Allison and Eric had been trying to conceive for nearly two years before they were referred to The Fertility Institute of New Orleans. After months of keeping ovulation charts and obsessing over her menstrual cycle, "We went and had testing done and found out it was a male factor," says Allison, 35.
The discovery threw the couple for a loop. "I was surprised," she says. "Women are traditionally the ones handling birth control and having to watch for our period each month, so traditionally the female is the one focusing on it.
"When you're trying to conceive, you, the female, are the one obsessing over it — figuring out when you're ovulating, and peeing on sticks all the time, and the guy is somewhat oblivious.
"When you realize that you did all that work and there was no way you could have known (what was keeping you from conceiving), there was no way you could have tested for that at home — it's a shock."
It's a common misconception, says Allison's obstetrician, Dr. Sissy Sartor, an infertility specialist at The Fertility Institute. "If you're not conceiving, the burden of guilt, so to speak, is on the female," she says. "A lot of couples don't realize that 35 to 40 percent of the time, there's going to be a male factor. And they're very surprised when they find out."
Advancements in medical sciences make pregnancies possible for thousands of couples who, years ago, would not have had a chance of conceiving: older couples and people with once-irreparable medical conditions, for example. But despite the wealth of information available on the Internet (or perhaps because of it), misconceptions, some entering the realm of myth, still abound.
"A misconception I hear a lot is 'I know he's not the problem, because he has a child already — it's clearly my problem,'" says Dr. Lindsay Wells of Audubon Fertility and Reproductive Medicine in New Orleans. "In approximately 40 percent of infertile couples, the male partner is either the sole cause or a contributing cause." That includes men who previously have fathered a child, she says. "Therefore, early evaluation of the male in a couple with infertility is essential."
Wells adds that celebrity culture has led America to believe it's fairly common and easy for women in their 40s and 50s to have healthy pregnancies. "The biggest misconception in patients coming to see me is that it is OK to wait until their late 30s or early 40s to have children. (They say,) 'I see lots of women in Hollywood having babies in their 40s, so why can't I?'"
This leads to yet another misconception: that in-vitro fertilization (IVF) and science can achieve what nature cannot. IVF has relatively low success rates in women older than 40, Wells says: less than 20 percent per cycle for women 40 to 42 years old, and less than 5 percent for women 43 and older. While the normal treatment for older women is directed toward stimulating egg production in the ovaries and assisted reproductive technologies such as IVF, "these treatments have very disappointing success rates beyond the age of 40," Wells says.
"A woman's best reproductive years are in her 20s," according to the doctor. "Fertility gradually declines in the 30s, particularly after age 35. Each month she tries, a healthy, fertile 30-year-old woman has a 20 percent chance of getting pregnant. By age 40, that chance is less than 5 percent per cycle. These are important numbers for women to know."
Sartor says she has seen her share of patients who have delayed childbearing until their 40s and are counting on IVF. "But IVF isn't going to fix everything that's wrong," she says. "IVF, as good as it's become, is not going to address the aging of the ovaries.
"If you wait until you're past your mid-30s, it's more likely that things are going to happen that affect the fallopian tubes or the uterus (such as fibroids or endometriosis, which can cause scar tissue and hamper normal function). A lot of times those issues can be addressed surgically or through medication, but what cannot be reversed is the aging of the eggs. There are no medications that can change the age-related decline."
Sartor says women shouldn't assume they can achieve a later-in-life pregnancy. "Women peak in their ability to conceive in their mid-20s, and then it stays about the same until the mid-30s, then it starts dropping — and then at 40 it really starts dropping much more rapidly.
"When I first went into practice, I didn't feel patients were encouraged to get pregnant sooner rather than later. And now, [obstetrician/gynecologists] are getting better about that. They're starting to tell women at 32, 'You really want to think about starting your family.'"
Part of the reason women feel comfortable delaying pregnancy is the media's portrayal of women, Sartor says. "In our society now, there's a dissonance between what the actual ovarian age is and what the cultural and social concepts are of fertility," she says. "A woman can look like she's 26 when she's 47 — we've gotten so good with our anti-aging treatments — and we have the concept that 50 is the new 40, that 40 is the new 30. This concept is that by staving off normal aging, or at least the appearance of aging, our ovaries are doing the same thing. But they're not."
