Should you seek out a fertility specialist?

People look to assisted reproductive technology for a number of reasons including:


Reason One: Infertility

Infertile couples are the most common utilizers of Assisted Reproductive Technology (ART) The most common is infertility. Infertility is fairly common. Infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. For women over 35, infertility is typically diagnosed if she is unable to get pregnant after six months (as opposed to a year). Infertility affects both men and women. (source)

 

How common is infertility?

According to the CDC, “12% of women aged 15 to 44 years in the United States have difficulty getting pregnant or carrying a pregnancy to term”. Infertility is not just a “woman’s issue”.

  • In 35% of couples, infertility was due to male and female factors.
  • In 8% of couples, infertility was due solely to male factors.
  • Finally, in 57% of couples, infertility was due to solely female factors. (source)

 

Causes of Infertility

Some common causes and forms of infertility include (source):

  • Male Infertility
    • Abnormal sperm production or function
    • Problems with the delivery of sperm
  • Female Infertility
    • Ovulation disorders
    • Uterine or cervical abnormalities
    • Fallopian tube damage or blockage
    • Endometriosis
    • Primary ovarian insufficiency
    • Pelvic adhesions

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Reason Two: Preserving Fertility (Egg or Sperm Freezing)

Age Related Concerns

Some women choose to freeze their eggs in order to maintain their fertility. Younger women generally produce higher quality eggs and higher quantities of eggs. In order to preserve fertility, some women choose to freeze their eggs or embryos for later use.

 

Chances of conceiving before 40

The mean age of first-time moms in 2014 was was 26.6. Globally, there is a trend towards couples having children later in life(source). However, for some women, waiting isn’t an option. Studies show that infertility becomes more of a problem as women age (age affects men as well, but not as soon nor as acutely). Studies show that with regular, unprotected intercourse 94% of women aged 35 and 77% of women aged 38 will conceive within three years (source, source). Other studies put the fertility rates of women between 35-39 at 82%.

 

Chances of conceiving after 40

Statistics for age 40 are a little harder to pin down. A popular statistic is that women after 40 have a 5% chance of conceiving per month. Or, in other words, if we do the math (1-(.95)^12), a woman over 40 has a 54% chance of getting pregnant within a year. This statistic comes from research done by Dr. Sherman Silber (source). Personally, I would take the research with a grain of sand as the research participants in Dr. Silber’s study were all women with infertility issues. These women were not representative of the population. For example, compared to the general population, you can expect the women in the study to have lower egg reserves and egg quality in comparison to the general population. Furthermore, women who are in their 20s and experiencing difficulty conceiving are more likely to “wait it out”. Meaning that it could very well be the case that these women would have been similarly infertile at the age of 25 as they are at the age of 40. Due to the cost of IVF, it is just more common for women to wait.

This is not at all to say that fertility does not decline with age. It certainly does and most doctors agree that if a woman wants to be sure she is able to conceive at least one child, she should do so by 40 at the latest. However, I suspect the fertility statistics for women over 40 are more nuanced and gradual.

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Reason Three: Cancer or Illness

Sometimes people look to preserve their fertility not as a result of aging, but of illness. For example, women with ovarian cancer may be able freeze some of their eggs before starting treatment (source). Similar holds for other illnesses or forms of cancer (e.g. men with testicular cancer).

Some young people in the military similarly may opt to freeze their sperm, eggs, or embryos in case they do not make it back from combat or have their reproductive organs damaged while serving (source).

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Reason Four: Genetic Disorders

Preventing Passing on Genetic Disorders

Another common reason for seeking out Assisted Reproductive Technology involves genetic disorders. If a couple has genetic characteristics that can be passed on to their child with high likelihood, they may undergo IVF in order to prevent conceiving a child with that genetic disorder.  The genetic disorders screened for are generally considered to severely decrease the quality of life of those born with it.

Common disorders tested for include (source):

  1. Cystic fibrosis
  2. Tay-Sachs disease
  3. Spinal muscular atrophy (SMA)
  4. Hemophilia
  5. Sickle cell disease
  6. Duchennes muscular dystrophy
  7. Thalassemia

When screening for genetic disorders, IVF is paired with PGD (Preimplantation Genetic Diagnosis).

 

Genetic Disorders Preventing Pregnancy

A number of autoimmune issues make pregnancy more difficult. In some of these instances, the body may perceive embryos as foreign bodies and attack them, preventing implantation and other times causing miscarriage.

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Reason Five: Social Infertility

Social infertility is used to describe women and men in non-heterosexual relationships may look to IUI or IVF to conceive with the help of donor sperm or donor eggs. Social infertility is also used to describe heterosexual couples that waited an abnormally long time to have children and now have difficulty conceiving.

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