Speaking of Infertility Awareness: The Question of Age + Pregnancy = Never-Ending Confusion?

Advanced maternal age and how it gets in the way of pregnancy is in the news again. This time, the focus is on how so many women have the misunderstanding that assisted reproductive technology can defeat age as a barrier to conception.

How many times have I heard, "Dr. Kristiansen -- I hate that term! Can't we use something different to refer to my age?" Sorry -- it's a rather tacky-sounding medical terminology shortcut that means "chronologically older than average for optimal fertility".

Here's a message that needs to be heard during this National Infertility Awareness Week:

The fact: Without intervention, most women in their 40's (and many in their 30's) would not get pregnant.

Another fact: Yes, IVF is incredible technology worth marveling at, and one of the reasons is its ability to facilitate conception in women who otherwise would not get pregnant.

The Big Myth: IVF is so effective, you can wait until you're of "advanced maternal age" to try and get pregnant -- and have a high likelihood of succeeding by way of fertility treatment.

That myth IS a fact for some women. But only for some women. Are you one of them? There's a good chance that a thorough diagnostic workup by a reproductive endocrinologist can provide clues to answer that question. Can we guarantee it? No.

I don't think either the media or fertility experts intend to confuse women about the question of age and pregnancy. But the confusion among women is apparently prevalent and ongoing.

Just as it would be overkill to suggest that all women in their teens or early 20's run out and get fertility testing to prepare for the future, it is unreasonable to recommend women put all their eggs into that future basket by expecting ART to be their surefire answer to pregnancy. (There is the option of freezing your eggs, a different but related story...)

So, the simple truth: If you're delaying conception until your late 30's or older with the intention of simply walking into any fertility center and getting pregnant easily on the first try, you're automatically decreasing your odds.

If you're like many of my patients and have delayed pregnancy for lifestyle reasons like not finding Mr. Right, wanting to give your all to your career before parenthood, or because your finances aren't in order yet, you can take heart in knowing that virtually any safe and effective technique will be made available to you here at Houston Fertility Center. Not only that, but the treatment will be delivered by a team of experienced, compassionate women.

We know how much you want a baby. We applaud your courage and tenacity in the pursuit of parenthood. We'll educate you about every treatment option. We'll be your cheerleaders in the journey. And we'll be honest with you, too.

~ Dr. Sonja Kristiansen M.D.




[Image: photostock | FreeDigitalPhotos.net]

Can You Have Too Much Information in Fertility Treatment?

Like many of my patients, my life revolves around information. Personally, I use the same technology as most of you to keep track of obligations and loved ones. Professionally, the Houston Fertility Center team uses technology and constant communication to manage our patients' treatment plans. In this era of digital info, we can all feel more empowered, more often, more quickly. It seems like there's always room for more information, doesn't it?

Is it possible we sometimes actually don't help things with our "more is better" attitude toward information?

It's quite common in my office to hear, "Dr. Kristiansen, we want a baby so badly, we'll submit to any test that exists to find out the problem." I applaud their desire to get to the root of the situation and make it better. For many patients, the "not knowing" is nearly as difficult as not having a baby.

Ironically, even when I have strong reasons to suspect a particular cause of a patient's infertility, some may feel very unsettled if I order only those tests that I know will hone in on that cause. I understand -- they want to cover every single realm of possibility, right up front, leave no stone unturned (so to speak), even if it means performing tests that have a low chance of being applicable in their situation.

Recently, an organization published fact sheets called "Five Things Physicians and Patients Should Question," authored by nine medical specialty societies such as the American Academy of Family Physicians and others. The point of this public information campaign: to encourage patient-doctor communication about eliminating unnecessary tests and procedures. The campaign was first started by the National Physicians Alliance and then further supported by the ABIM Foundation with a focus on evidence-based medicine.

There are two recommendations that are pertinent to gynecology:

1. Don't perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.
2. Don't recommend follow-up imaging for clinically inconsequential adnexal cysts. 

However, there are no similar recommendations specific to fertility treatment.

If you're trying to get pregnant and are worried there may be a problem, here are the tests that I recommend for virtually any fertility patient:

• Medical history: Not exactly a "test" but a good review of your health and even a little about your immediate family's health history can give us a lot of clues.

• Semen analysis: It really does take two, so there's almost no point in only looking for infertility causes in half of a couple.

• Pelvic exam: Even if you've had annual well-woman exams for years, it's possible that something's been missed or that things have changed in terms of your reproductive structure.

• HSG, unless you're using IVF: Hysterosalpingogram is the best way to determine tubal patency. If there's not a definite plan for in vitro fertilization (which is a very successful workaround for tubal factor infertility), then we need to know the pathway for your eggs is clear.

• AMH & Day 3 FSH: Simple blood tests, testing these two hormones give us a wealth of information about the quantity and quality of your eggs, for patients of all ages, and enables us to start your treatment plan most appropriately. There's no point being caught by surprise later down the line by an ovarian reserve that was in decline all along.

Of course, there are more diagnostic tools at our disposable if necessary. And that's my point: Simply having a wider array of tests and procedures does not make them all necessary. So why go through the expense of both time and money, not to mention additional anxiety, by submitting to every test -- unless we find, one step at a time, that your initial tests aren't revealing enough information to optimize your treatment path.

Can we have too much information? Not really, especially when it comes to our comfort level. We've all become very accustomed to the sense of control over our lives that comes from having all that data. But there are costs to being inundated with data, both financially and emotionally. Part of my job as a fertility specialist is helping patients find what's necessary and truly helpful from among the abundant but sometimes confusing options.

(Image: Jeroen van Oostrom | FreeDigitalPhoto)