Infertility

It is certainly true that more and more women are waiting to have children. We have seen a trend in our own practices, but this is not something unique to the Chicagoland area. In general, this is a rising trend that has been observed over the last few decades and particularly in high income countries like the United States.

In fact, in the past 30 years there has been a 36% increase in first births among women ages 35-39. Why is this happening? Well, in many cases people are waiting to have children due to financial concerns and a desire to focus on career opportunities. Some of this increased ability to delay pregnancy is also made possible by improved fertility options.

First, one needs to know the definition of infertility or as some prefer to call it, subfertility. The current definition is an inability to conceive or sustain a pregnancy after 12 months in a woman less than 35 years old or an inability to conceive or sustain a pregnancy after 6 months in a woman 35 years or older. This means that a couple has been having intercourse around the time of ovulation, each month, without the use of hormonal birth control (pills, patch, ring, IUD, implants) or barrier methods (male condoms, female condoms, sponges, diaphragms, spermicides, etc.) and has not become pregnant. Once the time period of 6 months or 12 months (based on your age) has elapsed without a pregnancy or a live birth, it is time to come see your Ob/Gyn for guidance and an infertility evaluation.

First, the Ob/Gyn physician will review the patient and her partner’s medical history to ensure there are no factors that may be contributing to their subfertility. If there is nothing noted in the history that is considered significant, both female and male testing is necessary. True, it is often assumed that fertility issues are due to the female partner (egg factor) but in almost equal amounts, the male partner (sperm factor) is to blame. Then, your Ob/Gyn will want to run some tests.

Your Ob/Gyn will want to test your hormone levels on a certain day of your menstrual cycle to make sure your ovaries are functioning properly and that the egg quality is normal. Remember, you have the most eggs you will ever have when you are still an embryo in your mother’s womb, and they continue to age from that point forward.

Your Ob/Gyn will also likely perform a procedure called an “HSG” or hysterosalpingogram to check that your uterine cavity or “womb” is normally shaped.  Your Ob/Gyn will also want to make certain there are no fibroids or polyps (noncancerous lesions) that may be hindering the embryo (baby) from implanting in the uterus. Lastly, the fallopian tubes are evaluated to ensure that they are open, or at least one of them is open. Remember that fertilization occurs in the fallopian tube and then the embryo travels to the uterus where it implants and continues to grow. So, if a woman’s tubes are blocked, the sperm cannot reach the egg to fertilize it and lead to pregnancy.

Finally, the male partner will need to provide a semen analysis (test to evaluate the sperm) so make sure there are enough sperm, that they are mobile, and that they are formed normally.

Once these three tests are completed, if there is no cause identified, your Ob/Gyn may choose to discuss medications with you that can be used to increase your chances of pregnancy. Depending on your Ob/Gyn’s comfort level, they may consider medications that will induce ovulation (clomiphene citrate or letrozole) with timed intercourse (having sex when a woman knows she is ovulating).

If that does not result in a successful pregnancy, your Ob/Gyn will likely refer you to a qualified Reproductive Endocrine and Infertility (REI) professional in the area who can assist you further with techniques like intrauterine insemination/“IUI “(where sperm is concentrated in a fertility lab after a male partner provides a sample and it is injected directly into the uterus on the day when the female partner is ovulating) or even in vitro fertilization/“IVF” (where eggs are harvested surgically from a woman’s ovaries under anesthesia and fertilized with the male partner’s sperm to form an embryo and then allowed to grow for up to 5 days in the lab and then placed back into a women’s uterus).

Certainly, these techniques can increase a couple’s chances of conceiving but also may or may not be covered by insurance and can be quite expensive. It is recommended that you call your insurance provider and inquire about fertility coverage rates before making an appointment with an REI provider.

Most couples will conceive on their own within the 12 months of timed intercourse if they are younger than 35 years old. That number has been quoted to be as high as 80-90%. However, as women age, and therefore the eggs in the ovaries age, there is a greater chance for aneuploidy (abnormal chromosomes/genetics) in women over the age of 35. That is why the interval before seeking help from your Ob/Gyn is only 6 months as opposed to 12 months. The good news is that science has progressed immensely, and now we have many techniques that can assist women and their partners in becoming parents!

Of note, for members of the LGBTQ community, it is important that you speak with your Ob/Gyn regarding family planning as soon as you decide to start a family as some of these techniques may be recommended immediately, including seeking the help of an REI provider to help with conception.