Coping With Infertility

rsz_infertileIf you’re having trouble conceiving, it may be difficult to know when you should seek medical attention.

By Lisa A. Lewis

When Hope Meeks and her husband, Owen, a couple from Maryland, started trying to conceive in late 2006, infertility treatment probably never even crossed their minds. After all, they were young and healthy and excited about starting a family. Within a few months, Hope became pregnant, but unfortunately, she had a miscarriage. Although Hope and Owen were extremely sad when they lost the baby, they thought Hope would get pregnant again if they kept trying. But that never happened.

In mid-2008, the couple consulted a fertility clinic for an evaluation and began infertility treatment two months later. After a long journey—and several unsuccessful procedures—Hope and Owen recently welcomed twins into their lives.

“It’s not only important to find the right fertility clinic but also the right doctor,” says Hope. “Our doctor never gave up on us, and he made the experience as pleasant as possible—despite difficult circumstances. He was always willing to explore other options if a particular treatment didn’t work. The entire staff was an amazing support network. Owen and I have a strong relationship, and going through infertility treatment together made us even stronger as a couple. When Owen and I look at these beautiful babies smiling back at us, our hearts melt. Our decision to undergo fertility treatment was the best for us, and there is no doubt in our minds we would do it all over again.”

Like Hope and Owen, many couples have difficulty conceiving. So if you and your partner find yourself in a similar situation, you’re not alone. According to the American Fertility Association, one in eight couples of childbearing age in the United States is diagnosed with infertility, a disease of the reproductive system that prevents conception. A couple is considered infertile if they haven’t conceived after one year of unprotected intercourse.

Female- and Male-Factor Infertility

The perception that infertility is a women’s issue is a common misconception. Infertility can be attributed to female or male factors—or a combination of both. In some cases, infertility can’t be explained, and a specific cause isn’t identified. Infertility is a medical condition, so don’t feel guilty or blame yourself. The inability to conceive isn’t your fault.

Although getting pregnant may seem effortless, conception is an intricate process that depends on many factors, and the conditions must be exactly right. Each month, a woman’s ovary releases an egg (a process called ovulation). The egg travels through the fallopian tube to be fertilized. For pregnancy to occur, a sperm must unite with the egg in the fallopian tube. If fertilized, the egg moves into the uterus and attaches to the uterine lining where it grows for nine months. If there is a problem at any time during this process, infertility can result.

According to the American Society for Reproductive Medicine (ASRM), factors that may contribute to infertility in females include ovulation disorders, blocked fallopian tubes, which can result from pelvic inflammatory disease or endometriosis (diseases that affect the reproductive organs), uterine fibroids and hormonal problems. Male infertility is often due to a problem with the sperm, such as low sperm count, abnormal shape or impaired movement. However, other factors can be responsible for infertility in both females and males.

When to Seek Help

If you’re having trouble conceiving, it may be difficult to know when you should seek medical attention. It’s easy to go into a state of denial or take a “wait-and-see” approach rather than admit that you might have a problem. In general, most physicians recommend that women consult their ob/gyn if they’ve been trying to conceive for at least one year and are under 35. Women who are older than 35 should consult their ob/gyn after six months. However, women with a history of painful or irregular menstrual cycles, pelvic pain or previous miscarriages, should see their doctor regardless of how long they’ve been trying to conceive.

If you’re a female who is concerned about your inability to conceive and meets these guidelines, schedule an appointment with your ob/gyn. Your doctor can perform a physical examination to evaluate your overall health. He or she may also be able to determine the cause of your infertility and recommend treatment options. However, if your ob/gyn can’t find a specific cause, he or she may refer you to a reproductive endocrinologist, a physician who specializes in treating infertility in both women and men. If you’re a male who is concerned about infertility, consult a urologist for a physical examination. Or make an appointment with a reproductive endocrinologist to be evaluated at the same time as your partner.

“It’s very important for women over 35 to seek medical attention sooner than women under 35 because of their biological clock,” says Jeffrey L. McKeeby, M.D., a board-certified reproductive endocrinologist at Shady Grove Fertility Center who treats patients in the Annapolis, Salisbury and Waldorf offices. “Age plays a vital role in a woman’s ability to conceive and is a biological limitation. So if she wants to get pregnant, she shouldn’t delay treatment for infertility.”

Read more: What to Expect, Therapy, Resources


What to Expect

If you consult a reproductive endocrinologist with your partner, he or she will ask questions about your expectations regarding infertility treatment. The doctor will also ask about your medical history and any known risk factors for infertility, such as tobacco and alcohol use and exposure to environmental factors, including radiation or chemotherapy. In addition, he or she will perform a physical examination and run tests to ensure that your reproductive anatomy is functioning properly. If you’re a female, the doctor will check your fallopian tubes for any blockages, make sure you’re ovulating, check your hormone levels and perform an ultrasound. If you’re a male, a semen analysis will be done. Depending on your situation, additional tests may be required.

