Should I advise my daughter to pursue a career prior to starting a family?

1. During the past 10-20 years, more  and more  women have chosen to delay starting their families so they can pursue a career.  In many cases, this is the right course of action for the individual and her family.

As people get older, particularly beyond age 30, pregnancy rates decline.  This becomes most noticeable beyond age 40.  Consequently, some women who are perfectly fertile miss the opportunity to conceive.

Pregnancy rates decline as women get older.  In each age range we can calculate the number of women who conceive, with each monthly ovulation cycle combined with exposure (intercourse), the pregnancy rates are 25% at age 20, 15% at age 30 less than 5% after age 40.

As an infertility specialist, I would recommend that family and childbirth not be postponed or placed in second position behind a career unless the individual involved is willing to live with the consequences of a potential lower pregnancy rate as she gets older.  She risks never achieving pregnancy.  On the other hand, it is a disservice to scare and alarm people that women cannot have children in their late 30’s  and 40’s and even beyond.  We are only talking about statistical odds.

THINK POSIVIVE!  BE SUCCESS ORIENTED

Studies suggest that peoplre who  do mindful meditation,  use acupuncture, or have psychological counseling have better pregnancy rates.

Positive thinking does help.  If you are depressed, seek help.  Counseling, psychotherapy and medications are available.

Remember- donor eggs, testicular biopsy, donor sperm or gestational surrogates “may” be a better alternative than adoption or childlessness.   Keep this in mind if: 

          You are not an ideal candidate; such as

1. Women over 38 years of age or males over 55
2. A male who requires a testicular biopsy to retrieve sperm
3. You have had intrauterine fibroids
4. You have autoimmune diseases (such as Lupus).
5. You are diabetic
6. Have a day 3 FSH hormone level of more than 10
7. Produce less than 4 or 5 mature eggs per cycle
8. You have bleeding or coagulation disorders
9. You have a history of cancer and chemotherapy or radiation.
10. You have an AMH  level less than 0.8

We know that “some” people with these aforementioned problems may achieve pregnancy with IVF and we (as opposed to some centers) will accept you for IVF treatment…but note, such couples have a lower success (live birth) rate than our standard cases.

In recent review of 158 sequential IVF cases, we found that due to the referral nature of my practice, only 44 of the 158 cases would be considered “standard” and they have a substantially better live birth rate.

A WORD ABOUT STATISTICS

Sorting through statistics for fertility treatment can be a confusing and disheartening process.  This may be especially true when comparing statistics between practices.    Some fertility clinics only accept patients they believe are the most likely to conceive through their treatment program.  Such a practice ensures that the clinic receives high marks for success rates.

We are very proud to offer a different approach.  As a referral center we accept a broad range of patients, whether or not they fall into the “most likely to conceive” category. With this approach, our numbers for success are sometimes lower than some other fertility doctors.

We are also proud of our success rates for our most fertilite patients, in our IVF or our Donor Egg Program.  We recognize that those with more complex health issues often will have lower success rates, however, we feel it is important to care for all of our patients and offer everyone a chance to conceive.

Finally, SART,FDA, CDC and Congress all suggest that we not compare statistics from one center to another for the above reasons.  Some centers with very high published rates may have a high percentage of patients with minimal fertility factors, e.g. fertile couples who wish sex selection to “balance” their family with a child of a particular sex.  These fertile couples are reported along with the truly infertile couples. This sometimes gives the appearance that such a  center has a higher IVF success rate, as they are specializing in easier cases..

Q: Why is the success rate with ART so low?

A: Studies of human reproduction indicate that, for a couple with proven fertility, the likelyhood of conception is only 20% per month. ART affords couples with infertility problems excellent chances for conception; often much higher than natural rates.

Q: Is there a possibility of multiple births from ART?

A: Yes, anytime more than one embryo is transferred, there is a chance for multiple pregnancies. It appears that the number of twin births is greater than the normal population (1 in 80). Triplets and quadruplets have also been concieved through ART procedures. Although we do not directly offer it, selective reduction is available to couples who concieve multiple gestations.

Q: Is there an increased chance of birth defects if I become pregnant through ART?

A: Maybe. Numerous studies have reported no increased risk of birth defects in children concieved through ART compared to those concieved in the general population. However, other studies suggest that couples with infertility, regardless of treatment used, have a small increase in risk.

Q: Can we still have intercourse while taking the hormone medication?

A: Yes. However it is recommended that the male abstain from ejaculating for 3-5 days preceeding the egg retrieval. This precaution ensures that the semen sample on the day of the egg retrieval contains the maximum number of mobile sperm. You may find that near the time of egg retrieval your ovaries will be markedly enlarged and tender, possibly making intercourse very uncomfortable.

Q: What activity restrictions are recommended during my stimulation?

A: As your ovaries begin to stimulate, they will become enlarged and tender. Limited activity reduceds the risk of ovarian torsion and/or rupturing the follicles on the ovaries. As a general rule, it is advised that you stop any activity which involves bouncing or jaring the pelvis by the time that you are returning for your first ultrasound to monitor your stimulation.

Q: What if I ovulate before the retrieval?

A: On the day of the egg retrieval, a vaginal ultrasound will confirm if the follicles are still intact. If they are, it can be assumed that ovulation has not occurred and oocyte retrieval will be attempted. The medications Lupron, Antagon or Cetrotide also help to assure that ovulation does not occur before the egg retrieval has been performed.

Q: How much activity is recommended after embryo transfer (ET)?

A: Most doctors recommend a fairly sedentary, quiet three days after embryo transfer. Thereafter, most patients resume their normal routines. Stenuous exercises, like running or heavy lifting etc. should be avoided until a pregnancy test has been performed.