Did you know that the Centers for Disease Control and Prevention (CDC) and the Society for Reproductive Technology (SART) require all IVF labs make an annual report about the patients they serve, including diagnosis and details of each cycle, in an attempt to learn more about IVF outcomes?
Every year, when compiling these stats for the CDC and SART I have to ensure that I’m reporting the correct diagnosis and reason for doing Assisted Reproductive Technology (ART) treatments. This may be important for us physicians to learn more about ART but does “finding the cause of infertility” really help couples conceive?
In my opinion, infertility is just a symptom. This is also the case with a diagnosis of no menses, irregular cycles, or low sperm counts. As a physician and clinician, my job is to investigate deeper. Why isn’t the patient ovulating? Is this the reason she is not getting pregnant? And, if I can induce ovulation with drugs, why then is she still not getting pregnant? Similarly, why does the patient have an abnormal semen analysis?
Fertility is like a puzzle and my job is to put it together by determining which of the pieces are missing or broken. To do this, there are a number of things I do as a fertility specialist:
- I check the patient’s egg factor: regular or irregular cycles, biologic age, and ovarian age (This is done through antral follicle counts from ultrasound and blood tests).
- I measure hormone levels (AMH and FSH, LH, Estradiol).
- I also evaluate the cervix, uterus and tubes by performing a hysterosalpingogram (HSG), an ultrasound and, in some cases, exploratory laparoscopic or hysteroscopic surgery.
- The fertility workup also includes a semen analysis to understand the male partner’s piece of the puzzle.
All the while I am conscious that although this investigation is crucial in helping design a treatment plan, a diagnosis doesn’t tell the whole story. The path to solving the puzzle is unique to each woman, as no two patients have the same pieces to work with.
Explanations do help people understand the why. But I’ve witnessed plenty of cases that defy a particular diagnosis; I’ve seen some patients with significant tubal disease or endometriosis get pregnant spontaneously. Some men with low sperm counts or 0% normal sperm forms go on to conceive without IVF or ICSI.
Conversely, many couples with infertility have “normal” reproductive health tests and then the diagnosis is “UNEXPLAINED infertility.”
For this reason, I’m loath to put a definitive label on fertility challenges, as so often I’ve seen a diagnosis open a door to unfair scrutiny and even I look at it this way: we don’t fault the cancer victim by harping on his or her failure to use sunscreen during their childhood, tobacco abuse as a teen, or overuse of alcohol or poor choices of food as an adult. The why is a moot and past point; the job of the physician and patient alike is to move on, by facing the illness and being proactive in its treatment.
Over the many years that I have been working as a fertility specialist, I have heard many women being self-critical and blaming themselves for a situation that’s clearly beyond their control. Similarly, I’ve heard spouses try to make each other take responsibility for infertility.
And so the blame game goes; women who have had pregnancy terminations question if their current fertility challenges are some kind of divine justice. Those with tubal factors may blame their infertility on wild and crazy days of sexual freedom. Still others with prior eating disorders feel they ruined their menstrual cycles. And some women stay stuck wondering why they waited so long and if their infertility is all age related.
Blame has no place. For example, waiting until you found the right partner to have kids with or the financial security was prudent thinking. An earlier active sex life, prior pregnancy terminations or an eating disorder from which you’ve recovered doesn’t normally compromise fertility. These are circumstances of your life. Ruminating on how it could have been different will not make treatments more successful.
Your best case scenario is to stay present and focus on taking care of yourself as you move forward to improve your chances to conceive.
In the mind-body philosophy of health, biography and biology are inextricably linked. However, the link is malleable; our perception of reality and our analysis of our history can be adjusted. When trying to understand why a couple is having trouble conceiving, we must remember that although we need to search for explanations in order to choose the most appropriate treatments, there should be no room for judgment. In the face of self-critical emotions or thoughts, I often recommend to patients that they get help in modifying their connections to the past in order to gain acceptance of their present situation and propel them forward in a more loving and gentle manner.
At WCWRC, we work with your mind and your body so that you can be successful in your journey to become a parent. This is why we confidently say: Together, we’ll find a way.
If you would like more information or to discuss you fertility, please contact the West Coast Women’s Reproductive Center.
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