Infertility: Epidemic or Hype?
Author: Frank LoRusso, MD
Infertility...few diseases strike such fear into the hearts of otherwise healthy women in the United States. Everyone knows someone, who knows someone, who has suffered from it. Popular magazines feed on this fear with headlines detailing every Hollywood starlet and pop music singer's plight with the dreaded infertility. The nightly news examines the tremendous cost involved with in vitro fertilization (IVF) and fertility medications. We see the dangers of such treatment in shows like "John and Kate plus Eight", the "Octomom" and such. Hopefully this disease is not contagious!
For those of you considering a family, fear not. Fortunately this insidious condition is relatively rare and there are safe and effective treatment options to be found right here in Western Wisconsin that won't necessarily break your bank account.
The old adage that "an ounce of prevention is worth a pound of cure" holds true when starting a family. The journey to parenthood begins before you stop your birth control with a visit to an Obstetrician/Gynecologist (OB/GYN). The visit should be scheduled as a "preconception visit" and under no circumstances should the term INFERTILITY be used until the criteria of the condition are met. Once this term shows up in a medical history, insurances can get particular about what they will and will not cover.
At your preconception visit, your OB/GYN should go through a detailed medical, surgical and family history of both you and your partner to identify potential risk factors. A little known fact is that while 40% of true infertility is of female origin, 40% is male and only 20% is both! Should any risk factors be found, a discussion about what types of evaluation and treatment exist about the given condition should follow. A pelvic exam may or may not be indicated at this visit.
The most important part of this preconception visit is to set realistic expectations for you and your partner on how long it can take to conceive. You should be educated as to when peak fertility occurs during your cycle and how to determine this. A personalized plan for testing and a timeline for when such testing is appropriate should be developed. You should leave this appointment feeling calm and optimistic. There's a greater than 90% chance you will be pregnant within a year!
What if pregnancy does not occur within the agreed upon timeframe, or if the stress and worry begins to get to you? It is then time to call your friendly OB/GYN and ask for help. The original plan may need to be modified, questions answered and people reassured. Your physician should always have a "next step" for your individual situation. If not, it is time for a second opinion or a referral to a Reproductive Endocrinologist. A Reproductive Endocrinologist is a physician who specializes in fertility issues. A word of caution here. Before starting any treatment, testing or medication, your OB/GYN should explain to you exactly what it is you are trying to achieve. Tests can be expensive and medications have side effects that may actually reduce your fertility. There needs to be a reason before starting it!
Finally, remember, stress can seriously reduce your fertility. Your body cannot differentiate between stress caused by drought, illness and starvation from crash diets, your boss is a jerk or not getting pregnant. It will respond the same way to each condition with changes in hormones like cortisol, thyroid and gonadotropins. These changes are designed to sabotage your fertility, preventing pregnancy when environmental conditions aren't favorable. This is why so many couples get pregnant once they have given up trying or adopt a child.