Article

Fertility Primer

Medical Contribution By Dr. Arthur Sagoskin
So you thought getting pregnant would come easily? You probably even spent time and money on preventing pregnancy, possibly for years, and now the irony stings.
It’s time for a Fertility Primer.

What You Thought You Already Knew

Most of us enter the “trying-to-conceive” arena armed with whatever we learned as teenagers about getting pregnant. Our educators may have been so focused on lessons about avoiding pregnancy that some of the informational details about how pregnancy occurs were passed over as not important at the time. We all start off knowing the basics about sexual intimacy and its possible results.

For most people, that’s all that’s required.

In fact, the average couple has about a 1 in 4 chance of conception, per menstrual cycle. Statistically, 80 percent of couples (with both partners in good health and having what’s considered an average amount of unprotected intercourse) will get pregnant within a year’s time.

For millions, though, a little more knowledge can go a long, long way toward making a baby.

First Things First

One of the easiest clues that someone will have fertility problems is irregular menstrual periods, according to Dr. Arthur Sagoskin. “That’s a pretty obvious indicator that a woman needs to see a physician, starting with her regular OB/Gyn.”

While absent or infrequent periods may seem like a bonus to some women, it can also be an indication of several health conditions, including infertility.

A woman’s menstrual and ovulation cycles are interwoven. It’s all based on a hormonal relay system that involves not only the ovaries, but also the hypothalamus and the pituitary glands. The hormones involved are follicle stimulating hormone (FSH), an estrogen called estradiol (E), luteinizing hormone (LH), and progesterone (P). The graph demonstrates how the ebb and flow of the hormones, just the right amounts of the right ones at the right time, result in both the maturing and then releasing of egg cells (ovulation) plus the building up and eventual sloughing off of the uterine lining (menstruation).

For conception to occur, a healthy supply of well-formed, properly moving sperm cells need to be ready and waiting, already in the woman’s reproductive tract just prior to the actual point of ovulation, around the middle of her cycle.

A glitch in any of the above details, whether it’s a malfunctioning gland, immature egg cells, problems with sperm, or others, can make getting pregnant difficult at best.

In addition to irregular periods, some other factors that may point to possible infertility are :

  • History of pelvic infection
  • Prior abdominal or pelvic surgery
  • Endometriosis, sometimes indicated by extremely painful and heavy periods

Men, too, have their share of fertility-impacting issues to consider, for example :

  • History of testicular trauma or infection
  • Prostate surgery
  • Diabetes

Both men and women should know that commonly transmitted infections like Chlamydia are a frequent cause of infertility in women and sometimes in men. So if you were using condoms during those years before you tried to conceive, that was indeed one of the best things you could’ve done to protect your future fertility.

How Do You Find Out?

A woman‘s age impacts her fertility so it has bearing on when experts recommend she seek assistance from a fertility specialist. But they don’t suggest every woman who wants to get pregnant needs to see an expert.

Dr. Sagoskin explains, “For women younger than 35, if they haven’t been trying for at least a year and there are no other obvious infertility causes, they may want to try for another few months before seeing a specialist. Insurance often won’t cover diagnostics or even consultation with a reproductive endocrinologist until the patient has been trying to conceive for at least a year.”

Fertility experts at Shady Grove Fertility and elsewhere do occasionally have consultation appointments with the “worried well” – young people who’ve read a lot in advance about getting pregnant and all the things that can go wrong.

With the increased availability of health information on the Internet, some people start off down the family-building road too ready to jump into the specialist’s office.

“We don’t always evaluate patients at that point,” says Dr. Sagoskin, “but we’ll talk with them about predicting ovulation and timing intercourse. We may perform a semen analysis, because it’s relatively inexpensive and the only way to determine some male-factor infertility issues.” Sagoskin and his colleagues will also suggest that patients read about treatment basics on the Shady Grove Fertility website.

A number of tests can be run through the patient’s OB/Gyn or even Family Practitioner’s clinic, and as Dr. Sagoskin said, will sometimes only be covered by insurance when ordered by the Primary Care doctor. Once the determination is made that either more complicated diagnostics should be performed, such as hysterosalpingogram (HSG), or if the initial tests indicate an infertility condition exists, many insurance policies will cover the initial consultation with a fertility specialist.

What if Fertility Treatment is the Answer?

The types of treatment that can be conducted through a non-specialist’s clinic are rather limited, primarily to artificial insemination like intrauterine insemination (IUI). However, says Dr. Sagoskin, “Not all OB/Gyns are comfortable performing even basic inseminations.”

In addition to physician experience and skill, Sagoskin says other factors that vary between a non-specialist and a reproductive specialist’s offices are their hours of availability and medication limitations. “Few OB/Gyns will have 24/7 availability (necessary for some types of infertility treatment), and most aren’t prepared to manage patient cases when injectable fertility medications are prescribed.”

Because there are so many variables that can cause a couple or individual’s infertility, treatments also vary from the most basic oral medication to IUI to in vitro fertilization (IVF) and preimplantation genetic testing (PGT).

How Do you Pay for it?

Unfortunately, insurance coverage for further diagnosis and especially treatment of infertility is not a given in all of the United States. Knowing this, centers like Shady Grove Fertility maintain expert financial services staff who are specially trained in guiding patients toward affordable use of the world’s most state-of-the-art assisted reproduction techniques.

In addition to being well-versed in both insurance plans and the variety of options for affording treatment, such as loans or other assistance programs, the staff of Shady Grove Fertility was the first in the world to develop a Shared Risk plan. Shared Risk allows couples who need to use IVF for conception to pay a fixed fee for up to six chances at getting pregnant with IVF. If treatment isn’t successful, 100 percent of the fee is refunded, leaving their family-building resources intact for other options such as adoption.

The Best Time to Have a Baby

Nobody likes learning about getting pregnant after it’s become an apparent struggle. Just visiting a website about infertility can make you feel like you’ve lost something. The truth is that infertility has always been around, that millions are affected by it, and the good news is that for those who need help getting pregnant, there has never been a better time.

Most people who seek treatment do not have to use IVF, often considered the most extreme and technical form of assisted reproduction. For those who need IVF, they can take comfort in knowing that after several decades of its use to create successful pregnancies; the techniques are well-honed and proven.