Let's Talk About: Infertility Treatments
At the beginning of March I posted an article about Infertility, Miscarriage, and Infant Loss, three topics that need more attention than they get. I had some friends and readers reach out to me and ask me to go into more detail about infertility and the treatments that are available out there for it. In this article I will attempt to break down the complicated, difficult, and at times painful world of Infertility and its treatments. Please be aware: I am not a doctor. If you are struggling with infertility nothing I say is a substitution for actual medical advice.
1 in 8 couples will struggle with conceiving or sustaining a pregnancy. There is a very good chance that you know someone who is struggling with infertility right now. Luckily for couples struggling to grow their families, there are a lot of options out there for treatment. Many of these options are also employed by lesbian and gay couples hoping to conceive a child together.
There are a lot of myths and misconceptions about infertility. For example, lots of people seem to believe that infertility rests primarily with the female reproductive system. Although it’s hard to know exactly, about a third of infertility cases are primarily female based, about another third are primarily male, and the last third are usually a combination of factors from both. (Homosexual couples were not factored into these figures). Another common myth is that if couples “Just relax and let it happen” pregnancy will just occur. This is also not true. Infertility is not even diagnosed until a year of unprotected sex has not worked (6 months if the female is over 35). And this is also a shitty thing to say to someone. Don’t do it. Please refer to my article about infertility, miscarriage, infant loss and how not to be an asshole for some guidelines on how not to say something really cruel to someone dealing with infertility. (Link at the end of this article)
After a year or so of trying to conceive has passed without success, or sustaining a pregnancy without success, the first step when one sees a fertility specialist is a round of testing. This testing can include anything from multiple blood tests to measure hormone levels, internal ultrasounds, and sperm count measuring. The testing can be invasive, time consuming, and expensive. Depending on your infertility diagnosis, testing may continue during treatments as well. If this sounds extreme, well, just wait. It gets more intense as you go. This is why I believe we need to be more supportive of couples who are undergoing infertility treatments. These people will undergo a great deal of pain and hard work to conceive a child, children conceived through Artificial Reproductive Technologies (ART) are deeply wanted and yearned for.
Some couples get answers during testing. They can find the cause of the infertility, be it hormonal or physical, and can begin treating the root cause. Some couples do not. About 10% of infertility is “unexplained”. This can be the most difficult type of infertility to treat because there’s no clear course of action.
Often the first step in the process of coping with infertility is medication. These can range from something as simple as Aspirin to hormonal medications to help treat any number of disorders. It seems that there are a whole world of hormones and hormone related medications to treat female factor infertility but there aren’t very many to treat male factor. These medications can have brutal side effects that can impact a person’s ability to live their life, such as mood swings, weight gain, nausea, vomiting, diarrhea, hot flashes, headaches, and many others. Some medication can be taken orally and some may have to be injected, often on a strict schedule to help boost or mimic the natural female hormones. Medications are often an important part of other reproductive technologies such as IVF and Intrauterine insemination (IUI). Some medications may be covered by insurance, but many plans only cover the cost partially.
Male factor infertility can be effected by any number of factors, sperm count (how many swimmers) and sperm motility (how good they are at swimming) are the two major ones. Most treatments for male factor issues revolve around lifestyle adjustments. Men who are a healthy weight, who eat well, don’t drink to excess, don’t smoke and don’t use recreational drugs will have a better chance of conception than other men. This is by no means an exact science and shouldn’t be taken to mean that smoking, drinking, drug use and weight gain are functional modes of birth control, they are not. There are some dubious studies being done suggesting that taking testosterone can increase male fertility, but from what I have seen the jury is still out. If lifestyle changes don’t work then many people with male factor infertility will move onto IUI or IVF.
