Infertility on the Main Line: Advances in Fertility Therapy and How Doctors are Helping Couples Though Fertility Challenges
A revealing, often bumpy journey through the fertility gauntlet with three local couples.
It’s the reality for an increasing number of couples grappling with infertility. Eleven percent of American women under 44 have difficulty getting pregnant or staying that way, according to a study from the Centers for Disease Control and Prevention. Many of them struggle in silence and isolation, hesitant to reveal intimate details.
In an effort to remedy that, three area couples have offered insight into their fertility journeys. Sex, money, emotional upheaval—they speak about things married folks typically keep to themselves. Most difficult, they agree, are the psychological effects. Month after month of disappointment can make anyone feel defective, or that nature is conspiring against them.
When Trying is Trying
Conceiving a baby is supposed to be easy, even fun. But most couples have to put forth a little effort. Up to a year is not uncommon.
That seems simple enough, but it can be a slow, downward spiral. Every month’s menstruation can feel like a failure. “We hoped and hoped, and I would constantly monitor myself to see if I felt any pregnancy signs,” says Media’s Colleen Leska. “We were disappointed every time, every month.”
Admitting a fertility problem—even to your spouse—can be painful. “Couples have their lives pretty well planned out, and they follow a familiar pattern: college, jobs, marriage, house, baby,” says Lynn Cohen, who runs support groups at Abington Reproductive Medicine. “If you get to the baby part and start having trouble, the story goes off course. This is very hard for couples to get their heads around, because they may have succeeded at most other things in their lives. All of a sudden, they’re faced with what they perceive as a failure—and a very intimate one.”
Often, one person is ready to see a doctor before the other is. That’s what happened with the Helms of Downingtown—who, like the Leskas, were in their late 20s and early 30s when they started trying. “Shelley wanted to go to a doctor long before I did,” says Brad Helm. “I wanted it to happen naturally.”
That would sound reasonable coming from most men, but not Brad, who is a testicular cancer survivor. In 2005, he had one testicle removed. Doctors warned him that the nine months of intensive chemother-apy might have compromised his fertility.
Even so, Brad didn’t agree to see a reproductive specialist until a year had passed without conception. “As a guy, you don’t want to be told that you can’t do something,” he admits. “It’s a pride thing. It’s irrational, but that’s the truth.”
Of course, women suffer gender angst, too. “In our support groups, one of the most common statements is, ‘I feel defective,’” says Cohen.
The Helms would eventually discover that Brad’s testicular cancer wasn’t the cause of their fertility problems. “When we finally went to Abington Reproductive, I was shocked at how many other things could be in play,” says Brad.
The American Society for Reproductive Medicine notes that 25 percent of couples have more than one medical issue contributing to their fertility problems. As such, both men and women should be evaluated. “The questions are, ‘Will this man’s sperm properly interact with this woman’s egg?’ and ‘Will this woman’s reproductive system be able to support the embryo and fetus?’” says Dr. Albert El-Roeiy of Crozer Chester Medical Center’s HAN Fertility Center.
“It’s a shame that they have to go through that year or six months of disappointment,” adds Dr. John Orris of Main Line Fertility. “But once they come to a reproductive specialist, it’s a whole new ball game.”
Blood, Eggs and Sperm
Couples go through a battery of tests after they meet with a fertility specialist. “Every couple is unique, and there’s no one-size-fits-all treatment plan,” says Dr. Michael Sobel of Abington Reproductive Medicine. “We do a lot of tests because, at heart, we are diagnosticians who are looking for every bit of information that we can use to treat the problem.”
For women, evaluations fall into two general categories. Endocrinology involves testing the blood for hormone levels, auto-immune diseases and STDs. Problems detected through blood tests can be treated with a variety of medications. In structural testing, doctors use ultrasounds, X-rays, hysteroscopy and laparoscopy to capture images of the woman’s uterus, fallopian tubes and ovaries in a search for abnormal-ities that would prevent production of eggs, their fertilization and their implantation. Among the most common problems are uterine polyps, fibroids, scarring and a uterine septum. “All of them are correctable through relatively routine surgical procedures,” says Sobel.
