For one in eight couples in the U.S. plagued with fertility problems, getting pregnant is an elusive -- and frustrating -- dream.
But if they seek medical help sooner rather than later, the outlook has never been brighter. Infertility treatments have improved, options have expanded, and doctors are more skilled at the techniques. Evaluations are done earlier than in years past, and the trend is to treat more aggressively, especially if the hopeful mom-to-be is older.
Artificial insemination is a technique that can help treat certain kinds of infertility in both men and women. In this procedure, sperm are inserted directly into a woman's cervix, fallopian tubes, or uterus. This makes the trip shorter for the sperm and bypasses any possible obstructions. Ideally, it makes pregnancy possible where it wasn't before. Intrauterine insemination (IUI), in which the sperm is placed in the uterus, is the most common form of artificial insemination.
Though the pregnancy...
"Success rates have improved dramatically in the last 10 years," says Mousa Shamonki, MD, director of in vitro fertilization (IVF) and a reproductive endocrinologist at the University of California, Los Angeles David Geffen School of Medicine. The average success rates for births at fertility clinics have roughly doubled in the past decade, he says.
In 2003, more than 48,000 babies were born in the U.S. as a result of assisted reproductive technology or ART, according to the CDC. That's an increase of more than 2,000 over 2002 and 7,000 more than in 2001.
The Earlier the Better
"Often couples [who can't conceive] are told by family members, 'Just relax and take a vacation, you will get pregnant,''' says Eric Surrey, MD, former president of the Society for Assisted Reproductive Technology (SART) and a fertility specialist in Denver.
That won't work for couples with underlying fertility problems, he says. And at some point, seeking medical help is wiser than persisting on their own. If a woman is under age 39 and has been attempting to conceive for a year without success, it's a good time to seek medical help, says Surrey. If she is over 39, the evaluation should be performed after six months of trying to conceive without success, he says.
Sometimes infertility can be treated with medication or surgical repair of reproductive organs. Another standard fertility treatment is to do one to three cycles of ovarian stimulation and intrauterine insemination, says Guy Ringler, MD, a reproductive endocrinologist at the Santa Monica -- UCLA Medical Center.
That involves stimulating the ovaries to boost egg production by giving medicine such as Clomid and then inserting a thin catheter into the uterine cavity to place the sperm there.
The treatment, he says, "will increase the pregnancypregnancy rate from about 3% per month to about 12% to 15% in women under age 40 and to about 5% to 7% in those over age 40."
"But many couples are saying, 'I want to be more aggressive,'" Ringler says. "Most often they say that due to age, but also to the success rate [of the more aggressive techniques]." Many ask to move on before the three months is up, he says.
If they move on to in vitro fertilization or IVF, the chances of pregnancy are greatly increased, he says. In IVF, the woman's eggs are surgically removed from the ovaries, mixed with sperm outside the body, and allowed to fertilize before the embryo is then transferred back into the uterus. "With IVF, if the woman is under age 40, the pregnancy rate is about 40% in the first attempt," Ringler says. In women over 40, the success rate is greatly dependent on age, he says.
Over-40 IVF success rates are tied to age, agrees Steven J. Ory, MD, a reproductive endocrinologist in Margate, Fla., and president of the American Society for Reproductive Medicine. For women 40 to 42, the success rate with IVF is about 15%, he says. But it's less than 5% for women over age 42. Still, he says, proceeding to IVF quickly is one of the biggest trends now, whatever a woman's age.