Overcoming Infertility: A Woman's Guide to Getting Pregnant

By Gerard M Honoré and Jay Nemiro

Confronting a problem that affects one out of 10 American couples, this all-inclusive, question-and-answerguide offers insight and encouragement in the face of infertility. Addressing the deep disappointment and emotional distress that accompany a diagnosis, this resource emphasizes that there is still hope regarding this daunting condition. Penned by a reputable endocrinologist who has treated thousands of couples, this helpful reference provides a way to navigate through a confusing time, clearly illustrating the most suitable treatment options. Topics covered include the causes of both female and male infertility, how to cope emotionally with a diagnosis, and utilizing the new Assisted Reproductive Technologies (ART). From choosing a fertility specialist to taking advantage of the most recent developments, this exhaustive study provides practical guidance for couples facing this overwhelming syndrome.

• Language: English
• Publisher: Independent Publishers Group
• Release date: Aug 30, 2010
• ISBN: 9781936374243

Book preview

An Addicus Nonfiction Book

Copyright 2010 by Gerard M. Honoré, Ph.D., M.D., and Jay S. Nemiro, M.D. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopied, recorded, or otherwise, without the prior written permission of the publisher. For information, write Addicus Books, Inc., P.O. Box 45327, Omaha, Nebraska 68145.

ISBN 978-1-886039-16-2

Cover design and illustrations by Jack Kusler

Photo of human sperm by Jason Burns/Dr. Ryder/Phototake USA

This book is not intended to serve as a substitute for a physician. Nor is it the authors’ intent to give medical advice contrary to that of an attending physician.

Library of Congress Cataloging-in-Publication Data

Honoré, Gerard M., 1957-

      Overcoming infertility: a woman’s guide to getting pregnant /

      Gerard M. Honoré, Jay S. Nemiro.

          p. Cm.

      Includes index.

      ISBN 978-1-886039-16-2 (alk. Paper)

1. Infertility—Popular works. 2. Infertility—Treatment—Popular works. I.

      Nemiro, Jay S., 1950- II. Title.

RC889.H53 2010

618.1′78—dc22                                                       2010021381

Addicus Books, Inc.

P.O. Box 45327

Omaha, Nebraska 68145

www.AddicusBooks.com

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

To my wife, Erika, and my children, Jossie and Wolf,

for putting sunshine in every single day;

and to the memory of my mother, Ellen Stone Honoré Ryan,

for her unfailing love, generosity,

and the riches of opportunity she gave me.

—Gerard M. Honoré, Ph.D., M.D.

To my wonderful wife, Gina—my life partner;

to my six children, whom I thank for their love, patience,

and understanding; to my entire staff, for their loyalty

and commitment to excellence; and to all our patients,

past and present, whose courage, grace,

and strength I continue to admire.

—Jay S. Nemiro, M.D.

Contents

Acknowledgments

Introduction

1 Infertility: An Overview

2 Coping Emotionally

3 Female Infertility

4 Getting a Diagnosis

5 Treatment with Fertility Drugs

6 Fertility Treatment Procedures

7 Reproductive Surgery

8 Male Infertility

9 Treatment for Male Infertility

10 Donor Sperm

11 Donor Eggs and Embryos

12 Gestational Carriers

Glossary

Resources

Index

About the Authors

Acknowledgments

Iwish to extend my sincerest thanks to Bob Schenken, M.D., and Jeff Deaton, M.D., for not only being unmatched as teachers, mentors, and friends, but for also being models of personal and professional excellence. They set standards few of us will achieve, but to which we should all aspire.

I also acknowledge Alisa Zinsmeyer Young, M.A., for her invaluable original contributions to this book in the fields of infertility counseling and coping. I am grateful for her professional expertise and for sharing so generously with us and with our readers.

Finally, though no less important, I wish to thank Chris Hinz and Rod Colvin of Addicus Books for their enthusiasm, professional editorial guidance, and lots of plain hard work in every phase of bringing this book to life.

—Gerard M. Honoré, Ph.D., M.D.

Iwant to thank a number of people who, directly or indirectly, have helped make this book possible. I would like to acknowledge my professors and teachers throughout college and medical school; they guided me through challenging years of hard work and motivated me to stay the course. I thank Richard Falk, M.D., a superb mentor who had enough faith in me to recommend me as Georgetown University’s first fellow in reproductive endocrinology and infertility. I acknowledge all the OB/GYN residents who continually challenged me to be a better teacher. I also thank Robert W. McGaughey, Ph.D., whose twenty-four-year partnership as our IVF lab director has helped thousands of our patients to become parents.

I would like to acknowledge my wife, Gina, who has been an ongoing source of inspiration and who continues to be supportive of me in my work, which often requires long days and nights. I am grateful to my six children, Aria, Shane, Talia, Judd, Ashley, and Chad, who are a daily reminder of why I do what I do. I thank my staff, without whom I could not practice the quality of medicine our patients deserve. I extend a very special thank you to all our patients, past and present, who are now the parents of nearly 10,000 babies—miracles of love and science.

Finally, I would like to thank Chris Hinz for her excellent editorial support and Rod Colvin of Addicus Books for his encouragement and for publishing this book on such an important topic.

                                     —Jay S. Nemiro, M.D.

