Affecting about 15 percent of American couples, infertility has received a deluge of publicity due, in part, to significant technological advances. On the flipside, there’s also been the hype and controversy from tabloids and reality TV.
For his part, Dr. John Orris wants to make sure people know the facts.
“One of the biggest [myths] I hear is: ‘If I take fertility medication, I will definitely get pregnant and I will definitely have multiples,’” says Orris, who is a reproductive endocrinology specialist at Main Line Fertility, with offices in Bryn Mawr, Paoli and West Chester.
Hardly a stranger to the rumors and misconceptions surrounding his chosen field, Orris points out that it’s anything but a quick and easy fix. He diagnoses and treats a complex range of conditions in both males and females. Their difficulty conceiving may be the result of more common conditions like low sperm count and motility or prior surgeries. More complex problems include endometriosis, polycystic ovarian syndrome and ovulatary dysfunction.
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In medical technology’s ever-changing landscape, Main Line Fertility is staying ahead of the curve with its participation in international studies.
“We’re examining the follicular fluid released by embryos during incubation in the laboratory, and looking for specific protein biomarkers that will help us determine the quality of the embryos,” says Eileen Davies, Main Line Fertility’s research coordinator. “A lot of people think we try to transfer three or four or five embryos, but we really only want one healthy pregnancy.”
With treatment, success rates in healthy female patients under 35 can be as high as 65 percent. But it’s hardly a one-size-fits-all process. Since a woman has only a 25 percent chance of conceiving each month, pharmaceutical interventions are often be the first step. By stimulating the release of more eggs per cycle, the likelihood of conception increases.
Upping the efficacy of the treatment process, in vitro fertilization and intracytoplasmic sperm injection have both made significant advances in the last five to 10 years. The lesser-known procedure of the two, ICSI deposits sperm directly into an egg, rather than waiting for the two to “meet up and do the dance,” Orris says.
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Both practices allow physicians to make a pre-implantation genetic diagnosis by combining one sperm and one egg to create an embryo, which is then biopsied to test for the correct chromosomal makeup and a variety of genetic diseases. That’s great news for recessive gene carriers from ethnic groups prone to disorders like sickle-cell anemia, cystic fibrosis and Tay-Sachs disease.
Meanwhile, breakthrough techniques for culturing embryos allow scientists to maintain specimens in vitro for five days rather than three. By waiting an extra 48 hours before implantation, embryos reach the blastocyst stage, the optimal condition for implantation in the uterus. And since their viability has already been established, fewer are transferred, decreasing the chance of multiple gestations.
By the time an embryo reaches the blastocyte stage, the cells have typically formed into two distinct entities: the inner cell mass and the early placenta. An early placental biopsy poses less collateral damage to the embryo than the same procedure done prior to division. It also provides enough data to assess the risk of anatomical, physiological or genetic conditions that would result in a failed attempt to conceive or birth defects—a real boon for women over 40, who could face a one-in-25 chance of having a child with a chromosomal abnormality.
“Say you’re 42 and you’re thinking about having kids, you can, for the most part, avoid that heartache by presenting the option to identify normal embryos,” says Orris. “Even if it turns out that there are no normal embryos to be had, you can come to closure with that and look to adoption or egg donation.”
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Since age is a major factor in the success of fertility treatments, Orris recommends egg freezing. “Embryos freeze quite well, but not every woman has a significant other, or they may be uninvolved in getting pregnant at one time or another due to any number of factors,” he says. “We know that nothing is 100-percent guaranteed in life. But this way, a woman can have a little part of themselves frozen in case they decide they’re ready to have children at a later time.”
Though a diagnosis of infertility is typically reached after a year’s worth of failed attempts, Orris recommends bypassing the waiting game and getting educated on your reproductive health right away. “Our goal is to identify any obstacles and address them in a prompt fashion to maximize success, so that a person doesn’t get discouraged or depressed, or lose their marriage, or give up hope,” he says. “That year does a lot of damage, and anyone owes it to themselves to be proactive and evaluate their options, instead of wasting their time before embarking on their quest to get pregnant.”
For more, visit mainlinefertility.com.
See “Fertility by the Numbers” on page 5 …
Fertility by the Numbers
Stats worth noting from the American Society for Reproductive Medicine (asrm.org).
• 12% of men and women under 45 are affected by infertility
• 25% have more than one thing contributing to infertility
• 40% are cases in which the man is at least the partial cause of infertility
• 25% of all female infertility problems involve irregular or abnormal ovulation
• 12% of all female infertility problems involve weight issues
• (Up to)13% of all infertility problems involve smoking