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Monday, October 4, 2010
John Petrozza MD, director of the MGH Fertility Center
What is In Vitro Fertilization?
In Vitro Fertilization (IVF) is the most common treatment for infertility. Simply put, it's the unification of the sperm and egg in a lab setting that is then inserted into the uterus through the cervix.
My partner and I have been trying to conceive for some time, how do I know when to visit a fertility specialist? How do I get started?
Approximately 85% of women are pregnant after 12 months, thus, if your partner is under the age of 35, it is appropriate to wait at least 12 months before seeing professional care. If your partner is between the ages of 36-40, it is best to seek help after 6 months, and once above the age of 40, 3 months is adequate. Of course, if your partner has any issues that may be concerning, such as irregular menstrual cycles, pelvic pain, worsening menstrual cramps, excessive menstrual bleeding, or a history of pelvic infections or surgery, it may be prudent to seek an evaluation much sooner. To get started, just contact your primary care physician or gynecologist for assistance and ask if a referral to an infertility specialist is needed. You may also call your local fertility clinic and ask if a consult is required.
What can my partner and I expect from our first visit to a specialist?
Usually, a thorough medical history will be asked of both of you. It is important that you know your medical history and medications. Often, your partner will have a physical exam and even a pelvic ultrasound to evaluate her reproductive anatomy. An initial set of diagnostics tests will be arranged, which often are timed to your partner's menstrual cycle, so it may take up to a month to get all the results back. In many ways, your main goal is to be supportive of your partner and learn about the process of diagnosing and treating infertility.
How many cases of infertility are due to male health issues? Approximately 40% of infertility is due to male factors.
I already have a child, so isn't it unlikely that the issue is mine?
No, since many factors can affect sperm quality such as overall health, environmental exposures, medications, smoking, excessive weight, excessive heat, genetic factors, and age.
Will a semen analysis be necessary? What is the collection process like?
A semen analysis is important because it allows caregivers to identify or rule out treatment options. Semen volume, concentration (count), motility (percentage moving), progressive motility (percentage moving forward), and morphology (percent of normally shaped sperm) are important factors in determining the cause of infertility.
The process of semen analysis is quite simple, although admittedly, can be quite stressful for the first time. We do everything to ensure that the process is confidential and as straightforward as possible. We ask that you abstain from any form of ejaculation for at least two days, but no longer than five days, to ensure the best sample possible. Collection happens in the clinic itself through masturbation.
Can I collect my semen sample at home?
We prefer you collect at the clinic rather than at home. There are many variables that can affect the quality of your sperm, such as length of time from collection to analysis, verification of proper specimen collection, traffic, weather, etc. However, if you are unable to collect in the clinic, the lab will be happy to supply you with an approved collection cup and identification labels. Also, if you are unable to collect by masturbation, we can supply you with an approved condom so that you can collect a post-coital specimen.
Are there different types of fertility treatments?
Treatments may be as simple as helping to time coitus around your partner's ovulation, intrauterine inseminations to get more sperm into your partner's uterus, or medications to increase the number of eggs your partner ovulates. In some situations, you may need in vitro fertilization to ensure adequate fertilization and better use of your sperm.
What is my role in the treatment process?
Your job is to understand the fertility process, support your partner, collect a sperm specimen when needed, and potentially assist in administering medications to your partner, many of which are injected. Of course, we will teach you how to use these medications correctly. You are an integral part of this process! If for some reason you feel that you cannot collect a specimen during your wife's treatment (anxiety, travel, illness, etc), please let us know, so that we can have you collect a specimen earlier in the process and freeze it, so that it can be thawed and used at the appropriate time.
How will IVF treatments affect my partner's health? Physically? Emotionally?
Most women do extremely well during the treatment process, but expect some occasional mood swings and episodes of anxiety and frustration. Your partner may feel bloated, have diminished libido, and at times even feel down. Be supportive and understand that this is often a very emotional time for both of you. We have experienced social workers who specialize in fertility cases and often patients find talking through their emotions and their challenges can be quite beneficial. It's all about making you and your partner feel more in control.
Are there greater risks with pregnancies resulting from IVF?
The biggest risk is the potential for a multiple pregnancy. Most often this is twins, but on occasion, there may be triplets or more. We work hard to minimize this risk by avoiding transferring more embryos than necessary. There is also the risk for ovarian hyperstimulation, which is associated with abdominal swelling, discomfort, and even shortness of breath. Ovarian torsion may also occur, whereby a stimulated ovary can twist on itself and hinder its blood supply which requires surgical intervention. There are some recent studies indicating an increased risk for birth defects in women undergoing IVF. The risk is clinically small, but your provider will discuss this with you in more detail.
Are there ways to improve the chances for successful IVF?
Eating healthy and maintaining a normal weight are crucial to ensuring a more successful cycle. Seeking care early is beneficial, since pregnancy rates and birth outcomes are directly related to you and your partner's age. Of course, avoiding smoking and/or second hand exposure will not only improve your partner's pregnancy chances, but also ensure a much healthier pregnancy.
How do I choose an IVF center?
Your primary care physician or gynecologist may have a center they refer to. In this case, it is important to ask why they refer there, how successful the program is, and what their experience has been working with that center. You can also visit the Society for Assisted Reproductive Technologies (SART) website and see the success rates for every program in your area. There are many factors that determine how those statistics are calculated, but this will serve as a good starting point. In addition, convenience of the center, operating hours, affiliation with an academic center, safety profile, background of the treating physicians, satellite clinics, and overall feel of the practice are all crucial elements in your decision.
Dr. John Petrozza is chief of Reproductive Medicine and IVF at Massachusetts General Hospital and directs the MGH Fertility Center. He will be speaking at a free fertility seminar at the MassGeneral/North Shore Center for Outpatient Care on October 13, from 6:00-8:00 p.m.
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