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Monday, July 15, 2024

Even Miracles Take a Little Time: How to Navigate Infertility the Smart Way

Life is funny… and that’s no joke! For some people, getting pregnant and having a baby seems like the easiest thing, an almost natural progression as women advance in both age and experience. For others, the journey to conceiving is incredibly difficult, with many obstacles in their way. There are many who are skeptical about how difficult this situation is for the woman, and often wonder, is it really that hard to get pregnant? Why are there modern-day struggles, with our oldest skill?

Research has shown that approximately one in six couples experience an unwanted delay in conception. The signature symptom of infertility is a failure to conceive after a year of unprotected sex. This is the point at which physicians recommend seeking interventions for fertility care.  Male infertility is just as common as female infertility, so it is important that both partners are evaluated to find out the cause.

While some couples may conceive spontaneously or with minimal advice or treatment,  others remain subfertile and require more complex and expensive assisted reproductive techniques (ART) like in vitro fertilization (IVF), with the use of an egg donor, sperm donor, or implanted embryo. These procedures help the sperm to fertilize the egg, and then implants the fertilized egg into the uterine lining, to help continue the pregnancy.

According to a report by the US Society of Assisted Reproductive Technology (SART), one million babies were born in the United States between 1987 and 2015 through SART treatments. This, therefore, begs the following question…

Why Is It So Hard for Me to Get Pregnant? 5 Key Factors to Consider

There are many factors that work together to facilitate conception, as well as a healthy pregnancy and delivery. They need to work in synergy. As a result, there is no one-size-fits-all answer for infertility, making it a confusing and difficult time for many couples. Here are some of the primary factors that impact how hard or easy it is to get pregnant.

1. Your Age

Once a woman begins to ovulate, typically during her teens, and her menstrual cycles become regular, her chances of getting pregnant are quite high, with women in their 20s and 30s having a one in four chance of conceiving per month. These odds progressively decrease as age advances, so that women in their 40s have a one in ten chance of getting pregnant.

2. Your Weight

Maintaining a healthy weight has been known to increase the chances of conception. Women with a body mass index (BMI) >30, need to consider modifying their diet and increasing their exercise regimes to lower their BMI.

3. Timing of Intercourse

A narrow window of opportunity exists during the days that a woman ovulates during her monthly cycles. Studies have shown that the probability of conception rises six days before ovulation, peaks at two days before ovulation, then fall by the day of ovulation. This suggests that sperm needs to be deposited in the female genital tract before ovulation in order to maximize the chances of conceiving. This requires tracking changes in the woman’s body due to the effect of increasing and decreasing levels of hormones like progesterone and oestrogen during her cycles. Identifying the ovulation period by correlating lab tests, hormone levels and sonography tests, and timing sexual relations during that time, has shown results, showing how hard it is to get pregnant, in these situations.

4. Lifestyle Factors

Smoking, consuming an increased amount of alcohol and caffeine, and the use of recreational drugs, by both the man and the woman, have been known to reduce the chances of getting pregnant.

5. Sperm Health

While men can produce sperm throughout their lifetimes, the quality of the sperm may deteriorate either with advancing age, or other genetic and acquired, lifestyle causes. At any age, if a man experiences difficulty in ejaculation during intercourse, decreased libido or impotence, then a physician’s consultation and sperm testing is recommended.

6. Specific Medical Conditions

Conditions like endometriosis, sexually transmitted diseases causing inflammation of the pelvis, female hormonal imbalances like polycystic ovarian syndrome (PCOS) may affect fertility in women, while varicocele and prostatitis may result in male infertility.

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12 Questions to Ask a Fertility Doctor

When a couple has been trying to get pregnant without success, it may be time to see a fertility doctor. If or when you do, here are the important questions to ask the fertility doctor. The best fertility doctor for you will have straightforward, honest answers, as well as experience and a bedside manner that puts you at ease.

  1. What are the investigations that need to be done to figure out why they are having a difficult time conceiving? How do they know if it is a problem with the sperm count, an ovulation issue, or difficulty with fertilization and implantation of the embryo?
  2. What are the lifestyle changes that can be made to make it easier to get pregnant?
  3. What is the first line of treatment for infertility?
  4. If medications don’t help, what are the other options?
  5. How do ART procedures work?
  6. What are the risks involved in surgical treatments or in vitro fertilization procedures? Are there specific risks to the mother or the baby?
  7. How are complications like low birth weight or premature birth handled, if they do occur?
  8. What are the chances of getting multiple pregnancies due to IVF treatment?
  9. What are the success rates for the treatments being offered?
  10. How long do these treatments take to work on average?
  11. Are they any previous patients who are willing to discuss the treatment, in order to give a first-hand review of the IVF process, from a patient’s point of view?
  12. How much is in vitro fertilization? How much does IVF cost?

There are various procedures that can be considered for a couple struggling with infertility.

According to the ASRM ( American Society for Reproductive Medicine)  between 85 and 90 percent of infertility cases are treatable. However, aside from age and health, the success rates also depend on the treatment procedure selected. Since the journey is a mentally, emotionally and financially challenging one, it is important to understand the various steps in treating infertility.