Doctors also need an egg count. “The status of a woman’s ovarian reserve is critical,” Orris says. “Her age is the number one thing that will affect that, but other things can contribute to it.”
For men, it’s all about the sperm. Samples are tested for volume, viscosity, concentration, contaminants in the seminal fluid, motility kinetics, and morphology. Of those, morphology is the most serious issue. Other factors can fluctuate from sample to sample, but morphology—the shape of the sperm’s head, midpiece and tail—remains consistent.
“An abnormality in morphology affects the sperm’s ability to perform its biological function,” says El-Roeiy. “We measure the sperm’s head, neck and tail, and evaluate their potential.”
Armed with answers to these questions, doctors offer patients treatment options. Medical histories and the couple’s age can determine how quickly they move through each.
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Sex and Drugs
“Mother Nature plays a numbers game,” Sobel says, “and we try to rig it.” Doctors do just that with Clomid, Serophene and other drugs that stimulate ovulation.
“We still wanted it to happen as naturally as possible,” says Brad Helm. “So my wife started using drugs.”
El-Roeiy offers this simple explanation: “A woman is born with a big reservoir of all the eggs she will have in her life. Every month, she takes her bag and goes to that reservoir and takes out 12-15 eggs. But she will use only one of those eggs in ovulation. With fertility drugs, we create the opportunity for more eggs to be happy and be used in ovulation. That way, her bag has more eggs that can be fertilized.”
With men, the rigging involves getting the sperm to that bag of eggs when the woman is ovulating. More sex might sound good to some couples. “But we’d already been trying for a year,” Brad explains. “And now, we were trying while she’s jacked up on hormones. Let me tell you how not fun that was.”
The medications manipulate estrogen receptors, so they can create mood swings. “I was all over the place emotionally,” says Shelley Helm. “No matter what mood I was in—or Brad was in—we had to have sex when it was time. Brad hated it. I’d say, ‘This is what we have to do. So come on!’ That’s a real turn-on, right?”
Brad called it “sex on demand” and said that it felt like a job he had to perform. “After a while, I’d act like I was sleeping,” he says. “But that wasn’t a good plan, because she’d always wake me up.”
Regardless of the hassle, it is effective. According to the ASRM, 85-90 percent of infertility cases are treated with drug therapy or surgical procedures. Fewer than 3 percent need advanced technologies like artificial insemination. Alas, both the Helms and the Leskas found themselves in that 3 percent.
IUI and IVF
Thanks to intrauterine insemination and in vitro fertilization, baby making has moved from the bedroom to the doctor’s office. The difference between IUI and IVF is where insemination occurs. With IUI, sperm are inserted directly into the uterus. In the case of IVF, eggs and sperm are collected, and insemination takes place in a petri dish. Viable embryos are then implanted into the uterus.
Both treatments are expensive. The average cost of an IUI cycle is $865. The IVF average is $8,158, with another $3,000-$5,000 for medication. In Pennsylvania, health insurers aren’t required by law to cover fertility treatments, and coverage can vary significantly from employer to employer.
Through Shelley’s employer, the Helms had a lifetime maximum of $10,000 for reproductive medicine. The Leskas paid for everything themselves. “We didn’t know how many IUI or IVF cycles we’d need, or if any of them would work,” says Tim Leska. “The financial stress became enormous.”
To pay for the treatments, the couples made lifestyle changes—no dining out, no vacations, no new car. “More stuff for the ‘no fun’ column,” says Brad.
In her support groups, Cohen hears plenty about the effects of such stress on a relationship. “It limits what couples can do to have fun and relax,” she says. “What tends to happen is that their entire marriage becomes centered on one thing: fertility treatments.”
Meanwhile, the physical demands continue. In both IUI and IVF, women use Clomid or other ovulation stimulators. They also have a steady series of appointments to monitor egg production, inject the sperm or extract the egg, and perhaps insert the embryo. Men must provide sperm samples. “I wanted to be with Colleen for every appointment she had,” Tim confesses. “But there were so many that I couldn’t make them with my work schedule. Over and over again, it seemed like my wife was going through things that I couldn’t help her with.”
