Starting A Family
Prevention and Treatment One in six couples will experience some sort of fertility issue when trying conceive. Know your options.
As with any health issue that has a long-standing stigma attached to it, infertility is not spoken about as often and openly as it should be. People are, therefore, unaware of just how widespread infertility issues are. The reality is that one in six couples will experience some sort of fertility issues when trying to start a family.
Getting to Know You
“When a couple comes into a clinic we start off by taking information about their history that is guided towards the different components of what it takes to get pregnant,” explained Dr. Fay Weisberg, Fertility Specialist and Founder of First Step Fertility. “We talk about age, the menstrual cycle, whether they’re having sex at the right time, and whether or not there any other gynecological issues from the past.”
As well as taking a full medical and family history, the fertility clinic will ask about all aspects of the couple’s lifestyle, and whether either partner is doing something that could be impairing conception. “Lifestyle is extremely important,” said Dr. Weisberg.
Testing and Treatment
As well as being cultured to check for any infections, a man’s semen will be tested for sperm count, motility, and morphology. A woman may have a pelvic exam including a Pap smear and swabs for infection, an ultrasound to assess her pelvis, extensive testing of her hormones, and a test that assesses the latency of her Fallopian tubes. Blood testing for infectious diseases will be done on both partners.
“Everyone’s body is different, so this means that an appropriate treatment for one woman may not be appropriate for the next,” explained Dr. Ellen Greenblatt, Medical Director at the Mount Sinai Centre for Fertility and Reproductive Health.
Fertility drugs can be used at the start of a cycle, these can help make an egg if a woman doesn't produce them naturally, or increase her number of eggs for improved fertility. During ovulation a woman may be encouraged to have sex at a certain time, or alternatively her eggs can be taken out, inseminated, and then put back in vitro, a process commonly known as IVF.
“The last point of intervention is in the second half of the cycle, after ovulation, where we can give progesterone. This is a hormone women make that helps support the lining of the uterus, and make it hormonally perfect so that implantation can happen,” explained Dr. Weisberg.
New Technology, New Methods
Historically, the chances of an egg surviving after going through a freezing and thawing process, and then leading to fertilization and pregnancy, were low. In recent years, egg freezing has been improved using vitrification, as Dr. Anthony P. Cheung, Founder and Medical Director of the Grace Fertility Centre, explained: “It’s a process of rapid cooling; it freezes eggs in such a way that allows for increased oocyte survival and increased pregnancy rates.”
During pre-implantation genetic diagnosis, cells from the embryo are removed and tested for known lethal genetic diseases. Embryos that are not affected can then be transferred safely into the uterus.
“Pre-implantation genetic screening - in contrast to diagnosis - for abnormal chromosome numbers (aneuploidy), a common cause of miscarriages, has been suggested to optimize pregnancy success,” said Dr. Cheung. “However, because embryo biopsy is required and false results remain a challenge, a more clinical experience and critical review is required before adopting this approach.”
Dr. Jason Hitkari, a Reproductive Endocrinologist at the Olive Fertility Clinic, explained that the chances of success with fertility treatment now, compared with 10 years ago, are vastly improved.
“There has also been a lot of research into how to improve a patient’s chances of getting pregnant through fertility treatment that has resulted in many changes to how the care is given,” he said. “Patients undergoing fertility treatment, such as IVF, should have the support and communication they need through their experience to make it as positive as possible.”
By: Joe Rosengarten