What Fertility Treatments Options Are Available?

1. Medications

The first step after doing multiple hormone level assessments, as well as sonography to visualize the anatomy and health of the reproductive organs, is fertility drugs. Taken as an injection or a pill, these include hormones that boost the production of eggs and induce ovulation. They also make the uterus more habitable to allow for easy implantation of the embryo. This is also known as Controlled Ovarian Hyperstimulation (COH) and has a high success rate, with 40-50% of women getting pregnant after a few cycles of medication, however, they do carry the risk of multiple pregnancies and the increased development of ovarian cysts.

2. Artificial insemination (Intra-uterine insemination / IUI)

Using the partner’s sperm or donor sperm, that has been specially prepared, the sperm is inserted directly into the uterus through a thin, flexible catheter. The woman might also be on fertility medications to improve egg production and improve the chances of fertilization. There is usually a 15-20% chance of success per cycle, with this method, and is a relatively simple outpatient clinic procedure.

3. In vitro fertilization

IVF is perhaps the most commonly known terminology for fertility treatments. The multi-step IVF process is a cycle that involves extracting the egg from the woman and fertilizing the egg with sperm in the lab, in order to develop an embryo.

Different fertilization techniques can be used to inseminate the egg:

  1. Intra-cytoplasmic Sperm Injection (ICSI): where the sperm is directly inserted into the egg using a microscopic needle, in order to fertilize the egg.
  2. Donor eggs or donor sperm: which are used when there is a problem with the eggs or sperm of the couple undergoing the IVF process
  3. Donor embryos: These are embryos that are donated from previous patients with successful IVF cycles to be used by other couples, where both partners are infertile.

One or two of the viable embryos are implanted in the uterus, with the hope that at least one pregnancy carries to term, while the other embryos formed during the cycle are stored, in case it doesn’t.

This is a relatively expensive procedure, estimated at over $12,500 per cycle and has varying success rates depending on the woman’s age. 41% of women under 35 years and 23% of women between 38-40 years old, experience success. While for many women, IVF is considered when traditional or natural methods fail, that is not always the case. For women who have blocked fallopian tubes, in severe cases of male infertility, or in cases where previously preserved eggs, a gestational carrier or surrogate is being used, IVF is often the first choice.

A relatively recent development in IVF technology is blastocyst transfer. Usually, embryos fertilized by IVF are transferred to the uterus early in its development. However, in blastocyst transfer, the embryos are made to grow for five days until they reach a later blastocyst stage. These blastocysts are then transferred to the uterus, to reduce the possibility of multiple pregnancies, while achieving a high success rate of the treatment.

4. Intrafallopian transfer

These procedures involve placing the gamete ( the sperm or the egg) or the zygote (the egg/sperm mixture) into the fallopian tubes instead of the uterus, in order for fertilization to occur. They are called GIFT (Gamete Intrafallopian Transfer) or ZIFT (Zygote Intrafallopian Transfer) respectively and are used for couples who have unexplained infertility or those in which the man has a low sperm count, the woman has at least one viable fallopian tube, but has problems with ovulation.

A New Solution to an Old Problem: IVF Alternative

Considering the high costs of fertility treatments in general, Famlee was developed as an easy and cost-effective solution to expensive traditional procedures for fertility. Research has shown that IVF treatments can cost above $12,500 per cycle, and these expenses cannot be born by most couples, struggling to conceive.

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The Famlee program addresses both the diagnosis and the primary treatment for couples who are finding it hard to get pregnant. An all in one at home fertility kit, it includes many features like:

  1. A 13 hormone blood testing kit delivered discretely to the doorstep. This includes the material required for dried blood spot testing, with simple, step-by-step instructions for the patients to collect the samples themselves and send them to the labs for testing.
  2. A smartphone application that can be downloaded and customized for the patient’s unique fertility journey. This includes a fertility tracker, that calculates ovulation dates, as well as provides access to a supportive community of other patients who have gone through or currently experiencing the same struggles.
  3. Telehealth consultations with providers to discuss their history, lab reports, and pro-active steps to be taken, to balance their hormones, and understand what their bodies need in order to get pregnant.
  4. An easy way to order FDA-approved medications that may be prescribed by the healthcare provider, which can also be conveniently delivered at home.

Couples who are actively trying to get pregnant and are trying to balance their hormones, as well as those who have been trying to conceive but have had no success and either not ready or cannot afford the cost of IVF and other surgical interventions for pregnancy, the Famlee program is a great, cost-effective and easy alternative. An added bonus is that the program is also covered by FSA/HSA.

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A woman’s journey with fertility is a complex and emotionally charged experience. The struggle is part of the story … and for some, the struggle is real! The right interventions taken at the right time can have a tremendous effect on the chances of getting pregnant, without having to spend on expensive procedures.

Empowering women to take proactive steps in understanding their bodies, building a relationship based on knowledge and trust with their healthcare providers, and providing convenient tools to help them with their fertility journey, are the most effective ways of helping women achieve their dreams of growing their families.

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