Couples Have Many Options to Address Infertility Problems
Couples have many options to address infertility problems
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 One in 10 couples trying to have a baby will experience some problem with conception. But the good news is there are many treatment options available and a good chance of success. The majority of couples who follow the complete course of treatment will conceive a child – including couples with unexplained fertility problems, said Aida Shanti, M.D., Director of the Division of Reproductive Endocrinology and Infertility in the College of Medicine at the University of Arkansas for Medical Sciences (UAMS). Shanti is a board-certified reproductive endocrinologist and the first female physician to direct an infertility and reproductive medicine program in Arkansas. She previously was director of the in-vitro fertilization program at Emory University in Atlanta. “In most cases we can identify the condition that is preventing pregnancy,” Shanti said. “But if not, chances are still good that there are treatments that will lead to conception.” The key for couples, Shanti said, is not to wait to visit a reproductive specialist if they think there is a problem. For couples with the woman older than 34, Shanti recommended seeing a specialist if they have not been able to conceive after three to six months. For younger couples, she recommended seeing a specialist after a year of attempting to conceive. “They shouldn’t get worried, because there are a lot of explanations for infertility and a lot of options to help couples, but they should not drag their feet on seeing a specialist,” Shanti said. “Studies have shown that a woman’s chances of conceiving begin to decrease after age 27 and dramatically so after 39.” The earlier a fertility problem is diagnosed, the better chance the treatment will work, she said. However, just because a woman is having regular periods does not mean there could not be a problem, Shanti cautioned. Gynecologists and urologists can help a couple pinpoint problems that could cause difficulty conceiving through a variety of tests. In about 40 percent of such cases, the difficulty can be attributed to some male factor, while in 40 percent of the cases the difficulty is related to a female factor. In most of the remaining 20 percent, both partners have some degree of infertility but even those couples can usually conceive with specialized treatment. A round of simple physical and laboratory tests will be performed on both partners. A semen analysis will make sure the male partner is producing sperm in adequate numbers and that the sperm are active enough to reach the egg. For women, there are tests on the uterus and the ovulation process. Through an X-ray of the uterus following the injection of a dye, the doctor can determine if the correct anatomy is present and if there is any blockage that would prevent the sperm from reaching the egg. With detailed information from the tests, infertility treatments can be customized for each case, ensuring the best chance of conception. At UAMS, Shanti said, treatments will typically start with the simplest and least expensive before moving on to more involved procedures. Treatment for some conception problems can include artificial insemination, or injecting sperm directly into the woman’s uterus. If other treatments fail, one option may be in-vitro fertilization (IVF), where an egg is removed from the woman and fertilized in a lab using the man’s sperm. The fertilized egg, or embryo, is then placed in the woman’s uterus so that she can carry and deliver the baby just like any other mother. Even if the man has a low sperm count, enough sperm can usually be found and IVF can be effective since the sperm is injected directly into the egg. Still another option, if either the woman is not producing good quality eggs or the man’s sperm count is so low no sperm can be obtained, is to use a donor. An anonymous egg or sperm donor can be used. In those cases, the couple can be given certain non-identifying information about the donor. Sometimes, a friend or relative of the couple is willing to provide an egg for fertilization. Whatever the circumstances, the decision to use a donor egg or sperm should be carefully considered and agreed to by both partners, Shanti said. One of the newest services available at UAMS is a test that can help couples using IVF ensure that certain diseases or disorders will not be passed on to their child. Preimplantation genetic diagnosis (PGD) can be used to identify genetic defects within the embryo created through IVF. Through PGD, a cell is removed from the embryo and the DNA sequence can be evaluated for several kinds of genetic or chromosomal problems. Shanti said PGD offers a new tool for giving couples peace of mind about the health of their baby. The test can benefit any couple at risk for passing on a genetic disease or disorder. PGD can also be helpful for women 35 and over. There are also several types of medications, both pills and injections, which can address problems with ovulation. Shanti said the use of fertility medications, like the other treatments, depends on the diagnosis of the infertility problem and the treatment that will offer the best chance of success. Minor surgical procedures are also an option for couples to correct anatomy problems that might prevent conception Costs vary for fertility evaluation and treatment, based on the extent of services needed. In Arkansas, some insurance companies are required by law to cover in-vitro fertilization up to $15,000 in most cases, unless either partner has had a prior surgical sterilization. Patients should first check with the insurance carrier about coverage. UAMS has been the pioneer and leader in infertility treatment in Arkansas for many years and is the first comprehensive ART (assisted reproductive technology) center in Arkansas. The UAMS program has achieved many Arkansas firsts in infertility treatment including the first IVF procedure in 1988, the first pregnancy through egg donation, and the first babies conceived through intracytoplasmic sperm injection. The IVF delivery rate of the UAMS program continues to outpace the national average year after year.
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