Childless, but not by choice — Treatment can help those who struggle with infertility
ILLUSTRATION BY elizabeth ellis
"I was embarrassed that I might be infertile,” says Marcia, a Granite State resident, as she looks back on her struggles in the 1990s to conceive. “I felt somewhat like a failure, [thinking that] I wasn’t able to get pregnant because my body was lacking something.”
For the millions of people who want but are unable to have biological children, the psychological toll of infertility can be tremendous. “The rate of infertility in this country is the same as that of breast cancer, but it’s not something that people talk about,” says Jaclyn Chasse, ND, a naturopathic doctor and the cofounder of Northeast Integrative Medicine in Bedford. “It can be a real silent struggle,” she says.
In the medical world, infertility means the inability to get pregnant after one year of trying to conceive — or after six months of trying, if the woman is 35 or older. It affects one in six healthy couples of reproductive age, according to the American Society for Reproductive Medicine. Patients who have experienced two or more consecutive miscarriages are considered infertile, since even though they are able to get pregnant, they are unable to achieve a viable pregnancy.
Infertility touches men and women equally, and while the source of trouble remains unidentified in one-quarter of patients, known causes of infertility include hormonal imbalances, anatomical abnormalities, advancing age, toxin exposure, and lifestyle factors such as drug use and smoking. Emotional stress also appears to affect fertility, but its influence is a bit of a gray area. “There’s never been any scientific proof that stress interrupts fertility, but we definitely see it,” says Rebecca Banaski, DO, MPH, an obstetrician and gynecologist at Garrison Women’s Health Center in Dover.
In recent times, fertility struggles related to aging have become increasingly common as more women choose to delay pregnancy. Although risks associated with pregnancy beyond the age of 35 have been well-publicized, many would-be parents appear to cling to the notion that 40 is the new 20, and are dismayed to discover that Mother Nature might have other ideas. “People are very surprised when they come in to find out that they’re already considered old,” parentally speaking, says Banaski. “They feel young and healthy, but they don’t understand that their ovarian quality has taken a hit, and there’s nothing we can do about that,” she says.
Age affects the fertility of men gradually, but egg quality and quantity in women roll downhill at a rapid clip as years pass, with the most precipitous decline occurring around the age of 35. A woman’s egg loss begins even before she is born, and over time, changes in her eggs make it more difficult for her to conceive while increasing the likelihood that something will go wrong if she does become pregnant. Although healthcare providers can help even older women become pregnant, “We can’t change the quality of somebody’s eggs,” Banaski says, and once they’re gone, they’re gone. “You can’t get anymore,” she says.
Given humans’ ever-ticking biological clocks, infertile couples who want to achieve pregnancy should not put off treatment. The rule of thumb is that anyone older than 35 should go for professional help if pregnancy does not occur within six months of trying to conceive. Those under the age of 35 can wait for up to a year. If there’s something clearly wrong or you fall into a higher risk category — you have irregular menstrual cycles, say, or your medical history includes a prior problematic pregnancy — then don’t wait at all.
In addition, individuals can boost their chance of a successful pregnancy by avoiding potential lifestyle and environmental dangers, Chasse says. You needn’t go to the extreme in your efforts to eat an optimal diet and limit contact with chemicals, she says, but take preventive steps as much as possible: drink water that is filtered; choose glass containers over plastic, since some plastics contain chemicals that can harm fertility; avoid chemical-laden cleaning and beauty products; eat nutritious food; and find a stress-management technique that works for you. “It’s really those small choices that add up,” Chasse says.
Of course, couples who want to pursue more aggressive treatment can do so. Testing might indicate that surgery is required, but in many instances, doctors can offer a less-invasive approach, such as medication to tweak hormones related to reproduction. Other treatment options can include intrauterine insemination (IUI), a procedure in which a doctor places sperm directly into the woman’s uterus, thereby bypassing the cervix and shortening the sperm’s route to the fallopian tubes, or in vitro fertilization (IVF), during which fertilization occurs outside of the woman’s body. A procedure called a “mini” IVF is also available now, at about a third of the price of traditional IVF, Banaski says — particularly notable because fertility treatments can be pricey and are not typically covered by insurance plans in New Hampshire.
Another option, freezing eggs in the hope of preserving them for future use, sometimes makes headlines but is not widely done, Banaski says. The fragility of eggs makes the freezing and thawing process risky, she says, “so it’s still pretty experimental.”
As for Marcia, tests linked her then-husband’s sperm to the couple’s conception difficulties. She does not regret the anxious moments she endured while undergoing fertility procedures that enabled her to get pregnant and feels blessed that doctors could help her achieve her dream of having a child. “When I think about what I went through to be fortunate enough to have [my daughter], I don’t even consider myself having really ‘gone through’ much,” she says, adding that she cannot imagine life without her daughter, who today is a thriving high-school sophomore who proudly and good-naturedly points out to friends her “test-tube baby” beginnings.
One size doesn’t fit all
Couples grappling with infertility who want the best of both worlds—a proven high-tech solution, mixed with a more natural, holistic approach—can have it. Those pursuing in vitro fertilization (IVF), for example, can choose to also work with a naturopathic doctor who will help support IVF with an integrative approach, says Jaclyn Chasse, ND, a naturopathic doctor and the cofounder of Northeast Integrative Medicine in Bedford.
Research on natural medicine used in conjunction with IVF has enabled doctors to better tailor recommendations for patients who opt for a multi-pronged approach to infertility, she says, which should come as welcome news to Granite Staters. After all, Chasse says, “If you’re going to spend $10,000 to go through a round of IVF out of pocket — New Hampshire doesn’t usually cover fertility services on insurance plans— you want to do everything you can to make sure that that first time is going to work for you.”