Depending on your age, infertility may or may not be a regular discussion topic, but for about one in every eight couples, it is a major source of discussion and concern. Resolve: The National Infertility Association` says that number equates to about 7.3 million people in the United States who are suffering from this disease.
`It’s really 40-40,` said Gina Cella of Cella Communications, representing Resolve. She said infertility is 40 percent women’s issues, 40 percent men’s issues, 10 percent a combined factor, and the remaining 10 percent are simply unexplained factors.
`Most couples look at this as the couple’s burden,` said Dr. Michael Grossman of CNY Fertility Center in Latham. `They don’t look at it to assign blame. It is their shared struggle.`
Grossman said that anywhere from 15 percent to 20 percent of couples will have infertility difficulties.
While the medical definition of infertility is the inability to become pregnant after one year of unprotected sex, it isn’t necessarily the definition doctors always use, and couples shouldn’t adhere to it as the golden rule either.
`The right time to start investigating is when the couple is concerned,` said Grossman. `For some couples, it’s six to eight years, and for other couples, it is two months.`
Both Grossman and Cella suggest that if the couple has not been successful in six months of trying to conceive naturally, there may be a cause for concern.
`A lot of people wait too long,` said Cella. `Age is a big factor in infertility.`
As women age, their ovaries age, making it more difficult to get pregnant, said Grossman. In addition to age, there are several other reasons why women ` and men ` might seek out a specialist earlier rather than later.
Grossman said women with irregular menstrual periods and those who are likely to suffer from scar tissue as a result of abdominal operations or infections would be wise to seek out an expert opinion early in the process. Additionally, men who have been recent users of anabolic steroids should seek out medical advice.
Finding a doctor to guide them through the process of conception is not a difficult task. Grossman said many women may find that their regular gynecologist may be well suited to treat infertility issues. The three factors he said couples should consider when choosing a doctor related to their fertility are the patient’s preference; the gynecologist’s familiarity with fertility issues; and the time available within the practice.
`A lot of evaluations, testing and even treatment can be done with a general gynecologist,` said Grossman.
If patients are comfortable with their own doctor, they may opt to stay working with them. However, some patients feel better working with a doctor who is considered an expert in the field of infertility.
While the patient may feel confident with their gynecologists, Grossman said the gynecologist may opt to refer the patient to another doctor. He said some are not familiar with the necessary workups or might have other areas of special interest and knowledge.
`A general gynecologist can do a lot of things and help in a lot of ways for a lot of people,` said Grossman.
He said that infertility issues are emotionally demanding, adding, `It takes a lot of time to treat patients with the compassion they deserve. It is hard to do that in a regular GYN setting.`
Grossman noted that much of the fertility-related work must be done on short notice, which may not fit in well with the rest of the practice.
Treatment options differ significantly from patient to patient and encompass a wide range of choices. When people hear about infertility, many associate it with in-vitro fertilization, in which an egg and sperm are taken from each partner and placed together in a dish. The insemination may happen on its own or be assisted by medical personnel. Either way, it is not the only option available to couples. Other medical treatments include prescriptions for pills or an injection, which increases the woman’s ability to ovulate. Intrauterine insemination places pre-collected sperm directly into the woman’s uterus during ovulation.
Although these procedures have all been successful in creating fetuses, they are not the only options available to couples struggling with infertility.
`There are a number of options available in treatment,` said Cella. `Some couples may choose to adopt, be child-free or go with other methods of treatment.`
`My motto and guiding principle is that I want to give people the information they need to make the right decisions for themselves,` said Grossman. CNY’s Web site does list other, non-medical options for its patients.
`Persistence is the key,` said Grossman, noting it often takes several cycles of treatment before pregnancy occurs. `There are options available that can help most couples most of the time. Treatment is more successful today than it’s been in the past.`
Medical treatments are typically tailored to address the patient’s age as well as why they might be having difficulties conceiving. Treatments are expensive and insurance coverage is not consistent. Resolve lists New York as one of 15 states that has passed laws requiring that insurance policies cover some level of infertility treatment.
`Overall, having insurance coverage for infertility diagnosis and therapy is a good thing,` said Grossman.
