If you've been trying to have a baby without success, you aren't alone.
Approximately one in eight couples has difficulty conceiving. And contrary to popular belief, it isn't always because of the woman. In fact, men and women are both equally diagnosed with infertility.
Infertility is defined as being unable to achieve a pregnancy after one year if a woman is under 35 years of age, or for six months if a woman is over 35 years of age.
So if you think you might have a problem with infertility, where do you start? It can all be very overwhelming. There is a wealth of information available, but distinguishing fact from positive rhetoric can be confusing.
If you're thinking about making an appointment with a fertility doctor, here is some information that can give you a leg up before you walk in the door.
These 11 items can help you understand the "big picture" of infertility and make navigating the process easier.
1. Find a doctor with whom you connect.
As you consider getting started, remember that you need a good partner in crime and someone that gets you. This is an important chapter in your life that connects you to your dream of a family. This doctor and health care team will lead you to achieving that goal, so it is critical that you have a bond of trust and caring.
2. Success rates are confusing.
Success rates are measured by your friends who sing the praises of their own success. They are also measured by your OB doctor's recommendations; the U.S. government, which reports fertility clinics success in IVF; and the Society for Assisted Reproductive Technology, which provides detailed information on each center. Some centers have high success rates, which may reflect that they only take easier cases. Other centers may have lower success rates but deal with harder diagnoses. Every patient and medical problem is unique, so ask questions that pertain to you. Inquire about your doctor's experience with your particular problem, as well as their success rates with women of your age. This is a big project and may require that you invest considerable finances, so don't be afraid to ask hard questions.
3. We can work with your biology, but we cannot change it.
We can change many things, but we cannot change how old we are. We doctors have years of training and experience which allows us to be professional problem solvers and troubleshooters for complex medical issues, but we can't change basic biology. Biology dictates that ovarian reserve declines with age, as does fertility potential in both men and women. Conditions like endometriosis and PCOS can be tempered, but not eliminated. While these biological facts of life cannot be changed, with a great team behind you there is a better chance of success.
4. Ouch! That is more than I expected.
The average cost of an IVF cycle is $12,000 plus $3,000-5,000 for medication. Across the country, that number will vary. The good news is that there are several avenues to curb the cost of treatment. Centers typically have multiple financial plans to consider. Some options provide a full refund if you do not deliver a baby, while others allow you to finance your treatment. Some centers offer a self-pay discount. Participating in studies may offer free or discounted treatment, while non-profits like the CADE Foundation and BabyQuest Foundation offer grants to those with infertility. Some couples are even crowdfunding their treatment on sites such as GoFundMe.com.
5. There's no place like home.
Depending on where you live, state law, insurance mandates and even treatment availability can help or hinder your efforts. States with insurance mandates are by law required to provide coverage for fertility treatments. If you're not sure where your state stands, take a look at the Fertility Scorecard by RESOLVE, The National Infertility Organization. State law concerning third party reproduction such as surrogacy or donor egg can vary greatly -- in Illinois surrogacy is legal, while in New York it is illegal to compensate a woman for being a gestational carrier. It is critical to do your legal research prior to treatment to avoid legal battles now or after the baby is born. Lastly, fertility centers are not equally distributed in location. In California there are 142 fertility specialists, while in Wyoming there are zero.
6. "Twins would be awesome!"
Yes, twins would be wonderful, but one baby at a time is safest. How many embryos are transferred during IVF is determined by the doctor and the patient. As doctors we share our recommendations, but the final decision is usually decided by both the patient and the doctor. Our goal as physicians is to deliver one healthy baby. For some patients, transferring more than one embryo may be optimal when taking into account age, diagnosis and finances, but for others, a single embryo may be best. Single embryos can also split and become identical twins. If you are averse to the possibility of twins or triplets, opt for a single embryo transfer.
7. Stop trying to be Superwoman and get support.
Ask anyone who has been through it -- infertility treatment is no cake walk. Yet many women and couples avoid talking to a counselor, don't join a support group and keep their journey private. There are no awards given for suffering alone. Being strong is knowing when you need to take care of yourself. Talk to a fertility counselor who specializes in helping couples and individuals thrive through the unique challenge of infertility. Or find someone to confide in to share some of the emotional parts of this process, which can be priceless. Many fertility centers have their own programs to support patients in treatment.
8. Are you crazy?! I would never use an egg donor!
You may need to consider other options to have a family. After three unsuccessful intrauterine inseminations, the odds of a pregnancy via IUI go down. If you have had several pregnancy losses and/or multiple failed IVF cycles, it may be time to look at other options. For some, third party reproduction options such as surrogacy, donor egg or donor sperm can allow couples and individuals to overcome their infertility struggles. Undergoing genetic testing or screening embryos through preimplantation genetic diagnosis (PGD) prior to embryo transfer may reveal new information. Adoption is also an option to consider. The question is not IF you will have a family, but how you will have a family.
9. Give me a break! Actually, taking a break from treatment can be a good thing.
Feeling exhausted and at the end of your rope? Yes, fertility treatment can do that. Taking a break to re-energize can really help. Stress does not cause infertility, but it does affect your fertility potential. A scientific study found that women whose enzyme alpha-amylase levels, a stress-related substance, were in the highest third had more than double the risk of infertility. If you need a break -- even if it is only for a month or two -- take it.
10. That is why they call it the "the practice" of medicine. It is ever-evolving.
In the world, there are always advancements and changes presenting new medical options. The practice of medicine could not have advanced to what we have today without trials, studies, and research. Around the globe, there are people hard at work trying to uncover data that can make pregnancy and parenthood a reality, no matter what the infertility issue. As a physician, it is critical to stay up-to-date on new medication and techniques to help patients conceive. When you are talking to a fertility doctor, ask them about the new techniques that the practice has adopted recently.
11. Fertility centers are not all alike, so look around.
Each fertility center is different, and it is important to consider those differences during your research. Practices may have multiple physicians, each with their own specialties and interests. Facilities will also vary greatly. Does the center have an IVF lab in their office or is this outsourced? Do they offer genetic testing/PGD? Do they have a research department? Take into account history, experience, services and staff when selecting a fertility center. It shows breadth and depth of an organization.
Don't forget to be your own advocate. Ask yourself. Ask Dr. Google. Ask your physician.
You will find your way. Just don't give up.
Dr. Angeline Beltsos, Medical Director and Clinical Research Director, Fertility Centers of Illinois