Treatment Advances Help Couples Overcome Infertility

After battling infertility for years, couples realize their dream

Thoughtful husband embraces his smiling wife after discussing potential fertility treatments with Scripps Heath.

Couples with fertility problems are not alone. It is estimated that 10 percent of normally fertile couples fail to conceive within their first year of trying and 5 percent fail after two years.

Infertility can cause emotional distress and make a couple feel isolated from family and friends, but if you are one of these couples, do not lose hope. With continuing advances in infertility treatments, many couples are able to overcome their fertility problems and conceive one or more children.

Maria C. and her husband are one such success story. After trying to get pregnant for four years without success, they went to Jeffrey Rakoff, MD.

The couple’s first attempt to have a child with in vitro fertilization (IVF) failed, but the second time was a success — twice over. The 37-year-old mom and her husband are the proud parents of healthy twin girls, and they are thinking about trying to have a third child using her frozen embryos.

“These girls are very special to us,” Maria says.

Donna Beadle and husband, Ryan, are another success story. After trying to have a child for 5.5 years, they realized their dream six months ago when they had a healthy baby girl.

“She’s everything that we could have imagined,” says Donna.

David Smotrich, MD, a fertility specialist at Scripps Memorial Hospital La Jolla , used a breakthrough diagnostic technology that enabled Donna to become pregnant with in-vitro fertilization. They too are thinking about trying to have another little one.

Common fertility problems

For most couples trying to have a baby, getting pregnant takes an average of six months. After having frequent, unprotected (without using birth control) intercourse for one year, about 10 percent to 15 percent of couples in their 20s and early 30s have difficulty getting pregnant.

For women in their late 30s and 40s, difficulty conceiving jumps to 40 percent to 50 percent. When this happens, there is likely a fertility problem.

In general, a couple does not need to seek medical advice for infertility until they have been trying to conceive for at least one year or have some obvious problem or condition that is interfering with conception.

However, a woman may wish to consult with a fertility specialist at any time if she is concerned about her fertility, has irregular or absent menstrual cycles, or a history of painful periods, miscarriage, pelvic inflammatory disease (PID), endometriosis, polycystic ovarian syndrome, uterine fibroids or other gynecologic problems.

Infertility may be due to a single factor in either the male or the female or a combination of factors affecting both partners. This was the case with the Beadles.

“The male partner alone is infertile about 4 percent of the time, and both partners have fertility problems about 20 percent of the time,” says Dr. Smotrich, founder and medical director of La Jolla IVF, located on the Scripps Memorial Hospital La Jolla campus.

For men, one of the more common reasons for infertility is a problem with sperm — no or few sperm may be produced, the sperm that are produced may be malformed and die before they can reach the egg, or the sperm may appear normal but function poorly.

Problems with the delivery of sperm from the penis into the vagina may also be a cause of infertility. These include erectile dysfunction, problems with ejaculation, or blockage of the ejaculatory ducts.

For women, one of the more common reasons for infertility is a disorder with ovulation that may affect the development of the egg. An estimated 30 percent of female fertility problems are the result of ovulatory disorders.

Other factors include blockage of the fallopian tubes, endometriosis, pelvic inflammatory disease, or a defect in the female anatomy that affects the movement of the egg to the uterus. A woman may also experience secondary infertility, whereby she can’t become pregnant or carry a pregnancy to term following the birth of one or more child.

For some couples, no obvious cause of infertility is found. Approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up.

IVF to the rescue

There are numerous infertility treatments with varying degrees of success. One of the most successful and exciting breakthroughs in the field of reproductive medicine is in-vitro fertilization, commonly known as IVF. IVF is the treatment of choice in cases of infertility when both fallopian tubes are blocked.

However, IVF may also be used for unexplained infertility, endometriosis, cervical factor infertility, ovulation disorders, or when a man has a low sperm count.

Basically, IVF involves taking mature eggs from the woman, fertilizing them with sperm in a dish in a laboratory and then transferring a specific number of embryos back to the woman’s uterus two to six days after fertilization is confirmed.

The remaining embryos can be cryopreserved (frozen) for use in subsequent cycles. Both Dr. Rakoff and Dr. Smotrich use IVF for a significant number of their female patients — whose average age is 38.

“More and more of the women we are seeing in our fertility treatment program, such as our IVF program, are now age 38 and above,” Dr. Rakoff says. “By the time career goals have been met, marriage has occurred and the couple realizes a delay in pregnancy has developed, the couple is often into their 30s and beyond. We are always happy to see younger patients as well.”

Approximately 25 percent to 40 percent of women who try in-vitro fertilization conceive. However, the likelihood of success can vary depending on factors such as the woman’s age, the reason for the infertility and the experience of the IVF program.

“As a woman ages, a decline in the rate of success occurs,” Dr. Rakoff says. “In women older than age 40, the success rates are often 3 percent to 10 percent at best per attempt.”

Other women, he explained, have significant reproductive problems and need various treatments, such as hormonal therapies, medications to promote ovulation or surgery to repair fallopian tubes and endometriosis, and often times, in-vitro fertilization.

Drs. Rakoff and Smotrich also caution that IVF can be a lengthy as well as emotionally draining process, so it’s important for the couple to have a clear understanding of what’s involved. It can also be extremely costly, especially if the woman has to go through more than one cycle, which was the case for both Maria and Donna Beadle.

Breakthrough diagnostic technology

A major technological breakthrough in the field of reproductive medicine that has the potential to improve pregnancy rates with IVF is preimplantation genetic diagnosis, known as PGD. This technology enables the fertility specialist to make a genetic diagnosis of an embryo before it’s placed into the uterus, so he or she can implant only those embryos that are genetically normal.

PGD is not a first-line treatment, Dr. Smotrich says, but is indicated for women with known risks for inherited disorders, those who have had recurrent miscarriages and IVF failures and those who are age 35 or older.

“For women over age 40, more than 50 percent of their embryos will be genetically abnormal,” he notes.

PGD involves taking a single cell from the embryo at day three and testing it for genetic and chromosomal disorders. Both Dr. Smotrich and Dr. Rakoff assert that the ability to look at the genetic makeup of embryos prior to placing them in a woman’s uterus is a tremendous breakthrough.

“Because an abnormal embryo would not be transferred to the uterus, PGD can prevent women from getting pregnant with children who have ”sparkle://articles/2529" title=“Down syndrome”>Down syndrome and other genetic abnormalities," Dr. Smotrich says.