Infertility: Beyond the diagnosis

Infertility. It’s a devastating and life-altering diagnosis.

Medically speaking, infertility is the inability to conceive after one year of actively trying.

But infertility is much more than that standard definition.

It spoils dreams of parenthood. It affects marriages and other relationships. It often leads to depression and emotional turmoil.

Today, Monday and Tuesday, SheSays examines infertility medically, emotionally and socially. We’ll look at the factors that contribute to infertility, options for treatment and its emotional impact, and share stories of families affected by it.

FARGO - Stefanie Fink will always wonder why it happened to her. Why did she struggle with infertility?

“My family is full of people able to have pregnancies no problem. Even my own family would try to be very supportive and say things like, ‘It will be OK.’ Well, it’s not OK. Or they’ll say there are plenty of options. Well, we know that. Why can’t you understand this is a struggle we’re going through?” Fink says.

After a seven-year journey to conceive daughter Ava, the Moorhead woman says one of the biggest misconceptions people have is that infertility doesn’t happen to them, that it only happens to older women, or people with a family history.

Like many women, Fink was told she had “unexplained infertility,” a maddening diagnosis. She was 29 when she and husband Troy first started trying to conceive a baby.

“It’s almost in desperation that you hope there’s something, to make it easier in your mind,” she says.

After five unsuccessful rounds of artificial insemination and then a non-viable pregnancy through in vitro fertilization, Stefanie became pregnant though IVF in March 2010. Ava, who was born prematurely, is now 17 months old.

“When I look at her, I think she’s an accumulation of our faith, she’s a product of science, but most of all she is just truly a miracle,” Stefanie says.

About 12 percent of American women ages 15 to 44 have impaired ability to have children, according to 2002 statistics from the Centers for Disease Control and Prevention, the most recent available.

Dr. Kristen Cain, a reproductive endocrinologist with Sanford Health, says there has been an increase in infertility. She points to two main reasons: age and weight.

Women are waiting longer to have their first child. The average age of a first-time mom in 2008 was 25.1, compared to 21 in 1970, U.S. Census figures show.

Americans are getting heavier, with two-thirds of U.S. adults overweight or obese, and one-third obese, the CDC says. “With increased weight comes increased ovulatory problems,” Cain says.

In about 40 percent of infertility cases, there is an issue with the woman, Cain says. In 40 percent it is male factor infertility, such as low sperm count, mobility issues or morphology (how the sperm is shaped).

And in 20 percent of cases, both partners contribute to the problem, Cain says.

A variety of factors can cause infertility in women, Cain says. Polycystic ovarian syndrome is the most common cause of irregular menstrual cycles. Scar tissue on the fallopian tubes may result after surgery on the abdomen, from endometriosis, or inflammation of the pelvic area. There can be cervical factors that impede the sperm’s trek to the egg.

And then there’s unexplained infertility. “That’s where we really do all the testing and don’t come up with a reason,” Cain says. “Unexplained infertility can be something that happens at the cellular level, the sperm is not able to enter the egg. It could be something to do with the egg fertilizing but not implanting.”

Age plays a significant role in fertility, because as a woman gets older, the number of eggs she has decreases, and the percentage of eggs that are genetically abnormal increases, says Dr. Randle Corfman, medical director of the Midwest Center for Reproductive Health. He treats infertility patients at clinics across North Dakota, including Essentia Health in Fargo.

At age 30, about one fourth of a woman’s eggs are genetically abnormal, Corfman says. That increases to about half at age 35, and 90 percent at age 40.

A couple, age 28 and with no known problems, has an 18 percent chance of conceiving any given month, Corfman says. This decreases to 14 percent at age 35, to 8 percent at age 40, and to 4 percent at age 42.

Cain says it raises her hackles when couples think age doesn’t matter, pointing to a 40-something or 50-year-old celebrity who just had a baby. The couple doesn’t realize that celebrity probably used donor eggs and other expensive fertility treatments, she says.

“There’s a lot of stuff in the media, movies, TV shows, movie magazines and women’s magazines that give women the idea they have forever,” Cain says.

Traditionally, a man’s age hasn’t been considered a factor. However, Corfman says recent research shows there is an increased likelihood of miscarriage and a higher risk of autism and mental illnesses in the children fathered by a man 43 years of age and older.

“The accumulation of genetic damage with time has a marked impact on the chances of conception for a couple,” Corfman says.

A couple’s age then dictates how aggressive they should be in trying to conceive, Corfman says. While infertility is often defined as one year of trying to conceive without success, couples age 35 and older don’t have that much time to wait.

Corfman presents couples with three options: proceed with conceiving, adoption or not having children. He says about 95 percent of the couples he sees proceed with fertility treatments.

“What we try to attempt to do is just make patients aware of their options and they make the decision which direction they want to go,” he says. “They know their ethics, their financial situation, and their religious beliefs. They’ll make the right decision for themselves.”

Couples seeking fertility treatment typically first go through a fertility work-up, including a detailed history, blood and thyroid tests, semen analysis and ultrasounds, which may take about a month. This will attempt to tease out any specific problems.

Most couples then try oral fertility medication, a common one being Clomid. This is often combined with artificial insemination.

Some doctors may prescribe injectable medications, though the use of these has decreased, Corfman says.

About 60 percent of couples will conceive within several months of doing these sorts of basic measures, Corfman and Cain both say.

The next step is in vitro fertilization, the most expensive and intensive fertility treatment, which involves the harvesting of follicles from the woman’s uterus and combining them with the man’s sperm before implanting the fertilized embryos back into the uterus.

Before trying any fertility treatment, Corfman stresses lifestyle changes to couples, including quitting tobacco use and weight loss.

“We’ve learned when a man or woman’s body mass index gets to be 30 or over, their chance for conception markedly decreases regardless what technology we use,” he says. “By simply tuning up their lifestyle, they can have a major impact on making this dream come true. That’s something we can’t do for them.”

Corfman advised Fink lose “a lot of weight” before proceeding with fertility treatments, she says. She took off 50 pounds in a year.

For Fink, the medical fertility treatments played a toll not just physically, but emotionally and socially.

She says her life began to revolve around numbers: weight, blood pressure, hormones, blood count. She was taking pills up to seven times a day and sometimes shots three times a day.

“There was times when my husband and I couldn’t go to dinner with friends because that’s the time I needed to do my shot which required, perhaps, I had to heat an area 30 minutes before, ice an area 30 minutes after,” Fink says. “There’s a sense of isolation you feel.”

That’s why Fink has made it her mission to reach out to women affected by infertility. She has served as a “fertility buddy” for other patients of Corfman.

“When I can get people open up that are going through it, the thing I want to be able to tell them is you are not alone and every situation is different,” Fink says. “I can be telling you all the positives, and because I had a positive result doesn’t mean you will. … We’re on this journey. We have to have hope that it will work.”

Coming tomorrow

• Read about the emotional aspects of infertility from the perspective of a Fargo therapist who has started an infertility support group and a first-person account of dealing with infertility.

• Coming Tuesday: A look at the financial aspects of infertility.

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