He said some companies do require patients to `jump through hoops,` which does not always seem to follow the most logical and least aggressive method of treatment. It does increase the number of couples who can consider medical treatment an option; however, coverage does vary from carrier to carrier.
SIDEBAR: Coping with the emotional side of infertility
By JENNIFER FARNSWORTH, Contributing Writer
`Tell your friends you will be back.`
That is what my friend’s doctor advised her after three years of unsuccessful fertility treatments. The `you` her doctor was referring to was the fun-loving girl whom I shared a room with in college. Treatments had made her a different person, and nothing I could say or do seemed to really ease the fact that she was not having success with conception.
For her, as with many women struggling with infertility, the emotional journey takes it toll.
The good news is that professionals can help with those emotions when friends and family cannot.
In addition to understanding the physical battle with infertility, understanding the emotional toll that it can take can be daunting, but professionals know that learning about what it can do to a person emotionally is just as important as understanding the physical aspects. Today, men and woman turn to therapy, group support systems and holistic medicine.
`It is the patient’s state of emotional health that can be a large factor working against them. When your body is in a state of stress — physical or emotional — different hormones and chemicals are released into the body which aren’t ideal for achieving a pregnancy,` said Larine Restive, embryologist and coordinator for Central New York Healing Arts in Latham.
CNY Fertility Center in Latham, and its partner CNY Healing Arts, work together to connect the physical and emotional aspects of fertility. They offer five programs and services to men and women that strive to meet the needs of their patients.
Dr. Robert Kiltz, the founder and director of CNY, said the center embraces a theory of integrative holistic infertility care, which takes care of the patient’s whole condition, not just the physical symptoms. Maintaining a balance of mind, body and spirit helps patients become parents, said Kiltz.
The Circle of Hope support group meets monthly, and meetings often include guest speakers who educate patients on the benefits of certain therapy options. The topics discussed include yoga, acupuncture, adoption and miscarriages. Another program is Fertile Friends One-on-One Support, which matches up two patients who have similar personalities. The pairs write in journals, attend counseling and most important, form a bond of friendship. For many people, connecting with someone who is going through the same experience is an invaluable comfort, according to Restive.
`Patients are encouraged to e-mail, call or meet their ‘fertile friend.’ We created this program because not all patients are as comfortable discussing delicate subjects in a forum,` said Restive.
Rebecca Rice, an acupuncturist at the Center for Integrated Health and Healing in Delmar and at One Roof in Saratoga Springs, said acupuncture has grown in popularity over the past few years. She said that while stress does not cause infertility, infertility most definitely causes stress. Rice said many people fear the needle use of acupuncture.
`Most women and men experiencing infertility will have some sort of emotional distress. Acupuncture can treat not only the cause of infertility, in many cases, it can also address the associated symptoms of stress, depression and anxiety,` said Rice.
Resolve: The National Infertility Association teaches people to stop feeling panicked about the fact that they are panicked. The group urges patients to build a bridge back to family by having family members educate themselves on the patient’s condition. Resolve believes that this will allow for a less isolated feeling. The group also gives physicians guidelines to give to their patients on allowing themselves to feel angry without burying those feelings.
`Depending on the counselor, patients may receive helpful tools to better deal with emotions that linger and become toxic,` said Rice.
Another option is message boards. Both Resolve and the CNY Healing Arts clinic offer online message boards. At CNY, the Fertile Friends message board is a program where patients post messages about a multitude of topics about infertility. Patients discuss what has worked for them and what has not, and how to get through tough times, especially holidays.
`Holidays can be stressful when pressure comes from both the inside and out. The same goes for when you feel as if all of those around you are having babies. It’s just a reminder that you are not,` said Theresa Cole, a patient of CNY.
Most counseling information says to allow yourself to cry and be angry and to remember that everyone copes differently. The physicians and counselors hope that the coping mechanisms available can help to ease some of the emotional stress.
My friend, now mom to 10-month-old Cecelia, did `come back,` when she was ready, and, of course, her friends and family were there.
For more information visit www.resolve.org, www.cny.healingarts.com or call the Center for Integrative Health and Healing at 689-2244. “