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.
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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.