It's difficult to write about fertility issues without dredging up cliches about frantic, 30-something women struggling to conceive before their so-called "biological clocks" run out. It's even more problematic when these caricatures appear to contain a kernel of truth.
"We talk about the biological clock — you do have one," says Dr. Richard P. Dickey, founder of the Fertility Institute, a clinic with locations in Metairie, Baton Rouge and Mandeville. "If you have any problems (conceiving) at all ... don't wait. You need treatment. By age 40, only 10 percent of women are still fertile on their own." If this blunt assessment strikes fear into your career-centric or procrastinating heart, take note: Several simple things can maximize fertility and ensure the health of your future children.
Dr. Vu Vuong, an obstetrician/gynecologist at Ochsner Medical Center's West Bank location, advises aspiring mothers to take prenatal vitamins while trying to conceive. The best pills have at least 400 micrograms of folic acid (to prevent birth defects) and supplemental iron (to cope with increased blood volume during pregnancy). Vuong stresses the importance of rapport with your doctor and of preparing yourself "socially (and) psychologically" for pregnancy.
"Not just physically but emotionally you should be ready," Vuonh says. Social support networks need to be there. To improve the odds of conception, the refrain we hear from physicians on most health-related topics still applies: Maintain a healthy body weight, quit smoking and exercise.
Older women should also talk to their doctors about the effect of medications on their fertility and on a fetus. They should undergo tests for the health problems many people face as they age, as these create complications from conception to birth.
"Simple things like ... thyroid problems, hypertension (and) diabetes are not good for the baby," Vuong says.
After taking these preliminary precautions, most women should be cleared to begin trying. Women are most fertile near the time of they ovulate, telltale signs of which include cramping near the middle of the menstrual cycle (around days 12 to 14), spotting and a clear discharge the consistency of egg whites. Ovulation thermometers, available at drugstores, can reliably clue you in to your most fertile times. Women should stop taking hormonal birth control the month of intended pregnancy, but no earlier: Vuong says the pill's after-effects are harmless to an embryo and should not affect one's fertility on a long-term basis.
With a little luck and an enthusiastic sex life, the journey to pregnancy is speedy and thrilling — in most cases. Infertility, defined by the Centers for Disease Control as an inability to get pregnant after trying for 12 months, complicates the lives of many individuals and couples. Dr. Ron Clisham, a reproductive endocrinologist at Audubon Fertility & Reproductive Medicine, says fertility specialists play multiple roles from physician, to myth-debunker, to life coach while they work with patients to understand why they aren't getting pregnant.
"In general, about 35 percent of the time it's going to be a male problem, 35 percent of the time it will be the fallopian tubes or some other kind of pathology in the abdomen, about 15 percent of the time it will be related to the lack of ovulation ... the rest of the time it's unexplained," Clisham says. "For the most part, you need to work on fertility problems as a couple."
The clinic's physicians run down a five-factor list of potential issues including ovulation, condition of the fallopian tubes, pelvis and uterus; male factors, the cervix and sexuality in general.
Some of these elements are easily examined: Menstrual cramps, unpleasant as they may be, are a good sign that you ovulate regularly. Other impediments may be less obvious. A history of sexually transmitted diseases, which can obstruct the fallopian tubes, fibroids (bloodless nodes that can grow inside the uterus), and polyps in the uterus all adversely affect fertility prospects.
Insulin resistance, a common issue for overweight women, also hinders a woman's ability to conceive. At the Fertility Institute, Dickey supports weight loss for any overweight woman trying to conceive.
"The one thing we tell most women they can do on their own is lose that extra 30 pounds," Dickey says. "Take your weight back to where it was when you were 20."
As Dickey hunts for an underlying diagnosis of what stands in the way of pregnancy, he doesn't delay treatment. Many treatment regimens begin with fertility pills: Clomiphene and tamoxifen (a drug often used to treat breast cancer) are two common prescriptions. According to Dickey, these medications work by increasing the level of the follicle-stimulating hormone (the hormone that makes eggs develop) in the body, and by increasing other hormones to the level they were when the patient was in her late teens.
Dickey suggests patients not wait more than three ovulation cycles before trying new techniques. If fertility pills fail, women can turn to in vitro fertilization. At $16,000 per cycle, this can be an option of last resort before considering donor eggs, donor sperm or adoption. (Some states mandate that insurance cover at least one cycle of in vitro fertilization, but Louisiana isn't one of them.) During this procedure, the doctor stimulates the ovaries with gonadotropin (a hormone associated with reproduction) injections that cause the woman to produce more eggs. The eggs are removed from the uterus and placed in a supporting environment; a clinician adds sperm later. Five days later, if fertilization occurs, physicians re-plant live embryos in the uterus two at a time.
"The latest thing we're able to do is offer pre-implantation genetic diagnosis," Dickey says. "Since January, we've been able to view all 23 chromosomes ... so only normal embryos are put back (in the uterus)." This dramatically reduces the possibility of birth defects in implanted embryos.
Dickey reports that in vitro fertilization does not solve the problem of "egg quality," the measure of the completeness of an egg's genetic material and its ability to respond to a follicle-stimulating hormone. Nothing stops this quality from deteriorating with time.
"You actually have the most eggs numberwise when you're a 16-week-old fetus," Vuong says. "The good eggs tend to ovulate first. It gets increasingly hard for the pituitary to tell the egg that it's time to ovulate."
For couples experiencing the emotional and physical challenges of a difficult fertility journey, the national infertility organization Resolve (www.resolve.org) sponsors related support groups and offers numerous resources concerning assisted reproductive technology, adoption, donor cells and child-free lifestyles. During infertility awareness week (April 24-30), the organization and its members hold nationwide events in an effort to "put the face on infertility."
"A lot more people are talking about it more openly ... It's not just about them wanting a baby, it's about the fact that their body has failed," says Rebecca Flick, director of strategic partnerships and projects at Resolve. She reports that infertility affects one in eight couples of reproductive age, or 7.3 million Americans.
According to Dickey, it is possible to test your fertility by checking the level of follicle-stimulating hormone in the blood and examining via ultrasound how many good eggs remain in your ovaries. In this case, a little knowledge isn't a dangerous thing — it's a good precaution.
"There's nothing wrong with being vetted," Dickey says.