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The Fertility Journey

The Challenges I See Everyday as a Reproductive Endocrinologist

Dr. Beth McAvey

For many couples, having a baby can take much longer to materialize than they expect. Millions of couples experience infertility and a large number of them seek medical care in order to build their family. As a Reproductive Endocrinologist, I see this every day in my office. Infertility rates continue to increase as the average age of the first-time mom continues to rise.

In addition, we are also seeing an increase in the number of patients who present for egg freezing, or fertility preservation, as more women wait to start families due to demanding careers or their desire to wait for the right partner. Couples are also electively preserving embryos for future use.

No matter what path people take on their parenting journey – one thing is clear: the subject of fertility can have intense physical, emotional and financial implications. And navigating this process can be overwhelming. Here’s what every person needs to know, well before they ever need to see a fertility specialist.

INFERTILITY IS MORE COMMON THAN YOU THINK

Infertility is defined as the failure to conceive after 12 months of unprotected sexual intercourse. If you’re over the age of 35, the timeline decreases to 6 months. Seems straightforward—have sex for an extended period of time and you’re bound to get pregnant, right? Not exactly. Many factors come into play when couples decide they would like to conceive.

The primary cause of infertility in women is irregular or the inability to ovulate. Polycystic ovarian syndrome, or PCOS, is the most common reason that women may not ovulate regularly and is the most common cause of infertility. Other reasons for female infertility include problems with the uterus (such as uterine fibroids or structural abnormalities) or blockage of fallopian tubes. Additionally, as women age, the quantity and quality of their eggs diminishes, making it increasingly more difficult to get pregnant and resulting in a higher incidence of miscarriage.

It’s not just women who have challenges with fertility. One-third of the time, infertility falls on the man’s side. Male factor infertility is often due to the inability to make enough (or any) sperm, the failure to ejaculate or other medical problems that may affect the number, shape, or motility of a man’s sperm.

For both men and women, certain lifestyle activities, including drug or alcohol use, being over- or underweight, poor diet, or exposure to environmental toxins or pollutants can also play a role in the inability to conceive.

Infertility is fairly common – approximately 1 in 8 couples have experienced infertility and more than 7 million people have received some type of infertility treatment in their lifetime. This means that in your circle of friends, at least one person you know has probably struggled to get pregnant.

FERTILITY PRESERVATION: INSURANCE FOR THE FUTURE

While some people are actively trying to get pregnant, there are also women who have decided to postpone pregnancy attempts. Elective egg freezing is a method that involves harvesting eggs from a woman’s ovaries and freezing and storing them until a woman (or a couple) is ready to become pregnant.

Women are born with all of the available eggs they will ever have. With age, the number of a woman’s eggs decreases significantly. It is estimated that a woman only has 30 percent of her eggs present at age 30. This number drops to 10 percent at age 35 and only 4 percent at age 40. There is also no way to regenerate new eggs.

For women or couples who know they want to start a family at some point in their lives, it is recommended they think about preserving their fertility early. This is not to say that a woman in her late 30s or 40s can’t get pregnant the ‘old fashioned’ way, but egg freezing is one way to guarantee that you have a choice for children later in life, if you so decide.

WHY DON’T MORE PEOPLE SEEK FERTILITY CARE?

Whether you’re having trouble conceiving or you’re interested in freezing your eggs, it can be difficult to know where to begin. Even for those who’ve done their research, the process can seem intimidating.

Many couples delay consulting a fertility specialist because they simply may not know they have a medical problem. Although there are better times than others during your menstrual cycle to have intercourse, if you’re not becoming pregnant after months of trying, it’s likely not a ‘timing’ issue – something else may be going on and you should consult a specialist.

Another common barrier to fertility care is cost. For many patients, insurance coverage can be variable, and out-of-pocket expenses can add up. The cost for an egg retrieval cycle can be upwards of $10,000, but when medications, genetic testing, and the embryo transfer are added, the total cost can be significantly higher.

Lastly, perhaps more importantly, are the emotional considerations that many couples or individuals experience. Infertility is often considered a silent struggle. Couples who have difficulty getting pregnant may experience a range of emotions, including stress, anxiety, frustration or depression. There can be a feeling that something is wrong with your body, and this frequently causes couples who are experiencing infertility to resist talking to anyone — including a doctor.

Infertility is common and a fertility specialist can help. Egg freezing is a way to safeguard your future and ensure that when the time is right to start a family, you have the opportunity to do so.

WHERE TO BEGIN

The first step for anyone interested in learning more about their fertility care is to speak with a gynecologist or a reproductive endocrinologist to help decide which tests to run and whether treatment is indicated.

One place to start is with the Glow Fertility Program, a free and individualized fertility program that provides coaching, access to the country’s top fertility clinics and doctors, favorable pricing on fertility medication and treatment, and financing options.

Science, technology, and access to care have all greatly improved the chances of conception for couples struggling to conceive. There are so many resources and new technologies available for individuals and couples who are thinking about or actively trying to start a family.

Whether your future child is a happy surprise, planned, or created with a little support from a doctor, one thing is clear – there is innovative technology and helpful resources to help you along the journey. 

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