fertility treatment is important to us, that's why we now offer several new affordable IVF options.
- New Lower Single IVF Cycle - $7,500 (a savings of up to $1,400).
- Conditional Multicycle IVF contracts now include ICSI (a savings of $5,500).
- Limited Time Offer: receive a 10% discount* on the base cycle fee of a Conditional Multicycle IVF contract. Consultation must be held by June 30, 2011 to receive the 10% discount. Schedule your consultation now!
Interested in learning more? Contact a financial counselor by calling 800.552.4363 or 703.698.7355.
No time for a consultation during the week? No problem! Click here to schedule one for the weekend when it's convenient for you.
Did you know that since 1984, GIVF has been responsible for over 24,000 pregnancies worldwide?
How to Keep Your Relationship Strong Through Infertility
by Phyllis Martin, MEd, LPC
The last thing a couple plans to lose when beginning infertility treatment is each other. However, there are steps you can take to nurture your relationship/marriage throughout your fertility journey.
After receiving an infertility diagnosis, the effort to have a child may quickly become your main focus. It can be a stressful time for both people in the relationship, and each of you will handle it differently simply because you are different people.
A diagnosis (or lack of diagnosis), finances, and juggling everything that comes with infertility treatment will impact you and your partner in a variety of ways. It is normal to focus on these stressors and attempt to find ways to minimize them. Conversations and life in general can quickly become dominated by planning doctor's appointments, getting medicine, dealing with insurance coverage, relaying information, and negotiating how to handle missed time at work.
In addition to all of the tangible aspects of infertility treatment, there is a wide range of feelings that impact you, your partner, and your social rapport with your extended family, colleagues, and friends. Feelings and relationships are also dealt with differently within a couple. For example, a woman may be upset because it seems all of her friends are getting pregnant easily, so she may opt to stop spending time with those friends. Her husband may think social time with friends will "do her some good," so when he arranges for her to have dinner with her friends, she may become upset and feel he does not understand her. Another common example: a man may not want to talk about his male infertility diagnosis, yet his wife keeps bringing it up thinking that sharing feelings will make him feel better. He may get angry, she may feel rejected as a result, and things deteriorate.
Finally, the way you and your partner make decisions may be quite different. For example, one person may make intuitive decisions, using "from the gut" feelings, while the other may be more analytical, relying on "research and information.”
Infertility can lead to feelings of isolation within your relationship. If issues such as anger, hurt, frustration, feeling ignored, or blame are not dealt with, those problems may continue even after infertility treatment results in having a child. It is important to make your relationship a priority during infertility treatment because having a child will not fix marital problems, it may in fact only complicate them.
All of these potential issues can be navigated in a healthy way. In fact, your fertility journey can also be a time that solidifies your marriage or relationship because you learn that, despite your differences, you can appreciate what each person brings to the relationship. By following a few simple steps, you can feel confident that you are helping each other to the best of your abilities.
Below are a few ways to ensure that you keep your relationship/marriage on the front burner, no matter what your fertility journey brings.
- Regardless of the diagnosis, infertility is a marital issue, not just a personal one. Think of yourself as a team so you don’t place blame or turn away from each other.
- Be sure to touch each other in loving, non-sexual ways at least twice a day.
- Have a date once a week. This can mean going out, lighting a candle and enjoying a good meal, or simply planning a night with popcorn and a funny movie.
- Plan something special for your partner that breaks from the routine.
- Pay attention when your partner is talking. Turn off the TV, phone, and computer.
- Greet your partner verbally and physically when he/she comes home. Alternately, find your partner when you come home and verbally and physically acknowledge him/her.
- Have a personal conversation at least once a week for 25 minutes that is not about infertility. Ask her questions about when she was a child, ask him questions about when you were dating and getting to know each other.
- Do thoughtful, unnecessary things for your partner such as empty the dishwasher, have the car vacuumed, or text a compliment or words of appreciation.
- Have a focus session that allows for an agreed to amount of time in which you will discuss infertility. Commit to ending the conversation when the allotted amount of time runs out. This ensures that the conversation will not drag on indefinitely, which is often the reason one partner fears bringing it up to the other.
- Keep in mind that you and your partner are a family, having a child is adding to your family.
- Put a picture of your spouse in your wallet, desk, or gym locker.
- Recognize significant special days for your partner (anniversary, birthday, etc.).
- Make your partner your priority. Keep in mind that whatever happens on your fertility journey, it is easier to endure it with your partner and within the context of a healthy relationship. Remember, infertility is a phase, marriage is not.
If you spend time putting energy and focus into your relationship/marriage, you will find that infertility treatment and emotional ups and downs will be more tolerable. If you find yourselves unable to communicate, unable to share, fighting more than listening, or are worried about your partner or self, consider outside support. Attend an infertility support group at GIVF or a RESOLVE peer led support group. If you prefer one-on-one counseling, seek out a counselor or marriage-strengthening weekend through a church or marital support group.
Phyllis Martin is a Licensed Professional Counselor and Infertility Specialist who is available to current patients, as well as those considering infertility treatment or who have undergone treatment. Click here to view the support group meeting schedule or here to contact Ms. Martin.
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.