The Truth about Fertility Treatments

Infertility can be heartbreaking for couples who are faced with wrenching decisions about treatment and a variety of emotions ranging from disbelief that something so natural eludes them to depression when friends and siblings conceive easily. Even for couples who are very close, infertility tests a relationship like few other things do. Suddenly, sex is no longer fun, but a tightly scheduled, tense part of the relationship. And it's common for a man and woman to handle the sadness and the disappointment that come with infertility in very different ways, which can further strain a previously tight union.

Infertility also is relatively common, affecting some 7.3 million women and their partners in the United States, or about 12 person of the reproductive-age population, according to the National Survey of Family Growth, CDC 2002, as reported by the American Society of Reproductive Medicine. 

While people tend to think of the inability to conceive as the woman's issue, infertility affects men just as often.

"It's actually about equal between men and women," says Mark Perlowe, MD, medical director of Georgia Reproductive Specialists in Atlanta, Georgia. "About 30 percent of the infertility is due to problems with the man, 30 percent with the woman, and 30 percent with both. And about 10 percent of the time, it's not possible to find what the problem is."

Even if there are no known fertility issues, such as blocked fallopian tubes in the woman or a low sperm count in the man, natural fertility gradually drops off with age.

"For women, there is a gradual drop in fertility starting at age 32," Perlowe says. "At age 38, fertility drops dramatically for women."

Men don't experience the steep drop in fertility that women do, but older men can father babies with problems, says Alice Domar, MD, executive director of the Domar Center for Mind/Body Health and the director of Mind/Body Services at Boston IVF.

"As men age, the miscarriage rates go up for their partners and also for things like autism and mental health issues in the babies," Domar says. "So older men may be able to get women pregnant, but the babies may not be as healthy."

What You Should Know

The good news is that the infertility treatments are helping more couples today than ever before. Here's what you need to know.

1. Infertility testing is necessary for both the man and the woman. Years ago, infertility was thought to be the woman's problem, but today it's well documented that the guy can have problems, too. "So both have to be tested," Domar says. "And that's even if the husband has kids from his first marriage and they had a baby two years ago." Sperm counts fluctuate, she says, and men can suddenly stop producing normal sperm.

2. In Vitro Fertilization (IVF) has been around for years, but success rates get better and better. In fact, the best programs boast a success rate of 50% in younger patients, says Matthew Cohen, MD, director of reproductive endocrinology at Long Island Jewish Medical Center. "Unfortunately, as the woman gets older, the success rates start to dwindle," Cohen says. "B age 40 or 41, the IVF success rate is around 20 percent at best."

3. Consider freezing your eggs. In the past three years, this technique has become much improved, says Cohen. Now if a woman is, say, in her mid or late 30s and not ready to have a baby yet, she can consider freezing her eggs. "Then when she meets the right guy 10 years later, it's not too late to have a baby," Cohen says.  

4. Help for male infertility has progressed, too. "When a man's sperm are mildly abnormal, we can wash and concentrate the best sperm and then place them in the uterus," Cohen explains. "In severe cases, this will be combined with IVF."

5. Consider counseling. Often couples get so caught up in the treatments that they can have trouble connecting with each other. It can be helpful to have someone to talk with - a trained professional, or a trusted friend who can act as a sounding board. "Infertility can bring couples closer," Perlowe says. "If you can survive fertility treatments together, you can survive just about anything."

Couples going through secondary infertility (they have one child already but can't seem to conceive again) should not lose sight of the fact that they already have a family, Perlowe advises. "It's important for them to celebrate being a family together," he says.


American Society of Reproductive Medicine: Quick Facts about Infertility