IUI, Intrauterine Insemination, is also called “Artificial insemination”. Basically sperm are prepared, “washed”, sorted, and placed directly into the uterus of an ovulating female. This can be done with donor sperm or non-donor sperm. Sometimes this is one of the first methods of conception for lesbian couples. It is also useful for couples that deal with low motility in sperm or thickened cervical mucus (which can block sperm from entering the uterus). Ovulation inducing medications are often used in conjunction with insemination, as well as lots of monitoring of hormone levels to make sure the insemination is happening on the correct day. It is most often performed in a doctor’s office and does not require anesthesia. The procedure itself is relatively quick and the most common side effect of the procedure is some discomfort or cramping.
IVF, Invitro Fertilization, is a whole world unto itself. About 1.6% of infants born in America today are conceived by IVF or similar procedures. According to the CDC there were 3.8 transfers per live birth. Meaning that successful (resulting in a living baby) IVF transfers are about 1 in 4. But the factors involved in each cycle are so numerous and varied that the odds can vary for any particular transfer. The cost of IVF varies, depending on type of procedures being done. Often the costs are prohibitive, with insurance only covering some of the costs. Anyone considering IVF should be sure to check their insurance policy and plan to probably end up paying their maximum out of pocket deductible, if they have one. The process usually has four major steps: Ovulation induction, egg retrieval, fertilization, and embryo transfer.
If IVF is agreed upon with the patients and doctor, the process usually begins with yet more testing. Some people will have eggs from the would-be mother which will be harvested, some people may use donor eggs from another female. In order to retrieve the eggs from the female first they will induce ovulation. During careful monitoring the female injects herself with multiple rounds of medication to ensure maximum egg development. Next is the retrieval process. The timing of this step is crucial. The eggs are harvested through “Vaginal ultrasound guided aspiration”, a process which uses an ultrasound to guide the retrieval process. Often the woman the eggs are being removed from will have IV pain relievers to help her be more comfortable. The male involved will be asked to provide another sperm sample, or donor sperms will be used. The sample will be washed then the eggs will be fertilized and incubated. The fertilized eggs will be monitored for a few days to see which ones are developing the best. The best developing ones are chosen for embryo transfer. Sometimes the ones that are not chosen will be frozen and stored for future transfers if they’re still viable. Different doctors may recommend a different incubation length depending on the circumstances. When it’s time to implant the embryos the female comes back into the office for the procedure. It is usually a relatively painless procedure, though some people report a bit of cramping during the placement. The chosen embryos are sucked up into a tube, then placed into the uterus by way of the cervix. Doctors usually use an ultrasound to make sure they’re in just the right place. After that the female may be required to rest with her head down and feet up for a few hours before being discharged. Women are often given progesterone to make sure that the embryos have the best chance of implantation.
Sometimes a couple will use IVF to implant a fertilized egg into another woman’s uterus, this is surrogacy. Depending on the type of infertility sometimes surrogacy is the best most viable option, it is also often very expensive because it is rarely covered by any sort of medical insurance.
No matter what method couples decide to go with to grow their families living with Infertility can cause a lot of emotional and spiritual suffering. Many people deal with not just the stress of undergoing invasive and time consuming medical procedures but also feelings of failure for not being able to get pregnant on their own and feelings of resentment that it seems so easy for everyone else. This can manifest itself in any number of different ways such as, anger, sadness, irritability, or depression. It can make hanging out with friends who are pregnant or recently became parents difficult. This is all normal and nothing to be ashamed of. Sometimes people dealing with infertility have to grieve either pregnancies that were lost or have to grieve the loss of how they thought building their family would go. This is normal and natural and nothing to be ashamed of. By the same token, if these feelings are becoming too much to bear, or if you just need some help coping, seeking out professional help and a support group of people going through similar experiences might be necessary and helpful.
Until next week, take care of yourself. You are worth protecting.
-Erin
For more information about Infertility, treatment options, and support visit Resolve.Org
CDC Data on IVF and live births. https://www.cdc.gov/art/artdata/index.html
My article on Infertility, Miscarriage, and Loss https://themagiccondomfairy.wixsite.com/themagiccondomfairy/single-post/2017/03/20/Lets-Talk-About-Infertility-Miscarriage-and-Infant-Loss