“During the initial consultation, patients get a pretty good idea about expectations,” says McKeeby. “One question I try to ask is ‘What is your worst fear?’ Most of the time, we can reduce their fear by explaining that aspect of the process better. Also, we explain that if they’re open to all aspects of treatment for family building, they’ll typically find success.”

Once your doctor has diagnosed the cause of your infertility, he or she can recommend appropriate treatment. Infertility treatment ranges from low-tech options to high-tech procedures and may include medications, intrauterine insemination (IUI), donor gamete (sperm or egg), in vitro fertilization (IVF) or gestational carrier (surrogate). According to ASRM, the average cost of an IVF cycle is $12,400, and the cycle may need to be repeated to be successful. Currently, only 14 states have laws that require health insurance to cover infertility diagnosis and treatment. Maryland is one of those states; but if you’re considering infertility treatment, familiarize yourself with the law, so you know exactly what is covered.

“Fertility clinics also treat single patients and same-sex patients who want to have a child,” says McKeeby. “Same-sex male couples use donor egg and a gestational carrier, and they usually use one of the male partner’s sperm. Same-sex female couples use donor sperm, and one of the women is usually both the genetic parent, meaning the couple uses her eggs, and the ‘carrier.’ But there are cases in which one woman is the ‘egg donor,’ and the other is the ‘carrier.’”

If you want to undergo infertility treatment, there are several factors you should consider before making a definite decision. Dealing with infertility is an extremely stressful experience. It can strain your relationship with your partner since you may not always agree about treatment options. In addition, some of the procedures may have unpleasant side effects, which can affect your physical and emotional state of mind. Treatment may be a lengthy and difficult process and can be very expensive. But most important, you must be willing to accept the fact that treatment may not be successful; there is no guarantee.

The Importance of Therapy

Procreation is a fundamental part of life, so if you’re unable to conceive, it’s only natural that you may experience feelings of inadequacy, guilt, anxiety, anger or depression. You may even feel jealous of your friends who have children. All of these emotions are perfectly normal. But you must deal with them. Consulting with a mental health professional who specializes in treating patients who are struggling with infertility can be extremely helpful.

ASRM recommends choosing a licensed mental health professional who is familiar with and has experience treating the medical and psychological aspects of infertility and reproductive medicine. Counseling can be particularly helpful if you’re deciding on treatment options, exploring family-building possibilities, considering third-party assistance (donor egg, donor sperm or surrogacy) or having difficulty communicating with your partner or agreeing on a course of action.

William D. Petok, Ph.D., a licensed psychologist who specializes in treating patients with infertility problems and has offices in Severna Park and Baltimore, says he treats a wide range of patients with varying needs and concerns.

“I treat patients—heterosexual couples, gay and lesbian couples and single women—who are considering treatment,” says Petok. “Women usually initiate the consultation, but men do as well. Unfortunately, in the case of infertility, women seem to be the focus. And men may be disregarded. But men want children, too. They just don’t talk about it, and they don’t feel comfortable seeking help like women do.”

Petok discusses the pros and cons, statistics, costs, side effects of medications and failure and success rates of treatment with his patients. He also tries to help them formulate a plan, set limitations and establish how far they’re willing to go to have a child. Another important issue he addresses with patients is if they’re prepared to deal with a multiple birth—a common consequence of infertility treatment—or if they’ll choose multi-fetal pregnancy reduction. Most important, patients must consider what they’ll do if treatment isn’t successful. Petok offers support and helps them explore their options. He also treats patients who are undergoing infertility treatment and helps them work though emotional issues that their medical doctor may not be able to address.

“It’s important to have a back-up plan in the event that treatment fails,” says Petok. “You must have a next step in place—whether it’s adoption or living child free. Infertility treatment is a major commitment. So if you choose to go down that path, you need to know your limitations—physically, emotionally and financially. I encourage all of my patients to be realistic, to have a good mental state and to stay hopeful.”

“There’s no better feeling than helping patients build a family,” adds McKeeby. “We share the journey with patients—the ups and downs of the roller coaster. So when we achieve success at the end of our journey, we couldn’t be happier.”

Resources

The American Fertility Association

theafa.org

American Society for Reproductive Medicine

asrm.org

RESOLVE: The National Infertility Association

resolve.org

 

Society for Assisted Reproductive Technology

 

sart.org