Fertility Treatments Successful in More Than Half of Cases

"Aren't you ever going to have kids?"

For the 6 million Americans struggling to get pregnant or carry a baby to term, that question goes beyond nosiness. It's a painful reminder that infertility often is ignored, misunderstood and even dismissed by those who haven't lived it.

"Infertility is a very real medical condition -- one we can trace to specific problems in the reproductive system," says Seattle fertility specialist Michael Soules, M.D., president of the American Society of Reproductive Medicine (ASRM).

Thanks to progress in medication, microsurgery and test-tube fertilization, more than half the patients who seek fertility treatment can expect a successful pregnancy. Depending on the problem, they can be treated by an obstetrician/gynecologist, urologist or reproductive endocrinologist.

But the first step for infertile couples should be educating themselves, says Diane Clapp, R.N., national medical information director at RESOLVE, the National Infertility Association.

"Infertility can make you feel isolated and out of control," she says. "Getting the facts about treatment options and knowing when to seek help empowers you to take that control back."

To start, test your knowledge with the quiz that follows.

1. Before seeking infertility care, all couples should try conceiving on their own for a year. True or False?

Answer: False. This may be sound advice for an otherwise healthy couple in their 20s. But for some women, it just delays vital evaluation and treatment, Ms. Clapp says. A year is too long if a woman is 35 or older; has had two or more miscarriages; or has a history of irregular menstrual cycles, pelvic inflammatory disease or pelvic surgery. In these cases, a couple who fails to conceive after several months of unprotected, well-timed intercourse should see a doctor.

2. Stress causes infertility. True or false?

Answer: True. This occurs when stress interferes with ovulation. But the reverse can be true, as well: Infertility can cause stress. "Infertility is a symptom of an underlying disease or structural problem," says Dr. Soules. "To suggest that relaxation is all you need for a pregnancy unfairly minimizes a medical problem."

3. Becoming pregnant with twins, triplets or higher multiples is a risk in all fertility treatment. True or false?

Answer: False. "Only couples taking ovulation-inducing drugs run the risk of multiple births -- and a lot of infertility treatments don't involve these drugs at all," says Dr. Soules. Even with these drugs, single births are the usual outcome.

Multiple births also may result from assisted reproductive technology, where eggs are fertilized outside the body and placed in the womb. The ASRM recommends transferring no more than two good-quality embryos.

Patients seeking any fertility treatment should ask about the risk of multiple births and how to lessen it.

4. Female fertility drops a lot at 40. True or false?

Answer: True. The 20s are women's peak reproductive years. Between 35 and 40, female fertility falls moderately. At 40, the drop is dramatic. "The quality of the eggs deteriorates," Dr. Soules says. "We're not sure if the eggs are just older and don't work as well, or if nature has a way of selecting the best eggs first."

5. Infertility is mainly a woman's problem. True or false?

Answer: False. The ASRM says infertility problems are split between the sexes. Doctors trace 40 percent of cases to the man, 40 percent to the woman, and the remaining 20 percent to a combination of male-female problems.

6. You can prevent types of infertility. True or false?

Answer: True. According to the ASRM, five main factors can affect fertility:

* Age. Women shouldn't delay childbearing beyond ages 35 to 38.

* Smoking. Women who smoke are less fertile and face earlier menopause.

* Weight. Excessively thin or obese men and women are less fertile.

* Sexually transmitted disease. Chlamydia raises a woman's risk for fertility problems. Women with more than one sex partner should use condoms and seek chlamydia testing.

7. "Once fertile, always fertile" is true for men. True or false?

Answer: False. Previously fathering a child won't bar future fertility problems, says Dr. Soules. Men, however, can stay fertile well into their senior years.