8 things every woman needs to know about her fertility

There are few things more heartbreaking than trying to conceive and can’t. However, fertility is not always in our control. An estimated 7.3 million Americans, or 12 percent of the population in their reproductive years, are infertile, according to the Centers for Disease Control and Prevention (CDC).

To make the challenge of conceiving more complicated, fertility misinformation can become a major stumbling block, especially with celebrities enabling impressions that it’s easy to pregnant later in life.

Thanks to today’s medical advancements, there are reasons to be hopeful. HCA Healthcare affiliated caregivers from Houston to the United Kingdom are helping couples get pregnant and sustain a pregnancy while walking them through the journey to parenthood.

“It’s nobody’s first choice to have to go to a fertility clinic for treatment,” Mary-Anne Singh, a counselor at HCA Healthcare UK’s Lister Fertility Clinic, said on the Health: Fact vs. Fiction podcast. “They might feel some sadness around that; some loss about not being able to do this naturally – that they need to get the help. Giving them a chance to talk about that loss, whatever it may be, whether they can’t use their sperm or their eggs, is a very important part.”

If this is your story, know that you are not alone. One in eight couples have trouble making a baby.  Fertility Specialist Alexa Clapp, MD, who practices at Houston Fertility Institute with a location at the affiliate The Woman’s Hospital of Texas in Houston, says the biggest step for patients is to make that first consult appointment.

Fertility Specialist, Alexa Clapp, MD

“Patients are nervous or overwhelmed by the fertility treatment process,” she said. “Whatever fertility treatment route they decide to take, we interact with them very closely throughout the process. That’s what I love about this field the most – the patient interaction and sharing in their successes. It’s extremely rewarding.”

We asked Dr. Clapp to answer some of our pressing fertility questions. She weighs in with eight things every woman should know about her fertility.

1. How long should a couple try to conceive naturally before questioning their fertility?

Infertility is defined as someone who is under 35 years old and is unable to conceive after one year. If a woman is older than 35 years old, then the recommendation is to seek evaluation if not pregnant after trying for six months.  There are also other conditions when someone would not wait the six months or a year. For instance:  women who have irregular menstrual cycles. That may mean they’re not releasing an egg (ovulating) every month. A woman needs to release an egg in order to get pregnant on her own. In that situation, one should see their general OB-GYN or a specialist earlier than the time frame mentioned above

2. Is age the only risk factor to infertility?

Age is an important risk factor for infertility because women can’t make new eggs. We are born with the number of eggs we have, and, as we get older, the number of eggs decline and the quality of our eggs is affected.  However, there are other reasons couples may have infertility, and an evaluation helps determine the specific reason.

Blocked Fallopian tubes: risk factors would include previous pelvic infections, previous pelvic surgeries, or endometriosis

Low sperm count or sperm motility

Uterine factor: for instance, a leiomyoma or fibroid in the cavity.

3. How is infertility diagnosed?

Infertility specialists check every structure involved in fertility, starting with an individual’s menstrual cycle history. There’s usually a workup process that involves:

• Determining whether a patient is regularly releasing an egg (ovulating). Specialists can learn this through a patient’s history and a blood test. Women with Polycystic Ovary Syndrome (PCOS) commonly have issues ovulating.
• Looking at the ovarian reserve – an estimated egg count: determined by follicle count through an ultrasound of the ovary and also hormone testing (follicle stimulating hormone and anti-Müllerian hormone) in the blood.
• Ensuring the fallopian tubes are open by a diagnostic test.
• Checking the uterus by ultrasound. For instance, if fibroids are found, further evaluation may be required.
• Lastly, as part of the workup process, examining semen to determine sperm count, motility, and shape.

We want people to get pregnant but we also want them to have a healthy pregnancy. All of the prenatal labs individuals would normally have done at their first OB visit, fertility specialists also perform ahead of time.

4. One of the treatment options that many women turn to is in vitro-fertilization (IVF). What is IVF?

An individual releases one egg when ovulating on her own. Through IVF, a patient’s ovaries are stimulated to grow more than one follicle and inside those follicles are eggs. The eggs are extracted outside of the body and are then placed or injected with the partner’s or donor’s sperm. The egg becomes an embryo when it is fertilized with sperm, and the embryos are then cultured in the lab for 5-6 days and then transferred back into the uterus.

5. How many cycles of IVF are too many?

That depends on the couple, the reason for the infertility issues, and how previous cycles have gone. Some patients have to do more than one cycle in order to achieve success. Some patients are lucky and are able to do one cycle. It’s a case-by-case basis for each patient.

6. What is the success rate of IVF?

The first successful in vitro fertilization procedure occurred in 1978. That baby celebrated her 40th birthday last year. Since then, there have been millions of children born to IVF.  Overall our success rates have increased since the very first IVF baby.  The success rate depends on the couple’s reason for infertility and a woman’s age.

7. What are some of the risks of IVF?

Overall, the risks are minimal. During the time of stimulation, the patient’s ovaries become enlarged and estrogen becomes elevated. Patients may feel bloated towards the end of stimulation. Typically, individuals are able to continue to work throughout the process.

People will also talk about the fear of multiples and higher order multiples (twins, triplets, etc) after fertility treatment.  However, the number of embryos placed back in the uterus during IVF has decreased and usually now only one embryo is transferred at a time.  Thus, the rates of multiples and higher order multiples have decreased.

More specific risks may be related to a patient’s medical history and your physician can review these risks with you.

8. What is the most common statement you hear from patients?

“I wish I would’ve come sooner.”

If you or a loved one have questions, would like to know more about fertility or the process, talk to your general OB-GYN or a reproductive endocrinology and infertility specialist to help you navigate the process.

Dr. Alexa Clapp is a reproductive endocrinologist and fertility specialist with Houston Fertility Institute with a location at The Woman’s Hospital of Texas, part of HCA Houston Healthcare.  Mary-Anne Singh is a counselor at the Lister Fertility Clinic, a member of HCA Healthcare UK, the international arm of HCA Healthcare.