All of us at SCRC are committed to education. Providing access to cutting edge research, dispelling common myths about fertility, and helping people understand how fertility treatment might be able to help them: it’s all part of our mission, and it’s important work. There’s a lot of information out there about fertility. Some of it’s great, some of it’s incomplete or outdated, and some of it is actually full of inaccuracies and misunderstandings. Sorting through it all to find out what you need to know can be a real challenge.
In our many years of speaking with and treating patients, there are some questions that our fertility doctors hear time and time again. Today, we’ll take a look at some of these queries and offer some straightforward answers.
What is the actual definition of “infertility”? When should I consult with my OBGYN or fertility specialist if I think it’s taking too long to get pregnant?
1 in 8 American couples struggle with an infertility diagnosis, and we are often asked “what counts” as infertility. A diagnosis of infertility is based on two factors:
- your age, and
- the amount of time you’ve been trying to conceive without getting pregnant.
Here is Dr. Ghadir answering this question in detail on Instagram:
The basic rule to follow:
- If you are under 35 and have been having unprotected intercourse regularly for a year without pregnancy, you meet the definition of infertility.
- If you are over 35 and after six months or more of regular unprotected intercourse you haven’t become pregnant, you also fulfill the requirements for an infertility diagnosis.
In both cases, it is in your best interest to ask your doctor for help as soon as you’ve been trying long enough to meet the diagnostic criteria for infertility. So many varieties of infertility are linked to age, and the sooner you seek an expert opinion, the sooner you can get some answers and get started with treatment that could change your life.
How do we find out why you are having trouble conceiving on our own?
Getting to the bottom of infertility begins with visiting a fertility specialist for a series of diagnostic tests and an in-depth medical history, for both partners. Initial tests such as:
- a sperm analysis for men, and
- blood tests/ultrasounds to check ovarian and uterine function for women
…can very often pinpoint a potential cause and suggest a path for treatment, or further testing. Up to 25% of the time, fertility is “unexplained”, which means that there’s no obvious cause. However, that does not mean that it is untreatable. Assisted Reproductive Technologies (ART) like In Vitro Fertilization (IVF) can be very effective even in cases of unexplained infertility.
What is fertility preservation, who is it for, and is it something I should be thinking about?
Fertility preservation usually means freezing eggs, sperm, or embryos for the future, using cryopreservation. When researchers and doctors first developed the techniques and technologies involved in fertility preservation, their goal was to help people facing a potentially fertility-damaging illness or treatment, such as cancer and chemotherapy. In the past decade, the technology has improved so much that eggs and sperm can be safely flash frozen and stored for up to ten years without any significant loss in quality, which opened up new possibilities and a wider audience for fertility preservation.
Egg freezing is an especially attractive option for young women who know they want to have children, but aren’t quite ready yet. Women’s eggs decline in quality with age. In fact, low ovarian reserve and poor egg quality due to age is one of the most common causes of infertility we see. When you freeze your eggs, you stop the clock on those eggs. Using younger eggs when you’re ready can make getting pregnant with the help of IVF much more likely. Costs are coming down, and more clinics are offering financing options, which has put the price of fertility preservation within reach for many more women. While it’s not a guarantee that you can have a baby “on demand”, it can give you more options in the future.
What happens if I want to freeze my eggs but I’m on birth control?
Depending on the doctor you see, you may be asked to stop taking your birth control for 1 to 3 months so that you can get back onto your natural cycle and hormone levels before embarking on a stimulation cycle. However, if you’re worried that you might get pregnant in that time, it is possible to simply use a blood test to measure something called anti-mullerian hormone (AMH). The results of this test can tell your fertility doctor about your ovarian function. Dr. Ghadir talks about how he approaches this question on Instagram here:
There is a long-standing myth that undergoing fertility treatment inevitably means that you are much more likely to have a multiple pregnancy. While twins and triplets are adorable, multiple pregnancies are much more risky for both mother and babies, and best practice in fertility medicine is to reduce risk as much as possible. Some types of fertility treatment, such as taking the fertility medication Clomid, does come with a higher risk of multiple pregnancies, which your doctor should discuss with you. This risk can be somewhat reduced with careful dosing and monitoring.
In the past, multiples were much more common with IVF treatment. Because the embryo transfer had to happen while the embryos were only a few days old, doctors routinely transferred multiple embryos (often five or six at a time) to increase the chance of a successful implantation.
Modern developments in both techniques and technology mean that we can now grow embryos in the lab for longer and transfer only a single strong, high quality embryo with good chances for success. In some cases, more than one may still be transferred, but only after careful thought and discussion of the risks.
Does freezing my eggs or undergoing IVF deplete my natural supply of eggs? Will I have any left afterwards?
One of the most common myths about fertility preservation and fertility treatment is that it will “use up all your eggs” and make it harder for you to get pregnant later. The answer is no. Here’s why:
Every cycle, your body activates and begins to mature a number of eggs in follicles on your ovary, while many more die off in the process, due to natural cell death.
- When you ovulate naturally, only one (or two, in rare cases) of those eggs will make it all the way to maturity and is released in ovulation. The rest are simply reabsorbed into your body.
- In a stimulated cycle, if you are preparing to retrieve eggs to freeze or to use in IVF, the fertility medications help your body grow more of those eggs to maturity. At the end of the cycle, you are left with the same number of eggs in your body that you would have had if you had never undergone the procedure, plus an additional number of mature eggs in the lab, ready to be frozen or fertilized.
You can hear Dr. Ghadir speak on this subject on Instagram here:
When it comes to your fertility, there’s no such thing as a stupid question. We want everyone to feel empowered to find answers to the questions that come up for them as they consider their options for fertility treatment and preservation. We hope this blog is a valuable and trusted resource for you as you do your own research, but nothing can match the experience of talking directly to an expert, asking your own questions, and getting answers right from the source. If you are worried about your fertility or just planning for the future, attending an in-person event or scheduling a consultation is the best way to find the answers you need.