By Annie Rosemurgy
Similar to many health issues, infertility is something we don’t typically think about unless we’re thinking about trying to get pregnant, actively attempting to get pregnant — or haven’t been able to conceive. But it’s amazing how common fertility issues are for women. According to the American College of Obstetricians and Gynecologists (ACOG), infertility affects up to 15% of couples.
WHAT IS INFERTILITY
Infertility is defined as the failure to get pregnant within 12 months of unprotected intercourse or donor insemination in women younger than 35 years, or within six months in women older than 35 years.
This issue has many underlying causes, including hormonal insufficiencies, low egg or sperm counts, or anatomical variables that block the egg and sperm from meeting in the first place.
The leading cause of infertility in the U.S. stems not from the aforementioned medical issues, but because women are delaying having children for personal, educational or professional reasons. That’s because “cycle fecundity,” or the chance that a woman will get pregnant during a single month, begins to drop off precipitously around age 35.
Dr. Bala Bhagavath, infertility medical director at UW Health Generations Fertility Clinic, notes that’s why the ACOG changed their definition of infertility in women over 35. (Previously it was 12 months for all women).
“More recently that definition has changed to six months in women over 35, because if you wait a year, you might be losing precious time to intervene,” says Dr. Bhagavath.
In general, infertility treatments seek to address the underlying issue, says Dr. Bhagavath. The ovaries can be stimulated with medications to improve the chances of pregnancy. Anatomical and structural concerns of the fallopian tubes or uterus may be addressed through surgery. To increase the possibility of conception, intrauterine insemination is another option, in which sperm is inserted directly into the uterus through a catheter (IUI), increasing the likelihood that sperm and egg will meet. All of these “lower tech” interventions are successful 30-40% of the time, says Dr. Bhagavath.
When these lower-tech measures prove inadequate over the course of three or four menstrual cycles, in vitro fertilization (IVF) is the gold standard. IVF involves a woman giving herself injections of hormones at home for 10 to 30 days (depending on the protocol used) to stimulate ovulation. Then, her ova (eggs) are harvested, fertilized in a laboratory and implanted in her uterus. “IVF is a remarkable tool against infertility. It’s a beautiful example of technology meeting a human need,” says Dr. Bhagavath.
However, he says, it’s important for people to educate themselves on the realities of IVF treatment. Success for younger women is higher than for women over 35 and the cycles of injections and ova harvestings can be emotionally and physically exhausting. Costs are a big consideration — 17 states mandate insurance coverage for fertility treatments but Wisconsin does not — and many private employers do not include it in benefits packages. While costs are variable, a single round of IVF averages $12,000.
Soon after their wedding, Emilee Markiewicz and her husband, Jared, tried to start their family, but things did not go according to plan.
“I just never got pregnant. I have friends who’ve had repeat miscarriages, but that wasn’t my case. I was never able to get pregnant in the first place,” explains Emilee.
The couple began to search for answers to their infertility puzzle, but little did they know how long and arduous their journey would be.
After a thorough medical workup on both Emilee and Jared, there was no apparent cause for the couple’s infertility. Emilee’s doctor suggested they start with the lower-tech, lower-cost approach of IUI first. However, after eight rounds of treatment, the couple still was not pregnant, and the failed attempts began to take an emotional toll.
“The hardest part of IUI was the waiting, counting days till we could try again,” Emilee says.
As the reality sunk in that IUI was not going to be a simple fix, the couple did not hesitate to begin the process of IVF.
“It was intimidating to think about all the costs, but we felt strongly like it was our best bet for having a successful outcome,” says Emilee.
Initially, IVF treatment went smoothly. After her first IVF round and egg harvesting, Emilee was elated to hear she had produced abundant ova, which were fertilized and sent to the lab for genetic analysis. Her happiness was short-lived — just days later she got the call that only two embryos were viable in the group. One of the embryos was implanted, but did not result in pregnancy.
Emilee recalls the heavy emotions surrounding her second round of IVF.
“I was exhausted emotionally, and the recovery after the second retrieval was much worse,” she says.
A second round of successful harvesting resulted in many ova — but only one of the fertilized embryos was viable.
The couple decided to play the odds the second round by implanting both of the viable embryos they had left. Emilee recalls the moment of staring at the positive pregnancy test in disbelief, then promptly taking three more tests to confirm the happy result.
“I couldn’t believe it — I’d never seen a positive [test]!” she says.
These days Emilee experiences exhaustion of a different kind — that of parenting busy five-year-old twins Brynn and Natalie.
“It was such a long journey but it feels long ago now, I almost forget the struggles.”