Springfield’s Dave Beccaria recalls the stress of waiting to hear if the procedures were successful for him and his wife, Susie Rowlyk. “The first time, we were hopeful, and it seemed like things were going to work out,” he says. “I remember getting the initial phone call that we weren’t pregnant. I realized then that this was going to be a longer process than we imagined.”
Many couples have multiple fertility obstacles. “Sixty percent have more than one problem,” says Main Line Fertility’s Dr. Michael Glassner. “But the vast majority will get pregnant with persistence. You don’t want to lose them because they lose hope.”
The Helms had the fastest success of the three couples in this story. Though they tried IUI three times without results, they needed just one IVF cycle to produce a successful pregnancy. Within a year of starting treatment at Abington Reproductive, Shelley gave birth to their daughter, Brynn, in August 2012.
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The other two couples would spend more than three years and thousands of dollars undergoing IUI and IVF. The spouses leaned on one another throughout the process. Over the years, they divulged bits and pieces of the ordeal to parents and siblings. But they didn’t seek outside help. None of the couples did.
Why the silence? “We were trying to manage our own hopes and fears, and couldn’t deal with anyone else’s,” says Tim. “My top concern was shielding my wife from anything she didn’t have to deal with.”
But there were things from which they couldn’t shield their wives. Seeing other pregnant women, getting invitations to baby showers, even being seated next to infants in a restaurant triggered waves of sadness. “I was beyond-the-moon thrilled for people,” confides Susie. “You realize what a miracle it is when people have babies unassisted.”
Hardest of all were the miscarriages. The Leskas spent Thanksgiving 2008 celebrating their pregnancy after fertility drugs and four rounds of IUI. They felt they’d hit the reproductive jackpot: twins, a boy and a girl. Then 28 years old, Colleen took time off from work as a kindergarten teacher to ensure a healthy pregnancy. When the three month mark passed, she was showing, and the Leskas announced their news. By Christmas, Colleen was at 20 weeks. A day later, she went into labor.
Tim awoke to his wife’s screams and found her in the bathroom surrounded by blood. At Crozer-Chester Medical Center, Colleen delivered her son and daughter. Only a pound each, they were too small to survive.
Not everyone suffers miscarriages. But for those who do, it adds to months, if not years, of disappointment and struggle. “Miscarriage after IUI or IVF is a whole other level of loss and sorrow,” Cohen says. “People say they feel as though nature or God doesn’t want them to have children.”
The Beccarias had three miscarriages, the oldest at eight weeks. “It’s gut-wrenching,” says Dave. “If I could’ve taken on the pain myself, I would have.”
In the midst of their shock and grief, the Leskas’ doctor convinced them to do genetic testing on their son. “It might seem morbid, but a miscarriage presents an opportunity for us to get information about the couple’s fertility problem that can add to our diagnosis and treatment,” says El-Roeiy.
Mamas and Papas
Results of the tests on the Leskas’ son revealed a hereditary chromosomal disorder called balanced translocation, which can interfere with conception. El-Roeiy put the Leskas on a different fertility track. Instead of IUI, they would use IVF to produce embryos, followed by preimplantation genetic diagnosis to screen each embryo for balanced translocation. “We take the sperm out of the man and the egg out of the woman, and fertilize them,” says El-Roeiy. “Then, we do genetic screening on a few cells of each embryo. Only the chromosomally normal embryos are transferred to the woman’s womb.”
It would take another year and three rounds of IVF to produce a successful pregnancy for the Leskas. Even well into the second trimester, they were understandably cautious.
For some, pregnancy is a time of joy and wonder, but that luxury isn’t afforded to couples who have had miscarriages. “Even as our daughter was being born, I was like, ‘Is she really here?’” says Dave. “Then she started crying, and it was like, ‘Yep, she’s here. Now what do I do?’”
Avery Beccaria was born in May 2010. And once the fertility formula needed to create her was decoded, it was used to help the Beccarias have a second daughter, Ellie, born in December 2012.
The Leskas had their daughter, Corinne, in January 2011, and they’re trying for more. In early 2013, Colleen became pregnant but miscarried after seven weeks. In April, she underwent another round of IVF.
“We’re going to have more children,” says Colleen. “I know it in my heart.”
And trying is only part of it.