Building A Family
Prevention and Treatment Dr. Gwen Goodrow, FRCSC OB/GYN, discusses fertility issues and the different options available to couples looking to start a family.
Having a baby is not always as easy as it seems, which is why if you’re starting a family, consider consulting a professional.
Mediaplanet: When should someone consider seeing a professional regarding fertility issues?
Gwen Goodrow: When couples want to start a family, they often spend time trying on their own. There are some people that the standard line of trying for a year is not in their best interest. Consider the following:
- Women who are 35 and older may want to see a fertility doctor sooner than 12 months because time may not be on their side.
- Women who have irregular cycles may have a condition called PCOS — where they ovulate or release an egg inconsistently — will benefit from earlier consultation because their eggs may not be growing reliably to be able to meet the sperm.
- Sometimes women with irregular cycles are starting to enter into menopause and time is definitely an issue to be able to conceive in this situation.
- Men who know they have an issue with their sperm in terms of numbers or swimming ability will also benefit from early consultation.
- Single women who want to start a family will need donor sperm so they need to see a fertility doctor when they are ready to start a family.
Ultimately, if the person or couple has a question about their fertility, it is better to see a specialist and ask the question than wait. Sometimes, they can wait too long.
MP: Infertilty affects one in six Canadians. What are the predominant risk factors associated with infertility?
GG: In Canada, as in other parts of the world, many couples are delaying starting a family until they are in their late 30s or early 40s. A woman’s age is a risk factor that can work against her ability to become pregnant in a timely manner. Other women can have irregular cycles and have PCOS which can make becoming pregnant difficult. Endometriosis — where the lining of the uterus sheds and travels up the tubes and plants outside of the uterus — can also make becoming pregnant difficult. These women often have painful periods. Women who have had surgery on their tubes or are missing an ovary secondary to surgery can have reduced fertility. Additionally, men who have had testicular cancer or undescended testicles as a child can have reduced sperm which leads to issues with fertility.
MP: What are some common misconceptions surrounding age, fertility and treatment?
GG: People believe that technology and treatment can make up for all of this but the bottom line is it can’t.Fertility treatment can help a lot but for the most part it can’t change biology. This is why it is important to seek treatment as soon as it is realized that pregnancy is not happening in a timely manner before it is too late.
MP: What are some recent advancements in the fertility field that families should know about?
GG: There have been two major advancements in the last 10 years that can make a large difference to couples with infertility. One is we now have the ability to freeze eggs successfully with very high rates of survival when thawed to use at a later date. The biggest impact this has had is in women who are suffering from various cancers and are about to undergo treatment that may have long term harm to their ability to get pregnant at a later time. These women can undergo treatment to gather eggs to put in the freezer before their cancer treatment is started. The eggs can remain there almost indefinitely to be used to make embryos after their cancer treatment is finished and they are ready to become pregnant. The other major advancement is having the ability to analyze embryos created from in vitro fertilization (IVF) to know which ones are normal and which ones are not. This technology is called preimplantation genetic diagnosis. A major reason why IVF is not always successful is that embryos that are genetically abnormal are created just as normal ones are created. However, they all look and act the same in the laboratory. When an abnormal one is put back in the woman, they either don’t “stick” or result in a miscarriage. By analyzing them before, we can weed out abnormal ones and increase the chances of the transferred embryo “taking” and leading to a pregnancy. We may also be able to reduce the chance of miscarriage too with this technology.
MP: Are there fertility options for same sex couples?
GG: Yes there are. For lesbian couples, they can create a family by using donor sperm. This sperm comes from sperm banks and there is lots of choice of donors. Lesbian couplesmay not be “infertile” so once they have access to using donor sperm, they may have an excellent chance of becoming pregnant.
There are options for same sex male couples too. This is a bit more complicated because in that situation, the couple needs to obtain eggs and a surrogate to carry the pregnancy.There are donor egg banks in the United States that Canadians can access via their fertility clinic so that can solve that aspect. Or maybe the couple have a family member or friend who is willing to donate their eggs to them. A carrier for the pregnancy is also needed.This aspect can be more challenging to solve because Canadians are not allowed to “pay” someone to carry their baby.