Will I ever have a baby? is a question fertility doctors hear all the time. The answer, unfortunately,is not easy to understand or explain. There are many factors that determine if fertility treatments, including In Vitro Fertilization (IVF), will be successful. However, state-of-the-art technologies, combined with good old fashioned bedside manner, are giving hope to couples who are nearing the end of their rope.
“In many cases, we are the last stop. They do not see a light at the end of the tunnel. We need to give them hope,” says William F. Ziegler, D.O.,FACOG, medical director of the Reproductive Science Center of N.J. “We have to address their reproductive health and psychological well-being simultaneously.”
Is IVF Right for Us?
Couples interested in starting a family often find themselves looking into In Vitro Fertilization after learning they are unable to naturally conceive.While IVF has helped countless women realize their dreams of giving birth, there are many reasons couples may decide against having this assisted reproductive technology.
IVF is an expensive proposition, and there are no guarantees. However, choosing a physician who will tailor treatment for each patient and couple increases the odds that a baby will be conceived, carried to term and born healthy.
Dr. Ziegler says that guiding the patient through an evaluation and making sure you make the right diagnosis is the first step to success. “We recommend testing the male through a semen analysis, evaluation of the woman’s uterus and fallopian tubes using an Xray or a specialized ultrasound, and determining a woman’s ovarian age through blood work,” he explains. “Once we have these results, we can decide if further testing is needed or if we can proceed with treatment.”
Since the days of Baby M, fresh transfer IVF has involved the following basic steps: medications are used to stimulate egg production; eggs are retrieved with guided ultrasound imaging; eggs are combined with sperm and fertilization is encouraged in a lab dish; once the eggs are confirmed fertilized, they are considered embryos; the embryos are monitored for a few days and then are implanted in the woman’s uterus.
Correct Diagnosis is Key
“IVF really starts far before eggs are stimulated,”says Dr. Miguel Damien, founder of Damien Fertility Partners in Shrewsbury. “It starts with correct diagnosis of the challenges you are experiencing.”
“Whenever a patient comes to me, whether they’ve tried IVF and have been unsuccessful or they are simply having trouble conceiving and don’t know why, I focus on correct diagnosis of the problem,” Dr. Damien says. “Everyone comes to me thinking they have a problem and looking for a solution. I can’t offer a solution until I know the reason they aren’t getting pregnant. Is there an ovulation issue? Is it a pelvicor tubal problem? Maybe the problem is with the sperm. How can we fix something when we don’t know the cause?”
There is even the possibility that the infertility issue is due to something completely unrelated. “For example, if the woman has a thyroid problem that is making her infertile or contributing to frequent miscarriages, IVF will not work,”says Dr. Damien. “We must understand the underlying medical issues that could be affecting infertility. Often small things are missed and, when fixed, make a big difference in the success of the IVF process.”
IVF Rates of Success
Many patients come to Dr. Ziegler with the pre-conceived notion that IVF treatments are 100 percent successful, he says. But the truth is,that’s not the case.
“We have a conversation about their underlying issue(s) and how it impacts success rates.We can be conservative or aggressive with our treatments, as appropriate,” Dr. Ziegler says.
“We are only transferring one embryo in our IVF cycles,” he says, “even though many infertility couples/patients have a “one and done” perspective. They want to go through the process and conceive first time out and, therefore, want multiple embryos transferred.”
However, transferring multiple embryos, Dr. Ziegler says, does not significantly increase IVF success rates, only multiple rates.
At the end of the day, this is true for all fertility doctors. Dr. Damien says “success rates are more difficult to track these days thanks to amazing technology advances in the process. For example, embryos can be frozen for later use. Also, pre-genetic testing of embryos prior to implantation can increase odds of success. Therefore, it’s difficult to compare success rates of various clinics because the procedure is not always performed in the traditional manner.”
According to Dr. Damien, patients considering IVF fertility treatment may be offered PGT (preimplantation genetic testing). The first few steps of IVF are performed the same but, before implantation, embryos undergo certain tests to check for abnormalities. PGT is not usually covered by insurance and generally costs about $7,000.
“Some places do a lot of PGT, some do half and half, and many don’t use PGT at all,” says Dr. Damien, “though implanting a normal embryo will increase the chances of success. You cannot compare all IVF programs when it comes to success rates.”
Reproductive Science Center of New Jersey
Infertility is a condition that affects approximately 1 out of every 8 couples, according to the American Pregnancy Association. “When to seek help is really up to the couple,” says board-certified specialist in Reproductive Endocrinology and Infertility, Dr. William Ziegler, D.O., FACOG. Dr. Ziegler is Medical Director of the Reproductive Science Center of New Jersey.
“If a woman is feeling stressed about the length of time it is taking to conceive or is worried there is a problem, then they should seek help,” advises Dr. Ziegler. “By definition, a couple should seek help if they have failed to conceive after one year if the woman if under age 35, or within six months if the woman is older than age 35.” An infertility diagnosis is given to a couple that has been unsuccessful in efforts to conceive over the course of one full year.
Common Causes of Infertility
The most common causes of female infertility include problems with ovulation, damage to the fallopian tubes or uterus, or problems with the cervix. “Age can contribute to infertility because as a woman gets older, her fertility naturally tends to decrease,” says Dr. Ziegler.
Ovulation problems can be caused by:
• Hormone imbalance
• A tumor or cyst
• Eating disorders such as anorexia or bulimia
• Alcohol or drug use
• Thyroid gland problems
• Excess weight
• Intense exercise that causes a significant loss of body fat
• Extremely brief menstrual cycles
Female infertility factors contribute to approximately 50 percent of all infertility cases, and female infertility alone accounts for approximately one-third of infertility cases. Male infertility can be the result of low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm, illnesses, injury, chronic health problems, and lifestyle choices.
“Overweight and underweight women have increased risk for infertility and less success with fertility treatments,” says Dr. Ziegler. “Consistent, moderate exercise and a healthy diet is good preconception care to help a woman maintain her reproductive health. “
Meeting Each Patient’s Special Needs
“There are many encouraging advances in fertility treatment, and every patient desiring to conceive should be treated individually, helping them to build a family in the best way specific to their needs and wishes” says Dr. Ziegler.
“A patient’s treatment is based on many variables,” says Dr. Ziegler. “This includes the cause for their infertility, other medical conditions, ovarian function, and results from prior fertility treatment.”
“Medications have evolved over the years, which helps us to fine tune a patient’s response so we can now decrease the risk of multiples and ovarian hyperstimulation,” adds Dr. Ziegler.
“For women that are older or if they are carrying a genetic abnormality, we are now able to test embryos for genetic issues prior to transferring them into a women’s uterus,” says Dr. Ziegler. “This has helped increase pregnancy rates in women with pregnancy losses and those at an increased risk for genetic issues.”
Cryopreservation is another exciting advance for women who may choose to delay pregnancy. A woman may choose to delay pregnancy for medical reasons such as cancer treatments including chemotherapy, radiation and surgery, which can speed up the natural decline in available eggs and increase the risk of infertility, or for personal reasons such as education, career, relationship and other social factors.
Cryopreservation is the freezing and storage of mature eggs or embryos for later use in assisted reproductive treatments. These treatment options help women address the disconnect between the readiness to have children and the biological limitations of aging eggs.
“At some point, maternal age becomes a factor in achieving the goal of parenthood” says Dr. Ziegler. “With egg and embryo cryopreservation, however, women can take a proactive role to protect their future fertility.”