Other fertility myths and misconceptions:
• It's easy to get pregnant. High school sex-education classes are so focused on preventing teen pregnancy "that people think unprotected sex automatically means pregnancy, when in fact, Mother Nature is very inefficient," Sartor says. "In the best of circumstances, a pregnancy occurs only 20 percent of the time people have unprotected sex. We won't even start (an infertility) workup until patients have gone one year without conception, or the woman is over 35."
• Coital positions affect conception. "Position doesn't make any difference at all," Sartor says. "You don't have to lie down for 30 minutes after sex; you don't have to hang from the ceiling by your feet. ... Many people also believe that diet or coital frequency can affect the gender of the baby. Those are myths."
• A woman's ovaries are the same biological age she is. "Decreased ovarian reserve" is a phenomenon in which the ovaries and eggs act older than they are. While there are tests to detect this, there is no cure.
• Freezing eggs is a good hedge against infertility later in life. "There is a lot of noise in the media about utilizing egg freezing as a way of keeping your fertility. ... The thing about egg freezing that doesn't come out is that it works best in young eggs. I'm seeing alot of women in their late 30s and early 40s saying, 'I want to freeze my eggs,' when it often is too late. If you're contemplating egg freezing, you really should do it before age 35."
• Birth control pills cause infertility. "The birth control pill does not cause infertility — short-term or long-term," Sartor says.
In Norma and David's case, too much Internet research made matters worse. Norma, 34, had dealt with endometriosis and other medical problems and did not conceive for several months after the couple quit using birth control in 2010. "My husband's the one who did the Internet research, and he read a lot of negative stories and he became very negative himself," Norma says. "I didn't even want to go online."
Once the couple visited fertility specialists, they learned that IVF was their best bet. Norma's eggs were harvested, fertilized and produced nine embryos. When she had her first transfer, the prognosis was good, but the embryos failed to implant. "And I obsessed over every little thing I did or didn't do," Norma says. "'What did I do wrong? Was I moving around too much? Did I get up too fast?' I was upset and disappointed."
Distraught, Norma turned to yoga. "I know yoga helped me," she says. "It made me focus on the present and not think about what happened in the past or what's going to happen in the future." With a new outlook, Norma and David went through a second embryonic transfer — and that treatment worked.
"Yoga made me relax and be more comfortable," Norma says. "I really, honestly believe that was a big help for me. I finally realized I'm doing all the right things to become a mother. ... The next time around, my state of mind was completely different."
As for Allison and Paul, they are going through a second procedure in which sperm is injected directly into the egg. Allison says she went online to research it and found information that scared her about her prospects for success. Sartor says couples must be careful about where they get information.
"We view the Internet as mostly positive, but it can be a double- edged sword," she says. "If you're a successful person, directed, always in control, and you're not conceiving, you're on that Internet 24/7. Even if you're smart as hell, it's hard to separate the wheat from the chaff. Taking the Internet with a grain of salt is good advice.
"Even better? Forget the Internet and talk to a doctor."
Dr. Sissy Sartor of the Fertility Institute of New Orleans offers advice to ensure women's pregnancies are as healthy as possible.
Protect yourself from sexually transmitted diseases (STDs). Some STDs are curable and some can irreparably damage the reproductive system.
If you consume alcohol, drink in moderation. Sartor cites studies that show more than two alcoholic beverages a day can significantly decrease a woman's ability to conceive.
Ages 37-40 and older
Remain diligent and focused on your goal to conceive. "Move forward with your foot on the accelerator, because you are definitely in a race against Mother Nature," Sartor says.
• Maintain a healthy body weight. Keep your body mass index between 19 and 30. Obesity decreases the effectiveness of fertility treatments, can lead to higher miscarriage rates and can cause significant problems while pregnant. "Eating healthily and getting regular exercise is important for women at every age prior to pregnancy," Sartor says.
• Quit smoking before pregnancy. Though most people know nicotine is harmful to a developing embryo or fetus, smoking decreases fertility in both men and women and leads to earlier menopause. Some women quit smoking as soon as they learn they're pregnant. While this is better than not quitting, it's not optimal. Early pregnancy can be tough, and the added stress of withdrawal from an addictive substance can make the first few weeks miserable. Experts suggest going off birth control no sooner than one month from the day of the last dose of nicotine (whether from a cigarette, nicotine patches or gum.) This allows enough time to get past the worst nicotine cravings and develop smoke-free habits.
• Be careful with herbal supplements. Many have not been adequately studied, and some research suggests over-the-counter supplements could hinder fertility. "Don't assume that just because it's not prescription it can't interfere in some way," Sartor says.