New Options Are Improving the Odds of Becoming Pregnant
By Cynthia Austin, M.D.
Gynecologists generally define infertility as not conceiving after one year of unprotected intercourse. Given the intricate nature of the human reproductive system, it’s not surprising that approximately one in every six couples will be diagnosed with infertility.
INCREASE YOUR CHANCES
There are many things you can do to boost your chances of becoming pregnant, improvimg your overall health and increasing your fertility:
- Healthy diet
- Regular exercise
- Maintaining a normal weight
Before trying to conceive, you should also stop smoking and drinking alcohol, and cut down on caffeine intake. If you have a medical condition, such as diabetes, make sure it is under control before trying to conceive.
IS IT TIME TO SEEK HELP?
Infertility is a private problem and many couples struggle with deciding when to seek help. If you have been trying for a year or more, you and your partner may benefit from an evaluation. Some couples should seek help earlier. Women over age 35 are advised to have an evaluation after six months of trying to conceive. Women with irregular periods and/or pelvic pain, men with a history of urologic problems, and couples who are stressed from their inability to conceive can seek evaluation earlier. I tell my patients that the “right” time to consult a specialist is when the couple sees the situation as a problem.
Infertility may be the result of a variety of factors. In women, the following can lead to infertility:
- Ovarian dysfunction
- Tubal blockage
- Endometriosis or structural abnormalities in the uterus, such as fibroids
In men:
- Anatomic or hormonal problems can reduce the number and/or quality of sperm, leading to problems with conception.
Sometimes, even the most comprehensive evaluation won’t reveal a single factor. But even when the case is not clear, effective treatments are available.
A RANGE OF TREATMENT OPTIONS
Because of all of the publicity around in vitro fertilization (IVF), many couples come in thinking that is what we will recommend. Fortunately, there are many other options, including:
- Medical therapy
- Reproductive surgery
- Intrauterine insemination
Cleveland Clinic’s fertility program provides the full range of state-of-the-art services for the diagnosis and treatment of infertility. Patients are seen in a caring environment, where the major emphasis is not only technological excellence, but also on accessibility, personal attention and emotional support.
The specific treatment that is right for you will be determined by your physician based on your age, overall health, medical history, extent of the disorder and the course it is expected to take, your tolerance for specific medications, procedures or therapies, and most importantly your opinions and preferences.
Medical therapy is used to correct ovulation dysfunction (irregular or infrequent periods). Pills or daily injections can be used to improve the process. Intrauterine insemination is an option for patients with mildly abnormal semen analyses, as well as those with unexplained infertility, in combination with fertility drugs. Intrauterine insemination is an office procedure in which semen undergoes a “washing” process and the sperm are placed into the uterus using a slender plastic catheter that is inserted through the cervix. If necessary, couples can choose intrauterine insemination using anonymous donor sperm, although IVF can be successful even when the male partner has severely low or no sperm at all in his semen analysis.
When infertility is caused by an anatomic irregularity, such as scar tissue, endometriosis, ovarian cysts, fibroids or blocked fallopian tubes, surgery may be warranted. The vast majority of surgical procedures used to address infertility can now be performed on an outpatient basis using a laparoscope (a type of endoscope) inserted through the navel, or a hysteroscope, which used a vaginal approach to reach the uterus. Both types of endoscopic procedures offer success rates as good or better than open surgery and result in reduced costs, quicker recovery, fewer complications, less pain and better cosmetic results.
ADDITIONAL HELP WHEN NEEDED
The American Society of Reproductive Medicine reports that 85 percent to 90 percent of cases of infertility are successfully treated with conventional therapies, such as:
- Drug therapy
- Surgical repair
For those patients who are unable to conceive with these methods, reproductive technology, such as IVF, may be the solution. During IVF, the ovaries are stimulated with injectable fertility medications so that multiple eggs will mature. Once monitoring with ultrasound and blood tests indicate that the eggs are ready, they are collected with an ultrasound-guided needle while the patient is under deep sedation. The egg collection procedure takes about 20 minutes and is painless.
Fertilization is accomplished by exposing the eggs to sperm in a culture dish, or by directly injecting a single sperm into each mature egg (intracytoplasmic sperm injection, or ICSI). After fertilization, embryo development is monitored over the next three to five days. Usually two to three embryos are then placed into the uterus with a small catheter through the cervix. Excess embryos can be frozen for future use.
In the early years of IVF, success rates were very low. Today, IVF is a safe, time-proven assisted reproductive treatment with a very high success rate.
Dr. Austin is the Director of In Vitro Fertilization in Cleveland Clinic’s Ob/Gyn & Women’s Health Institute. She sees patients in the comprehensive Fertility Center at the Beachwood Family Health and Surgery Center.