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Understanding the problem

*Infertility affects 6.1 million American women and their partners, or about 10 percent of the reproductive age population.

*In about 40 percent of infertile couples, the male partner is either the sole cause or a contributing cause of infertility.

*Female infertility problems break down like this:

            - 25 percent have irregular/abnormal ovulation
- 35 percent have tubal blockage and/or peritoneal factors.
- 35 percent of the women who have a laparoscopy have endometriosis.

*About 20 percent of couples who do a complete diagnostic work-up are diagnosed with unexplained infertility because no specific cause is identified.

*More than 70,000 babies have been born in the US as a result of all assisted reproductive technology (ART), with about 45,000 of that total specifically credited to IVF results.

*In vitro fertilization and similar treatments account for less than 5 percent of infertility services, and only three-hundredths of one percent (.003%) of US health care costs. (Statistics from the American Society for Reproductive Medicine)

*The World Health Organization (WHO) estimates that approximately 8-10 percent of couples experience some form of infertility problem. On a worldwide scale, this means that 50-80 million people suffer from infertility. However, the incidence of infertility may vary from region to region. In France, 18 percent of couples of childbearing age said that they had difficulties in conceiving.

Primary infertility is the inability to become pregnant after a year of regular, unprotected intercourse. Secondary infertility refers to a couple who has birthed a child, but cannot bring about pregnancy (or the live birth) of a second child.

Diagnostic measures
Your doctor is a lot like Sherlock Holmes. Each case is different, each is a mystery, and each requires great attention to detail. Not all the following diagnostic tests are required for every woman, but as additional concerns arise or as pregnancy continues to be elusive, more tests will be performed. The treatment plan is tailored for each couple’s specific needs. Remember that no one has the precise medical history that you do. Your doctor’s goal is for you to get pregnant using the least invasive, least complicated means possible.

After a year of unprotected, frequent (2-3 times per week) intercourse, a couple should get pregnant on their own. Any longer than that with no pregnancy, and it’s time for intervention. But by the time you give up trying to get pregnant on your own and head to the doc, you’re ready to make some fast progress….

Other topics covered in this chapter:

Tests for her
The first goal is to make sure she’s ovulating and when….

Test for him
Semen analysis is the first test done to assess the man’s reproductive health.

Entry level procedures and medications
Timed intercourse: The specialist may suggest trying an initial effort at making intercourse happen more frequently by paying closer attention to the woman’s body temperature and ovulation cycles. This is an attempt to have the sperm in the fallopian tube at the time the egg is released and begins to travel down the tube….

Mid-level options
Moving up the ladder of complexity, your doctor may include these measures in your fertility treatment plan. Hormone therapy: “Fertility drugs” act on the glands that produce key hormones….

High-tech options
Not long ago, these techniques were considered cutting edge, but now they’re available to anyone—well, anyone with mildly deep pockets. In a few years, more procedures will be added to this list as sci-fi becomes reality….
 

Cutting edge technologies
These procedures are not readily available today, but are being perfected and tried in a limited number of clinics around the country. By comparison, IVF was once cutting edge, and now it’s mainstream. It was introduced in 1978, and first used in the US in 1981….

Choosing a clinic
Those who pursue fertility procedures and those who pursue adoption have similar anxieties when it comes to finding a safe, reputable group of professionals to affiliate with. When you begin to think about finding a fertility clinic, here are some questions to consider….

Fertility drugs: A bite out of your wallet
My pharmacist-friend, Bob, gave me several examples of the costs of fertility drugs. It’s not for the faint of heart or wallet! One woman bought a one-month supply of fertility meds, and while she only had to cover her co-pay (total of $300), the insurance company picked up the rest—about $11,000—for one month! Another woman was in her eleventh month of treatment and had easily spent about $60,000 on meds. (Remember that these costs are meds only—no procedures, doctor fees, or tests.) A third example was a couple who racked up such expenses that when the procedures finally produced a live birth, she had to go to work and put the new baby in day care just so they could begin to pay off the medical bills accrued in getting the baby. 

Suggestions from those who’ve been there, done that
Experience is the best teacher, so here are helpful hints compiled from couples who have walked through infertility treatments.

1. Get yourself a handy-dandy, spiral notebook for medical notes and questions.
2. Take your spouse with you whenever possible.
3. Ask your doctor or pharmacist for a print-out of any possible side effects on all medications.
4. Try not to compare yourself to the other couples who have gone through similar procedures.

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