The Modern Path to Parenthood
From Brooke Shields to Chrissy Teigen, the topic of infertility is no longer off the table in Hollywood—or at home. With an ever-increasing wealth of information regarding infertility now available, more hopeful parents are having conversations about this hurdle to having a family. Not only has this new level of openness lifted some of the emotional burden associated with fertility issues, it has also helped dispel myths related to this medical issue, as well as shine light on the many treatment options available today.
Infertility Myths vs. Facts
One of the most prevalent myths swirling around fertility issues is that it’s a woman’s problem. The reality is, infertility affects women and men equally, approximately 40 percent each, with the remaining 20 percent resulting from a combination of male and female factors or just plain unexplained.
Other myths with no footing in reality include whether men wear boxers or briefs, being healthy or having a healthy sex drive means you can’t be infertile, and an orgasm is required to get pregnant. The simple reality is fertility and infertility issues, like many other medical concerns, don’t play favorites and can affect anyone at any time.
True Causes of Infertility
Although there are a variety of medical causes of infertility, some health issues are more common with regard to fertility. For instance, dysfunction of the ovulation process quite often disrupts a woman’s ability to get pregnant. Women suffering from polycystic ovary syndrome (PCOS) may have irregular menstrual cycles or not ovulate. Endometriosis, when uterine-lining tissue develops outside the uterus, can also vastly impact fertility.
Structural problems with the female reproductive tract, such as fibroids, polyps or scarring, may also negatively impact fertility. On the male side, low sperm number, low sperm motility and low testosterone all can affect fertility. “When it comes to male fertility, it’s all about the number of healthy sperm—easily demonstrated with a simple lab test,” says Scott D. Miller, MD, of WellStar Urology and WellStar North Fulton Hospital. For both men and women, increased age also plays a pivotal role in fertility, because the older we get, the less fertile we become. The key to resolving fertility issues is for both partners to get tested. “You can’t predict infertility,” says
Carolyn R. Kaplan, MD, of Reproductive Endocrinology & Infertility Group. “There may be more than one problem.”
Today’s Treatments for Infertility
While there are many “old wives’ tales” regarding how to improve fertility, for the most part, they have no effect at all. Instead, some of the easiest steps men and women can take to improve their fertility are simple lifestyle changes. “Do not smoke,” says Natalie Stentz, MD, MSCE, of Shady Grove Fertility. “The rate of infertility is approximately twice as high in male and female tobacco smokers.” Those who use vaping products are not exempt. “There is ample evidence that cigarette smoke contains carcinogens and has negative effects on sperm motility and function. There is evidence that e-cigarette flavors contain toxicants (or toxic substances) and carcinogens and may damage male fertility,” Dr. Kaplan says.
Maintaining a healthy weight, exercising regularly, avoiding alcohol and smoking, and reducing stress also will aid in improved fertility. Of course, there are a number of medical treatments available to treat infertility. Intrauterine insemination (IUI) is one of the most common treatments for a number of fertility problems, and involves placing washed sperm (which involves removing dead sperm, white blood cells, and seminal fluid, and concentrating the sperm into a very small volume of fluid so it can be used for intrauterine insemination) directly into the uterus at the time of ovulation.
In Vitro Fertilization
In vitro fertilization, or IVF, is a more aggressive treatment, and consists of taking eggs and sperm from the female and male partners and combining them in a lab. The fertilized egg is then implanted in the female partner. Success rates with IVF are usually higher than IUI, but cost is much higher. If the woman’s tubes are blocked or the sperm count is very low, then IVF is the best option. “IVF has come a very long way,” says Obehi A. Asemota, MD, of Aspire Fertility Atlanta. “It’s a very good way to conceive for the right patient.” She goes on to say the technology involved has improved substantially, leading to very good success rates. “It has become more affordable with the possibilities of grants and discounts of medications that can help alleviate the costs of IVF,” she says.
For some women, hormone treatments can be a viable option as well. “Oral fertility medications work by helping your body increase its own production of the hormones that encourage your ovaries to develop eggs,” Dr. Stentz says. “Injectable fertility medications contain the same hormones that your body makes to develop eggs, but are delivered in concentrated doses. It is important to know that studies have shown that fertility medications do not increase a woman’s risk of cancer.”
On the male side, hormone manipulation also can be effective in treating infertility. “The goal is to get the testicle to maximize production,” says Ronald E. Anglade, MD, of Georgia Urology P.C. “When they produce more testosterone, that may lead to more effective sperm production.” Surgery could be another option for men. For instance, they may want to consider vasectomy reversal or need microscopic reconstruction to bypass a blockage.
Because many women and couples are waiting later in life to have children, there are a growing number of women who are freezing their eggs. “This is due to changes in educational and career opportunities for women as well as changes in social norms,” Dr. Stentz says. “As such, more women are freezing their eggs early as insurance against an uncertain future.”
More and more LGBTQ couples also are utilizing fertility treatments to start their own families. For instance, a female couple will come in for donor insemination; another scenario would be with one partner donating the eggs and the second partner receiving the egg implants, says Dr. Asemota. Male couples are using egg donors and surrogates, she adds.
When faced with the stress and uncertainty of fertility issues, it can be easy to buckle under the pressure, pressure from one another and from family and friends. However, it’s important to stay focused on the goal. “Don’t blame one another,” Dr. Asemota says. “Infertility is just like any other medical diagnosis. The good news is there are treatment options. For most couples, there is hope.”
In addition, keep in mind this is you and your partner’s private medical business and yours alone. “There are many resources and support groups for those struggling with infertility. That said, you do not owe anyone, even family or close friends, an explanation about your attempts to conceive or struggles with infertility,” Dr. Stentz says.
Overall, it’s important to know two key facts about fertility issues. First, you are not alone, and, two, there are options available. “A lot of infertility patients feel they are the only ones suffering from this. One in eight couples suffer from infertility,” Dr. Asemota says. “There are good treatment options, and they should seek help. They should not suffer alone.”