Infertility is a significant problem that affects about one in 10 couples. For years, couples were told they could seek fertility treatments if they had not achieved a viable pregnancy over the course of a year using no form of birth control. That is still true for some couples, but as researchers and physicians learn more about the myriad causes of infertility, evaluation and treatment may occur sooner rather than later.
“We start out with an evaluation, and a majority of the time we don’t need to do significant infertility care. There are smaller problems we can address,” says Dr. Valerie Ratts, an obstetrician/gynecologist who is board-certified in reproductive endocrinology and infertility with Washington University Physicians.
For instance, problems with ovulation often are treatable with prescription medications. “With milder and less expensive therapies, many couples are able to achieve success,” she says.
Moving forward quickly with effective treatments is a focal point for infertility specialists. Ratts says that avoiding the frustration of failed treatment attempts is an important goal for physicians and patients alike. Initial treatment strategies should work within three to six months. If they do not, it may be time to explore more advanced assistive techniques.
“The data would suggest that it makes sense to go from mild therapies straight into IVF (in vitro fertilization) in terms of lower cost and better success rates,” Ratts says. “That’s a new view—that when the simple therapies don’t work, the better thing to do is go to IVF and help people conceive.”
However, some physicians and patients are restricted from using in vitro fertilization due to religious or ethical concerns. Catholic doctrine prohibits IVF, in which an egg is fertilized in a laboratory and the resulting embryo is implanted in the uterus.
“A lot of my patients have ethical issues with IVF,” says Dr. Michael Thomure, a SLUCare gynecologist who is board certified in reproductive endocrinology and infertility. Saint Louis University and SLUCare does not offer IVF. One of the major concerns cited involves the potential that multiple embryos will be created but, at times, more embryos are created than implanted. The embryos that are not implanted could be frozen, but not all patients can afford the associated costs, yet don’t feel comfortable having the embryos destroyed.
“The real goal in IVF now is to have a high pregnancy rate with a very low multiple pregnancy rate,” Ratts says. “The goal of IVF therapy should be to achieve one singleton pregnancy at a time because that’s safest for the mom and baby and is also often best for the dad and family.” Twins are often manageable despite the increased risks, but “when we get into a situation of triplets or more, that is an obstetrical disaster,” she adds. Researchers are working on methods to identify the most potentially viable embryos and implant one or two instead of several.
Fertility naturally declines with age, so Ratts and Thomure recommend that women 35 and older who do not get pregnant within six months should seek the opinion of a board-certified infertility specialist. “The younger you are, the better infertility therapy works, so we want to identify people early because our chances for success are better the younger the patient is,” Ratts says.