What is infertility?

While many struggle with infertility, people might not know of their options to help them conceive. This National Infertility Awareness Week, a Baylor College of Medicine reproductive endocrinologist and infertility specialist (REI) highlights how to navigate the journey to create a family.

“Infertility is the inability to achieve a healthy or successful pregnancy within a certain period of time,” said Dr. Terri Woodard, associate professor in the Division of Reproductive Endocrinology and Infertility at Baylor and Texas Children’s Hospital and professor in the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center.

Indicators

If young, healthy patients under the age of 35 have unprotected intercourse for a year or more without becoming pregnant, they should have an evaluation. Women over the age of 35 should see a specialist after six months of trying, or sooner if they have other risks for infertility. Risks for infertility include irregular cycles, endometriosis or a previous treatment that affected their fertility.

Risk factors

Irregular periods signal irregular ovulation. If a woman is not ovulating or releasing an egg each month, they will not get pregnant. Other risk factors include a history of medical conditions such as:

• Endometriosis.
• Pelvic inflammatory disease.
• Tubal disease from a previous surgery that caused scaring in the abdomen and pelvis, resulting in the fallopian tubes not opening, so the egg cannot meet the sperm.

“For both men and women, those who have been treated for cancer or other medical conditions where they had to receive gonadotoxic medications could be at risk,” Woodard said.

Next steps

Those who struggle to conceive should see an REI, an OBGYN with three extra years of training in caring for people with infertility.

“Patients sometimes get afraid and think seeing an REI means automatically doing IVF, and that is not the case,” Woodard said. “The first step is educating patients on how they can hopefully optimize their natural fertility and do a workup to see if there are things that might be easy fixes to help them become more successful in their conception attempts.”

Know your options

Natural conception

Leading a healthy lifestyle with diet and exercise is beneficial for fertility. Smoking has a negative effect on women trying to conceive, especially for those doing more intensive fertility treatments like invitro fertilization (IVF), as it decreases the success rates by half. Alcohol consumption should be moderate to very little. Avoid recreational drug use. Moderate caffeine use is fine, but drinking it in excess, such as an entire pot of coffee every day, is associated with an increased risk of infertility.

Specialists provide reproductive education to patients, teaching them about the menstrual cycle and the optimal fertile period for women. They educate patients on the fertile window and when to have intercourse, which is generally five days before ovulation and the day after. Ovulation predictor kits also are available over the counter to help determine when to have intercourse. REIs discuss the frequency of intercourse and health optimization in terms of taking prenatal vitamins with extra folic acid.

“Sometimes those are things people don’t know that are very simple and fix the problem without us doing much else,” Woodard said.

Beyond natural conception

A wide variety of options might be applicable to patients depending on the results of their evaluation.

“If we do a workup and everything seems to be normal – semen analysis looks good or only mildly abnormal, open tubes and good ovarian reserve – then we can try something like ovulation induction where we give oral medications for five days in the beginning of the menstrual cycle,” Woodard said.

The purpose of ovulation induction is to recruit a follicle or a few follicles to grow to release eggs. An REI will monitor the patient to know exactly when to try to trigger them to ovulate. This is timed with intercourse or intrauterine insemination, especially if there is a mild male factor (slightly low motility), to help them get that boost to get pregnant. This is the least invasive type of fertility treatment.

IVF stimulates the ovary with fertility drugs to try to recruit multiple follicles. Instead of getting one to three follicles, they might get several follicles based on the patient’s age and ovarian reserve. Over the course of about 10 to 12 days while the woman is taking the injections, specialists will monitor her frequently to examine her response.

“Once we think we can get a good number of mature eggs, we trigger the patient to get ready to ovulate. Before they do that on their own, we do a transvaginal oocyte retrieval where the patient goes under anesthesia, and we extract each egg from each follicle. Then, in the lab, we take the partner’s or donor’s sperm and fertilize the eggs to create embryos,” Woodard said.

The embryos are grown in a lab over the course of a week. Patients can choose to do genetic testing on the embryos to determine the sex and if they have the normal number of chromosomes. Then, they freeze the embryos and transfer them back to the patient when ready to conceive. Some might choose to do the transfer immediately if they opt out of genetic testing.

“Infertility can sometimes be a long, lonely journey, but there is help. Talking about it should not be taboo. It is a medical condition and seeing a fertility specialist does not mean that you absolutely must do things like IVF; that is one of the huge misconceptions. There is a lot we can do before IVF to help people build their families,” Woodard said.

By Homa Warren