Or can they? Early menopause, older eggs, diminished ovarian reserve, ovarian failure – all of these diagnoses can be improved. To what extent? No one knows. If the fertility issues is not age- related, and there is a fibroid, PCOS or endometriosis, these are more structural and hormonal issues, and are more easily remedied. But when it comes to DNA, the jury is still out on how much Fertility Doctors can change a man or a woman’s biology.
Around 10% of couples in America are infertile, and there are around 1500 fertility specialists (Reproductive Endocrinologist or RE) in this country, and yet most women opt to work with their OBGYN instead of a fertility specialist. Or, women wait too long before moving on to an RE, while they could be wasting valuable time and energy as they are losing a potential ovulation or cycle to conceive with each passing month. Some women spend too long taking Clomid or other drugs with their OBGYN. Only Reproductive Endocrinologists (RE’s) conduct highly specialized procedures such as in vitro fertilization (IVF), whereas OBGYNS can only prescribe fertility drugs that help stimulate egg production and maturation. Some OBGYNs will have their patients stay on fertility drugs for more than 6 months or longer – not something you want to do for more than a certain amount of time for the sake of your health, especially if it is not working. The latest studies show that women ages 38-42 years old, with unexplained infertility, who proceed immediately to IVF (rather than the common practice of trying other treatments first) have the best chances of having a baby in the shortest amount of time.
Some clinics offer a program called “risk sharing” where a patient pays a lot of money up front and after a certain number of IVF cycles, if she does not get pregnant, she gets the money back. If she gets pregnant right off the bat, then the clinic still keeps the money. The risk is actually more stacked towards the patient, as these programs only sign up the women who have a great chance of getting pregnant right away. Sometimes these clinics till give the woman an aggressive treatment plan in hopes to get her pregnant as soon as possible, when it may not be the best or safest path towards pregnancy for that patient. Be careful and do your research – make sure your doctor has your health and your future baby’s health at the utmost importance.
Most of the health risks are well known to doctors – risk of multiples, complications with twins, blood pressure issues and gestational diabetes risks. The health risks to children born through IVF are lesser studied, although in the U.S. and in Australia the children are as healthy as any other population. In Europe teh studies vary, and some populations of children born through IVF have a slightly higher level of issues with body fat, glucose and blood pressure. The Australia study plans to follow-up with these children down the road to continue to see what the health of these children is like. A discussion of the risks and unknowns associated with assisted reproduction should be an important part of any doctor-patient discussion.
Most clinics do not let you know what support you may need or where you can get it. Medications, indecision, financial issues and failed treatments can ruin a marriage and break you down. At a minimum, clinics should let couples know the support services available in the region, even if patients don’t ask for them. Hiding feelings is not healthy. Some women develop post traumatic stress disorder (PTSD) after certain types of failed cycles, and for this there is now help – psychologists and therapists who specialize in infertility can be greatly helpful, as can group meetings, acupuncture treatments and other therapeutic activities.
Congress requires the Centers for Disease Control and Prevention to publish an annual report on the success rates of fertility clinics offering assisted reproductive technology. The results can come off as difficult to understand, sometimes because of the medical language, but also because of the way they frame the information. Some research groups suggest they be called failure rates instead of success rates, as 9 out of 10 women do not get pregnant (age 41-42) in the U.S. on average. The Society for Assisted Reproductive Technology (SART) is working on a free, online patient predictor model that will give patients a better sense of their probability of success – this, in conjunction with the CDC reports should be much more revealing.
Many doctors will push more treatment – either because they genuinely think and want you to get pregnant, or because they want to upsell you. It’s a doctor’s job to take care of you and guide you through this to your benefit, and doing emotional assessments after or before cycles may help with this. Patients should ask their doctor how their experience compares with that of patients with similar profiles, and consider stopping if their results are worse than average. Patients are best served by an assessment of their chances, the risks involved, and support if they decide to stop treatment.