Inside Infertility

Inside Infertility

—Molly Each and Nancy Maes

Every year, nearly seven million couples deal with the heartbreak of infertility. Rather than enduring it alone, most seek the counsel of a fertility specialist. Calling on physicians with high levels of experience and expertise and an array of available treatments, many women who previously thought becoming pregnant was impossible have been able to bear children.

The decision to seek medical help isn’t easy, especially considering such factors as cost, timing and emotional investment. Rather than panic too early (or delay assistance for too long), most doctors recommend consciously trying to conceive for at least a year. “The vast majority of people should have been pregnant by then,” says Dr. John Rinehart, the physician behind local fertility clinic Reproductive Medicine Institute. “If you haven’t, it’s time to start looking for problems.”

However, guidelines change for women as they age. “If a women is 35 or older, and she’s been trying for six months, the couple should consider seeking help,” Dr. Rinehart says. “Fertility actually begins to decline after the age of 27, much younger than originally thought. Consequently, as a woman gets older, her age becomes an increasingly significant issue.”

Once a couple seeks assistance from a physician, they will undergo a series of tests to determine the core problem of their infertility. In general, fertility issues are split nearly evenly, with 40 percent attributed to men, 40 percent to women, 10 percent to both partners and 10 percent inconclusive. Doctors should be able to determine the issue in about a month and begin a course of treatment. A competent doctor will present several options along with the associated risks, giving patients control over their own treatment patterns.

In terms of success rates, In Vitro Fertilization (IVF) is the hands-down winner. IVF is a process that enables the sperm and egg to be manually combined in a lab. If fertilization occurs, the embryo is then placed back into the uterus, using a process called embryo transfer, to develop normally.

“There is nothing we have to offer on a single-cycle basis that has the same success rate as IVF,” Dr. Rinehart says.

Still, IVF is costly, and it can be hard on the body. In the first step of IVF, women must undergo a program of injections to bump up egg production, a process that is not without risk. And egg development must be closely monitored, adding to the expense. Thus, recent developments have produced In Vitro Maturation (IVM), a safer and less costly twist on IVF. In IVM, a woman’s ovaries are not stimulated with medication to create multiple eggs. Instead, immature eggs are retrieved from unstimulated ovaries and undergo the maturation process in a lab, where they can be easily monitored.

“There’s a desire in our field to reduce the amount of medication used,” says Dr. Mary Wood Molo, a physician at Women’s Health Consultants and director of the IVF program at Rush University Medical Center. “In this case, we’re utilizing technology to spare the patient medications.”

Even with larger innovations in the works, Dr. Rinehart says that smaller factors are having the largest impact on the field. “The Internet has changed the practice,” he says. “Couples are much more informed about what’s going on, but it’s important to remember that there’s no filter on the Internet to give you an idea about how accurate or significant the information is.” Without additional numbers and background data, information can be easily skewed or taken far out of context or perspective. “One of the major changes in our role as physicians is to help put this information in its proper perspective as it relates to the individual,” Dr. Rinehart says.

The recession has also made its mark on fertility treatments, especially IVF, which can cost anywhere from $10,000 to $20,000. And while Illinois insurance is legally required to provide fertility coverage, several exclusions surround the law. For example, your employer can deny coverage based on religious beliefs. Employees of large corporations may be covered under federal benefits, which don’t include infertility. Or, if employers have less than 25 employees, they’re not required to provide benefits. Any of these scenarios leave many couples footing the entire bill. Dr. Rinehart remembers several patients who have taken out second mortgages on homes to make the procedure happen.

If the cost of IVF is too steep, doctors will still do what they can to help a couple conceive. Though success rates may not be as high, less expensive routes do exist, ranging from hormone injections to medications to Intrauterine Insemination (IUI), a process in which the sperm is injected into the uterus during ovulation. “We’ll try to avoid aggressive or invasive methods,” Dr. Wood Molo says, noting that often an outpatient surgery to restore anatomy or treat endometriosis (a medical condition that contributes to infertility in women) is a faster—and less expensive—route.

Undoubtedly, infertility treatment requires an intimate and often emotional patient-physician relationship, and it’s important for couples to choose a doctor who’s right for them. Couples should consider patient attention and approach, which can vary widely. “It’s not as if we have a protocol,” Dr. Wood Molo says of her practice. “Couples get a plan based on their body and fertility factors. We create individual plans rather than say, ‘Do this three times, then do this three times.’”

Patricia Williams (name has been changed) understands the importance of that philosophy. For several years, she was treated for infertility at a Chicago clinic. “I went through IUI several times and IVF probably three times. I had a surgical procedure to find the problem, and the surgeon said my cervix was so serpentine that he couldn’t get into my uterus to take a look,” she recalls. “It was like a factory.”
After the barrage of unsuccessful treatments, she went to New York to see a well-known infertility specialist. There, she was equally disappointed with the doctor’s approach. “My husband said I could see one more doctor, and then we would be done shopping for second opinions,” she says. “Because if you look hard enough, you can find someone to tell you anything you want.”

As her last resort, Williams ended up seeing Dr. Wood Molo. “She was the first physician who was really curious and took an interest in my case,” Williams recalls. “She really focuses on solving problems in a way that is highly tailored to each individual. She is working with people who are sometimes depressed, emotional and desperate, and she [knows] whether you’re open to humor or if you need a hug. And if you need explanations, she will draw pictures describing all the options.”

After performing an MRI of Williams’ uterus, Dr. Wood Molo ended up removing a small septum, which is a congenital malformation. Williams became pregnant shortly after the simple procedure. She and her husband are now the parents of a 3 ½-year-old son as well as a daughter born this past summer.

Williams’ case is a clear illustration of a major facet of infertility treatment: A couple must trust their physician, whether they’re in the throes of treatment or at the beginning of the process. “If a couple has been trying, and they’re not getting pregnant, and they have a question, they should feel comfortable going to their doctor and asking, ‘Should I be concerned?’” Dr. Rinehart says. Once that trust is established, the journey to a family can begin.

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Published in Chicago Health Winter 2010