Macaroni Kid: Ask the Expert

By Mark Payson, MD at CCRM Northern Virginia (contributed article) July 25, 2018

1. When a couple is experiencing difficulty getting pregnant, when would you recommend they seek professional help?

Technically, infertility is defined as one year of attempting pregnancy without success, but that is the longest amount of time someone should wait. There are many reasons to seek help early, if there is any reason to already suspect a problem such as a failure to ovulate manifest as irregular menstrual cycles, a history of pelvic infection, or a surgery that could have damaged the fallopian tubes. For women 35 years and older, whose fertility is already declining, it is prudent not to wait more than 6 months before seeking help.

2. How do you best select a fertility clinic? Is there anything in particular people should look for?

The success of a clinic is based on the experience and care of the physicians and clinical team, as well as the quality of the laboratory that will handle the eggs, sperm, and embryos. It is important to assess both of these aspects. But you should also look for a place where you are treated as an individual, and receive attention for your specific personal circumstances. At CCRM, myself and all of our physicians partner with each individual patient to develop custom-tailored analyses and treatments to help ensure the best outcome possible. I would recommend reading the bios of the physicians, ensure they are board certified, as well as look for online reviews if available (but always take those with a grain of salt, and base it on the general consensus, not a single review).

The success rates of clinics are also published online by SART; however, it’s best to pay most attention to the success rates when transferring a single genetically normal embryo. A good clinic should have at least a 50% live birth rate in that situation, and the best clinics will have a 60-70% success.

3. Is infertility more common in women? What sort of treatments are available for men and women struggling with infertility?

Despite the attention paid to female infertility, the cause of infertility is equally as likely to be the male as the female. Therefore it is critical that both men and women undergo testing and evaluation. Fertility treatments have advanced greatly over the past decade, and there are many options. The first step is to undergo some simple diagnostic steps to determine the cause of infertility. Depending on the cause of infertility, treatments may include medications to induce ovulation, intrauterine inseminations, or in vitro fertilization where eggs and sperm are combined in the laboratory to make an embryo, and then the embryo is placed back into the woman.

4. How common is infertility after a successful pregnancy? What tips would you give to couples facing secondary infertility?

Some women who have had one child successfully have trouble having a second one. This may simply be that time has passed and as we age it is harder to get pregnant, or perhaps there has been a change in fertility of one of the partners. Couples having trouble conceiving their second child should be evaluated the same way someone who has never had a child is, and should not wait a long time before seeking out that evaluation.

5. For same-sex couples, can you walk us through what the process is like when deciding to have a baby?

Same-sex couples have the advantage of already knowing right away they will need some outside assistance, so it is often an easier adjustment to deal with the process. However, they still require a basic fertility assessment to determine which procedures will be the most effective. For female couples, the process will involve selecting donor sperm and performing IUIs. Sometimes IVF is used if indicated by fertility testing or if the couple wishes to have one partner carry the child from the egg of the other “reciprocal IVF.” For male couples, it will require selecting both an egg donor and a gestational carrier. Your fertility clinic will be able to help you with this process. But it is important to be with a clinic that has experience with LGBTQ parenting and is supportive of the process, like CCRM.

6. Are there any lifestyle changes that women or men can make to help boost their fertility?

I generally tell patients the question is actually the reverse. What are the things that will hurt my fertility? Most people with a healthy lifestyle and diet do not need to make any drastic changes. You do not need to take special fertility supplements or have a special fertility diet, BUT do eat right, get some exercise, do not smoke, do not drink alcohol to excess. Common sense goes a long way!

7. What are the common myths of IVF and egg freezing you hear most often?

Many people do not realize that female fertility starts to decline significantly at age 35, they think they do not need to worry about fertility until after 40. Unfortunately, the chance that an embryo will have chromosomal errors increases significantly starting at age 35, which both decreases pregnancy rates and increases miscarriage rates. Although IVF and egg freezing can help many people have children who would not be able to otherwise, it is not a time machine!

8. IVF has been around for 40 years this July, what types of innovations in fertility treatments can families access now? Any predictions for the future?

The biggest advancements have come in our ability to effectively freeze (“vitrify” technically) both embryos and now eggs with very high recovery rates, which can help preserve fertility. Also, the advances in genetic testing allows us to dramatically increase pregnancy rates, and decrease miscarriage rates, by ensuring we are only transferring chromosomally normal embryos. CCRM uses genetic testing, allowing us to limit our embryo transfers to one embryo at a time and further decreases the risk of multiple babies or complicated pregnancies.

9. Is CCRM Northern Virginia putting on any promotions that we can share?

CCRM Northern Virginia prides itself on having exceptional success rates due to its nationally recognized laboratory and team of physicians. In our local center, we are also able to provide very individualized care with the physicians performing the ultrasounds and procedures for their own patients. We have a monthly "fertility on the fifth” seminar, where patients can come and, at no charge, meet with the physicians, ask questions, and tour the facility. We are always happy to show off our state of the art home!

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