Introduction

In my practice as a reproductive endocrinologist, I’ve met thousands of women who have tried, without success, to have a baby of their own. I have seen firsthand the emotional distress these women endure, and I understand how these feelings can cast dark shadows on every part of their lives. My goal is to help these women become mothers. First, we must find the road to take to accomplish that goal. I begin by asking questions in effort to discover why she is not getting pregnant. Once I have more information, we can start drawing out the map—the plan for reaching a diagnosis and the plan for treatment.

When I first meet a woman in my office, we begin the first of many important conversations. I always try to listen carefully to her concerns and share with her as much information as she seeks. I believe real knowledge can give peace of mind, and that knowledge along with emotional support brings inner strength. It is the treatment plan and this strength that takes these women and their partners to eventual success.

I hope this book serves as a resource that gives these many brave women the answers to their important questions. My goal with the book is provide readers with the knowledge, strength, and hope they need to take their journeys toward families of their own.

—Gerard M. Honoré, Ph.D., M.D.

My intention in writing this book is to make the journey a little less stressful for women who are trying to have a child. I hope this book will empower you and your partner by giving you useful information. Having had the privilege of working with thousands of couples who have faced infertility, I’ve found that knowledge leads to understanding, and understanding leads to empowerment.

By knowing how infertility can occur and the challenges it can pose for both you and your partner, you’ll be better equipped to make informed decisions about issues ranging from diagnostic tests to treatment. You’ll also be ready to handle the emotional and psychological roller coaster that often accompanies each development and decision throughout fertility treatment.

I encourage you to find a physician with whom you can develop a true partnership—a doctor who is committed to providing competent, compassionate care and who also understands the fears and feelings a woman may experience in attempting to achieve her dream of becoming a mother. Remember, even if you are successful in getting pregnant, your emotional journey continues. You’ll want the continued support of your physician.

It is my hope that, once you have a healthy baby in your arms, you will be able to relax and enjoy motherhood, and you will look back and say it was all worth it.

                                      —Jay S. Nemiro, M.D.

1

Infertility: An Overview

Not being able to have a baby can be heartbreaking. You no doubt know the frustration. Perhaps you grew up believing that one day you’d be a mother. Now you’re not so certain. You’re also not alone. It’s estimated that as many as 10 percent of reproductive-age females are grappling with infertility, the inability to conceive after one year of unprotected intercourse.

However, just because you haven’t conceived doesn’t mean you can’t. Infertility is a medical problem that can be diagnosed and treated much as any other health issue. Over the past few decades, medical science has made great strides in treating both female and male infertility. So you needn’t lose hope. With help, it’s quite possible that you can have a baby.

Infertility: A Shared Problem

As a woman, you may feel solely responsible for your inability to conceive. However, infertility is not just a female problem. In fact, nearly 40 to 50 percent of infertility cases involve factors related to the male. In 10 to 35 percent of cases, both the female and the male have a fertility problem. Another 15 to 20 percent of cases are said to be unexplained—meaning doctors don’t have a concrete reason for a couple’s inability to conceive.

Common Causes of Infertility

In women, the most common causes of infertility involve ovulation factors and a diminishing supply of quality eggs. Most women ovulate normally into their late twenties; however, by age thirty-five to thirty-eight, the ability to ovulate normally may decline. Ovulation may also be affected by factors such as thyroid problems and hormone imbalances. Other major causes of female infertility involve problems with the fallopian tubes, cervix, and/or uterus.

In men, the focus is on the quantity and quality of sperm. Age is not usually a factor in a man’s ability to produce sperm; however, any damage to his reproductive organs can cause problems with sperm production and delivery.

In addition, certain lifestyle factors may affect the ability of both sexes to conceive. For example, in women, Chlamydia infections and other sexually transmitted diseases (STDs) can damage the fallopian tubes, resulting in infertility. In men, the use of alcohol, marijuana, and other recreational drugs has well-documented harmful effects on sperm production.

Smoking tobacco may or may not be harmful to reproduction. Some studies show that nicotine and other chemicals from smoking can impair the ovaries and interfere with their ability to create estradiol, the hormone specifically involved in egg production. In fact, some estimates are that tobacco use reduces fertility in both females and males by about 15 percent. Other research, however, shows no evidence of this effect.

Keep in mind that couples aren’t tested for infertility simply because they drink alcohol or smoke. They’re screened for infertility because they’ve been unsuccessful in their pregnancy attempts. Previous behaviors may come up in the evaluation, but there are likely other reasons for the problem.

Types of Infertility

Couples who have never conceived are said to have primary infertility. Couples who are unable to conceive even though they’ve had a child previously have secondary infertility. In fact, infertility sometimes first surfaces when a couple attempts to have a second child. In many cases, however, couples experience both primary and secondary infertility.

Treatment for Infertility

Thanks to modern technology, help is available for couples having difficulty conceiving. The treatments, described later in this book, range from fertility drugs that can help the ovaries release eggs to microsurgery that can repair physical problems in both women and men. The biggest treatment breakthrough in reproductive technology during the past thirty years has been in vitro fertilization (IVF), a procedure in which fertilization occurs outside the body when an egg and sperm are joined in a laboratory; the embryo is then implanted in the woman’s uterus.

Costs for Treatment

The costs linked to fertility treatment can vary greatly, depending on the procedures you have done, where you live, and which doctor you see. Treatment costs can run into tens of thousands of dollars if you and your partner must undergo high-tech procedures, use donor eggs, or engage a gestational carrier.

Does Insurance Pay?

Although infertility is considered a disease, insurance coverage for fertility treatment is mandated in fewer than fifteen states.