Rosanna Turner
newsroom@vaildaily.com
VAIL CO, Colorado

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March 18, 2013
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Vail Daily health story: Understanding fertility

When a woman reaches her 30s, the awareness of her biological clock can go from a small ticking whisper to a full-blown alarm bell. With so much confusing and conflicting information about fertility, it can be easy for 30-something women to feel worried about getting pregnant. Dr. Keith P. Samuels, obstetrician and gynecologist at Colorado Mountain Medical, said that having concerns about one's fertility is a normal response to aging.

"It's a natural thought process to worry as you get older (about) your chances of infertility," Samuels said.

But knowledge can also help assuage one's fears in regards to both fertility and infertility. We asked Samuels to answer some frequently-asked questions women and couples have about fertility, to help us to better understand how fertility works and the options available to women over the age of 30 who want to have children, but haven't yet.

When does fertility decline?

A woman's fertility rates do change in their 30s and 40s. According to the American Society for Reproductive Medicine, a 30-year old woman has a 20 percent chance of getting pregnant per menstrual cycle, while a 40-year old woman has a 5 percent chance. Since starting his practice 20 years ago, Samuels said now more women are waiting longer to get pregnant. Statistically it's harder for women to get pregnant after the age of 35, and Samuels said your fertility rates drop each year.

"There is not a specific age that it becomes more difficult to conceive," Samuels said. "Fertility declines as you get older and with each year a woman's ovarian function deteriorates. This is a very normal function of aging."

Is there a way to test for infertility?

Measuring your fertility is not as simple as taking your temperature. There are a number of factors that can affect fertility, such as not having regular periods or ovulating regularly, tubal damage in the ovaries, smoking or alcohol issues, and other serious medical issues that can contribute to infertility, such as endometriosis. In addition to these, Samuels said sometimes the cause of infertility is unknown.

"A lot of things that decrease fertility can be identified or treated," Samuels said. "Once a patient undergoes a (fertility) workup and nothing is identified, it's unexplained."

Typically women are considered infertile after trying to get pregnant without using birth control for one year. Men can also be a factor in infertility. There are many medical conditions, as well as unexplained issues, that can contribute to a couple's inability to conceive.

Dr. Samuels said if a woman is under the age of 35, it is not usually recommended for her to undergo fertility testing before that one-year mark if there are no obvious factors that suggest infertility. If a woman has concerns or specific circumstances, fertility testing could be pursued earlier.

"Initially, the most important test is attempting to get pregnant," Samuels said. "We wouldn't necessarily want a woman to go through costly and time consuming tests prior to trying to conceive. Of course, at any time, a woman can discuss (fertility testing) with her physician (if she wishes to do so)."

How common is In Vitro Fertilization?

There are a number of assisted reproductive technologies (ARTs) available to aid in conception. According to the Centers for Disease Control and Prevention, ART procedures involve surgically removing eggs from a woman's ovaries, combining them with sperm in the laboratory, and returning them to the woman's body or donating them to another woman. There are three types of ART: in vitro fertilization (IVF), intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT).

According to the CDC, 147,260 ART cycles were performed in 2010, resulting in 47,090 live birth deliveries and 61,564 infants (some deliveries produced multiple babies). The use of ART has doubled over the last decade, and now one percent of all infants born in the U.S. every year were conceived via ART.

Dr. Samuels said in vitro-fertilization is a procedure couples usually consider only after more conservative methods have failed. Not all couples who are given the option of IVF decide to go through with the procedure, and money can definitely be a concern, as most insurance plans do not cover these types of fertility treatments.

Should women freeze their eggs before it's too late?

Freezing a woman's eggs refers to two different types of procedures. The first is embryo cryopreservation, in which a woman undergoes IVF to stimulate egg growth. Then the eggs are removed, joined with sperm in a laboratory to produce an embryo, and then frozen. Embryo cryopreservation is sometimes done for young women with cancer, as chemotherapy and radiation treatments can increase one's chances of infertility. The second type is oocyte cryopreservation, in which the eggs are not fertilized before frozen. Women must take medication to produce more eggs for freezing and the average cost of each cycle can range from 6,500 to 15,000 dollars.

This past October the American Society for Reproductive Medicine deemed egg freezing no longer "experimental," causing speculation as to whether the procedure would now become commonplace for women. Samuels said the procedure has become more common in the past 10 years, but it's only one of many options women have in regards to aiding in fertility.

"Unless there are extenuating circumstances with the potential loss of fertility, such as certain surgical procedures or chemotherapy, which may render a woman infertile, harvesting and freezing embryos do have some risk," Samuels said. "Some women, though, do feel more compelled to consider this option as they approach a certain age for many reasons."

When they reach their 30s, should women worry about their fertility?

Once identifiable factors affecting fertility are treated or ruled out, there is no guarantee that a woman, regardless of age, can get pregnant.

Samuels said it's often hard for women to talk about infertility issues.

"A patient may have a friend who is able to have children, and for them it's not as easy," Samuels said. "They put pressure on themselves, feeling like they failed in some way, even though they can't cause themselves to be infertile. This can be a very difficult subject for couples to discuss."

However, Samuels thinks it's important for couples to be informed about their options for conceiving a child, and to not focus solely on negative-sounding reports or statistics.

"Through the many forms of ever-evolving assisted reproductive technologies available, there is still hope that we can help (a couple) achieve their goal of having a family," Samuels said.

While worrying may be their first response, a better approach for women and couples might be to seek out answers before their fears about infertility overwhelm them. Getting pregnant can happen by accident, but learning about how fertility works can help us see that, yes, bringing a child into the world is indeed a miracle, but there's also a lot of science and research behind it too.

For more information about fertility, visit www.asrm.org or www.reproductivefacts.org.


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The VailDaily Updated Mar 18, 2013 04:55PM Published Mar 18, 2013 04:53PM Copyright 2013 The VailDaily. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.