Fertility - Maximizing Your Options
with Dr. Grace Janik, Director of Reproductive Endocrinology
St. Mary's Hospital
Research has showed that many people think a woman's fertility does not decline until she nears the age of 40, but the actual age it begins to decline is 27. The decline in fertility increases more rapidly after age 35 and most notably after age 40. By her mid-40s, a woman has little fertility left because her ovaries produce fewer viable eggs.
"To help patients make correct choices, it's important they see a physician and receive accurate fertility information," said Dr. Janik.
Improved medical techniques have made it easier to diagnose infertility problems and successful treatments are available.
Grace Janik, M.D.
Columbia St. Mary's
It's important to get a complete work-up, which takes two to three cycles to complete. You can get a diagnosis quickly and begin treatments. Two-thirds of the patients need just first-line therapy, which lasts from six to 18 months.
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According to the American Society of Reproductive Medicine, approximately 6.1 million couples in the U.S. - about 10 percent of the reproductive-age population - experience fertility problems. Infertility is a disease that affects the male or female reproductive system with almost equal frequency.
The average couple, with no fertility problems, has about a 20 percent chance of getting pregnant in any given month (or menstrual cycle). Eighty percent of couples get pregnant after a year of trying. If you have not gotten pregnant after one year of unprotected intercourse, Dr. Janik advises that you seek treatment.
"It's important to get a complete work-up, which takes two to three cycles to complete. You can get a diagnosis quickly and begin treatments. Two-thirds of the patients need just first-line therapy, which lasts from six to 18 months."
Dr. Janik said the causes for infertility include male factors (40%), uterine and tubal factors (40%), ovulatory factors (40%), cervical factors (5%) and unexplained factors (10%). These numbers do not equal 100% because infertility often is the result of more than one factor.
Endometriosis
Endometriosis one cause of female infertility. Endometriosis, which causes adhesions and cysts as well as pelvic pain, leads to scarring of the fallopian tubes and/or uterus. This scar tissue can prevent ovulation from occurring. Transvaginal hydrolaparascopy is a new diansotic procedure used to inspect the pelvis for adhesions or endometriosis. It is used in the office and takes about 15 minutes. It sometimes replaces laparascopy, a surgical procedure that is done in the hospital.
Treatments
"I individualize the care plan depending on the diagnosis," explained Dr. Janik. The cause of the couple's infertility determines which first-line therapy is used. Some first-line therapies include insemination, laparoscopy (a surgical procedure), medications for ovulation induction and antibiotics, which are prescribed when cervical factors are the cause.
When a first-line therapy is unsuccessful, assisted reproductive technologies (ART) or controlled ovarian hyperstimulation with insemination are additional options. "I feel controlled ovarian hyperstimulation with insemination is a cost-effective treatment that is underused," said Dr. Janik. There is some risk of multiple births with this therapy but she added, "In 12 years of my practice here, I have only had one multiple birth."
Factors that decrease the success rates of infertility treatments become more likely as a woman gets older. These factors include: increase in miscarriage and ectopic pregnancy, abnormal eggs, endometriosis, uterine fibroids, sexually transmitted diseases and male infertility.
In vitro fertilization
In vitro fertilization (IVF) is an example of an assisted reproductive technology. It can help when a woman has blocked or absent fallopian tubes, or a man has a low sperm count. In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body. The fertilized eggs (embryos) are then placed in the woman's uterus. In vitro fertilization becomes less effective as a woman ages and the quality of her eggs declines.
Egg donation
Egg donation increases the chance of pregnancy in the woman over 40. "Egg donation winds back the biological clock; it reverses the age-related fertility decline," said Dr. Janik. "But it can be a difficult decision for the couple. Some patients will not use it for personal or religious reasons."
But it is becoming a more popular option and there are waiting lists at egg banks. Donors can be a relative, friend or a stranger. For ethical reasons, Dr. Janik said egg donation is not available to a woman over 50 years old. A new technique being studied is called egg fusion and it allows the chromosomes from the mother's egg to be transferred to a donor egg, but this is still in experimental stages.
Ways to preserve fertility
• Do not smoke
• Reduce your risk of developing sexually transmitted diseases
• Maintain a normal weight
• Receive treatment for endometriosis
• Receive accurate age-related fertility counseling
