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Ask Stanford Med: Expert in reproductive medicine responds to questions on infertility

Ask Stanford Med: Expert in reproductive medicine responds to questions on infertility

couple sitting2Infertility is a reality faced by 10 to 15 percent of U.S. couples. For some, the topic is emotionally charged. And while many may have questions related to reproductive endocrinology, research and treatment options may not be favorite table topics for a night out with friends. So for this edition of Ask Stanford Med, we’ve asked Valerie Baker, MD, the division chief of reproductive endocrinology and infertility and director of Stanford’s Program for Primary Ovarian Insufficiency, to respond to such questions about infertility. Her answers appear below.

@giasison asks: Can you name the 3 top causes of #infertility in your current practice?

Age-related decline in fertility (particularly decline in egg quantity and egg quality with age), sperm problems, and lack of ovulation.

Charmaine asks: Is it true that infertility could be a side effect of vaccination? Why?

No, vaccinations do not cause infertility.

Michelle asks: How have treatments for infertility evolved over the last 10 years? And what might treatments look like 10 years from now?

The biggest advance since the mid-90s has been our ability to help couples with extremely poor sperm quality to conceive. I hope that 10 years from now we will have treatments that help couples where a woman is suffering from premature loss of her egg supply to conceive with her own eggs. Right now, the main choice for women with extremely low egg supply and low egg quality is oocyte donation, where the egg comes from a donor.

Shabba92 asks: What are the most common treatments in your clinic? What percentage of patients wind up undergoing IVF?

The most common treatments are intrauterine insemination (IUI) and in vitro fertilization (IVF). We also do ovulation induction for women who are not ovulating on their own and surgery if needed to correct certain problems. Many couples are able to conceive with simpler treatments and do not need IVF. Fewer than half need IVF.

Eloise asks: As many people are waiting longer to begin having children, is there an age at which you’d recommend a woman should freeze her eggs? And if she’s more susceptible to infertility due to Polycystic Ovarian Syndrome or another form of ovarian insufficiency, would that number change? Thank you.

It is difficult to give a specific age, as some women may have premature loss of eggs at a young age, while others maintain a good egg supply for a longer time. However, in general, it could be reasonable to consider egg freezing if there is no likelihood of becoming a parent by age 35. If a woman can freeze eggs earlier in life, they will be of even better quality than if she waits until she is in her 30s. But if women freeze eggs at a young age, they may never need to use them. Women with polycystic ovarian syndrome seem to maintain their egg supply later in life. There can still be a problem with egg quality for women in their late 30s and early 40s with polycystic ovarian syndrome. But the supply of eggs seems to remain good. On the other hand, if a woman is at risk of primary ovarian insufficiency (also called premature ovarian failure), she may want to freeze eggs at a much younger age. It is possible to get an idea about egg supply by doing a blood test (for the hormones AMH, FSH, and estradiol) as well as by ultrasound to examine the antral follicle count (counting the number of the tiny sacs of fluid in the ovary that contain microscopic eggs).

Scope Editor asks: At what point do you advise women who are having difficulty getting pregnant to consider seeing a specialist? And for those women, can you walk us through the initial appointment with a fertility expert? What typically happens?

In general, if a woman is 35 or over, it is reasonable to see a physician if there is no pregnancy after about six months of not using contraception. For younger women, it is reasonable to wait 12 months before seeking an evaluation. If a couple knows that there may be a reason that they will have difficulty conceiving (e.g. if a woman has irregular menstrual cycles and is not ovulating), an evaluation can be initiated whenever the couple is ready to conceive. The first visit can be with a fertility specialist or a gynecologist. At the first visit, relevant medical history for both the man and the woman (for heterosexual couples) is reviewed. Couples are given guidance regarding lifestyle changes that may  improve fertility such as weight loss (if obesity is present) and smoking cessation (if the man or woman smokes). A specialist is likely to perform an ultrasound at the first visit to examine the uterus and ovaries. The recommended testing will vary depending on the particular couple, but will  typically include a semen analysis, a blood test to assess egg supply (ovarian reserve) and some other hormones, and an evaluation of the fallopian tubes to make sure that there is not a tubal blockage preventing  the egg and sperm from meeting. At a visit with a fertility specialist, it would now be common for a couple to also be offered preconception genetic carrier screening to determine if the couple would be at risk of having a child with a known serious genetic disorder.

Previously: Ask Stanford Med: Expert in reproductive medicine taking questions on infertilityResearchers describe procedure that induces egg growth in infertile womenOh, baby! Infertile woman gives birth through Stanford-developed technique, Quitting smoking for the baby you plan to have together and Sex without babies, and vice versa: Stanford panel explores issues surrounding reproductive technologies
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