Fertility Treatments Health Article

Definition

Infertility is a problem with the reproductive system that results in the inability of a man or woman to achieve a pregnancy or of a woman to carry a pregnancy to live birth. The accepted definition within the medical profession is the absence of conception after at least one year of regular intercourse without birth control. Regular intercourse refers to intercourse at least two to three times per week. The term is also used to cover women unable to carry a pregnancy to term because of miscarriage. Infertility is not sterility, which is the term used to mean conception is not possible under any circumstances. Infertility is not a new disease or condition, but it appears as if there has been an increase in infertility rates in the past few decades. Some factors that may relate to this increase include an increase in the age of women wanting to conceive, an increase in the spread of sexually transmitted diseases, and the rise in the level of toxic chemicals in our environment. Infertility does affect people of all ages, ethnic backgrounds, socioeconomic groups, and both sexes.

Purpose

The purpose of fertility treatments is to achieve a successful pregnancy and outcome. Male factors account for approximately 30-40% of all cases of infertility and female factors cause about 40% of cases. Close to 15% of cases are a result of a combination of male and female factors; whereas in 5-10% of cases, no cause can be found.

Many couples may begin their quest for fertility with their primary care physician, who is usually a medical doctor certified in family medicine. The primary physician can do a physical exam on both individuals but should refer the couple to a specialist in obstetrics and gynecology to initiate the infertility evaluation process. Infertility is described as either primary or secondary. A couple who has never achieved pregnancy is experiencing primary infertility, whereas a couple who has had a pregnancy in the past, regardless of the outcome, is experiencing secondary infertility.

For an egg to be fertilized, sperm produced in the testes must not only be present in sufficient number in the semen but they must be capable of moving far enough and fast enough to travel through the female reproductive system (motility), and capable of penetrating the outer layer of an egg. Male infertility may be a result of small quantities of sperm; prenatal exposure to diethylstilbestrol (DES) (a medication given to women to prevent miscarriage in the 1950s); exposure to radiation, certain pesticides or heavy metals (lead); or diseases that reduce the body's ability to produce sperm. Female infertility may be related to irregularities of the fallopian tubes; endometriosis (tissue resembling the lining of the uterus growing in the abdomen); irregular ovulation or lack of ovulation; abnormalities of the uterine cavity; and/or cervical problems such as abnormal mucus.

A couple should consider seeing an infertility specialist (a physician certified in reproductive endocrinology and infertility) for any of the following reasons:

• a woman experiencing irregular menstrual cycles or irregular ovulation
• a woman with a history of three or more miscarriages
• a woman older than 35 years of age
• a woman with a history of pelvic infection or previous pelvic surgery
• a woman who needs microsurgery for endometriosis or for tubal damage
• a man with a poor semen analysis such as low count, poor motility, abnormal appearance, or requiring microsurgery
• a couple with unexplained infertility whose tests came back normal but still have not conceived after two years
• a couple who needs more advanced treatment, such as injectable ovulation-induction medications or assisted reproductive technology (ART)

There are over 300 fertility clinics in the United States and each one has a varying rate of success. A couple should investigate the services of the ones they are considering to save time, money and emotional upheaval. In 1992, Congress passed the Fertility Clinic Success Rate and Certification Act, which requires the Centers for Disease Control and Prevention (CDC) to publish the success rates of clinics throughout the United States where ART is performed. This report is intended for laypersons who are considering using ART to achieve pregnancy and provide an objective review utilizing a common method of reporting success. Besides success rates, a couple should consider the following:

• Is the physician board certified in reproductive endocrinology?
• How much experience has the physician had with diagnosing and treating infertility?
• What are the fees for office visits and are payment plans available?
• What is the policy regarding cancellation of appointments and filing of insurance claims?
• Will a physician or someone else on staff be available twenty-four hours a day, seven days a week, including weekends and holidays?
• Will lab and ultrasound facilities be open seven days a week?
• Will the couple see the same physician for their visits?
• Will decisions on tests, treatments and referrals be made jointly between the couple and the physician?