Dr. Lauren Roth of SGF’s Silver Spring, Rockville, and Frederick, MD offices breaks down all things infertility in her podcast with Primary Care RAP.*
Listen to the podcast here.
What does Dr. Lauren Roth discuss in the podcast?
INFERTILITY. Dr. Lauren Roth defines what infertility means by taking listeners through the different stages of one’s infertility journey beginning with the infertility workup/evaluation, diagnosis, different treatment options, success rates, and much more.
Infertility is defined as:
- If female age is under 35, having unprotected intercourse for 1 year without getting pregnant
- If female age is over 35, having unprotected intercourse for 6 months without getting pregnant
- If female age is over 40, having unprotected intercourse for 3 months without getting pregnant
*If a woman has irregular menstrual cycles or no cycles at all, and/or if any of the above criteria have been met, it’s recommended to see a fertility specialist right away.
Causes of infertility
Infertility can be caused by the female, male, both partners, or what is considered unexplained (where there is no clear diagnosis for either the male or female).
- Causes of Female Infertility
- Egg quality
- Anatomy (uterus, Fallopian tube)
- Endometriosis or PCOS
- Causes of Male Infertility
- Sperm (count, motility)
- Sexual dysfunction
How do we test for infertility?
An evaluation of both the male and female helps to determine a diagnosis for why the couple is having trouble conceiving.
- Bloodwork and ultrasound, which answer the following questions
- Egg quantity: Does the women have enough eggs to yield a pregnancy?
- Fertilization: Are the woman’s Fallopian tubes open to allow passage of the egg?
- Uterine factors: Can an embryo implant in a woman’s uterus and sustain a pregnancy?
- Semen analysis answers the following question
- Is the sperm of good enough quality to fertilize the egg?
What is the treatment for infertility?
- low sperm count à In vitro fertilization (IVF)
- no sperm count à sperm can be retrieved surgically and with intracytoplasmic sperm injection (ICSI), the sperm can be inserted into the egg by an embryologist in the lab
- mild or normal sperm count with ovulation à optimizing the cycle with medications such as Clomid or Letrozole, which are then used in combination with intrauterine insemination (IUI)
- no ovulation and normal sperm count à medications such as Clomid or Letrozole with timed intercourse
What are risks of treatment?
While there is a low risk of multiples (only 10%) when using oral medications, SGF monitors patients daily with bloodwork and ultrasound to assess for those risks. If the ovarian response is too strong, the cycle is cancelled to decrease the chance of high-order multiples.
How do patients afford treatment and is it successful?
Some states such as Maryland have mandated fertility coverage, and most insurances cover initial diagnostic testing and some level of treatment. For those without insurance coverage, SGF offers unique financial programs to help ease the cost of treatment and make it more affordable.
Success rates for treatment mostly depends on factors such as age and diagnosis. Overall, success rates for IUI is about 10% per cycle (falling on a range of 5 to 25 percent based on maternal age and other factors). SGF continues to improve and refine the process by optimizing each cycle with new medications and protocols, but there is less control with IUI, Roth shares.
In IVF, the process is more controlled, which allows for higher success rates. For IVF success rates, the chance of live birth for patients per transfer under 35 years of age is around 50 to 60 percent, and in most cases patients have extra embryos to freeze for later transfers. For patients older than 35, success rates depend on number of eggs retrieved because that is what predicts excess embryos.
Dr. Roth also provides helpful information for talking to your OB/GYN or primary care provider about concerns you have about not being able to conceive and what can be done to help them you through the process. While the recommendation is for the OB/GYN or primary care provider to refer patients to a specialist sooner rather than later, some physicians might recommend medications under their care before referring to a specialist.
The important takeaway is not to wait too long to seek help. More and more OB/GYNs are referring patients to SGF when infertility is first suspected, citing the advantages of patients going to a specialist whose entire practice is focused on infertility. Infertility impacts couples medically, emotionally, and financially. You want to be sure that you are going to the best place for you and your partner.
To learn more about infertility or to schedule an appointment with Dr. Roth or another SGF physician, please contact our New Patient Center at 1-877-971-7755 or complete this brief online form.
*Primary Care RAP is a monthly audio CME program. “RAP” stands for Reviews and Perspectives in primary care and each month they provide over 3.5 hours of health education. Whether reviewing changing practice patterns, covering new literature, reinforcing core concepts, or interviewing some of the top health care providers, listeners can get information on a variety of health-related topics.