For the love of family

Melissa and her husband have always wanted children, but after two years of trying unsuccessfully to conceive, she was diagnosed with what fertility experts call “unexplained infertility.”

According to Dr. Albert Yuzpe, a leading Canadian fertility expert, Melissa’s condition is actually quite common. Unexplained infertility — when a couple is unable to conceive with no known cause identified — affects up to 15 per cent of couples who are experiencing difficulty conceiving. For Melissa, not having an answer as to why she couldn’t get pregnant was emotionally brutal for her, she recalls. “There was no reason why I couldn’t,” she says, “but it still didn’t happen… Not having an answer was very frustrating. You’re never given a diagnosis, and everyone just tells you to keep trying.”

Yuzpe, a recipient of many awards including the prestigious Canadian Fertility and Andrology Society Award of Excellence in Reproductive Medicine, and co-founder and co-director of the Genesis Fertility Centre in Vancouver, says that couples often are left to deal with the stress of infertility as best they can on their own since many don’t seek help early in the process.

“In the case of unexplained infertility, you can’t fix what isn’t broken,” says Yuzpe. “It means something is going on, but there are many steps in the reproductive process that we just can’t test for with our current technology. But, these couples can certainly benefit from fertility treatment.”

Despite the emotional turmoil they experienced, Melissa and her husband did conceive their first-born — a daughter named Maria, now age 6 — naturally. The proud parents decided two years after Maria was born that she needed a sibling. To their dismay, they experienced fertility issues again.

“To me, fertility was this big, overwhelming emotional rollercoaster,” shares Melissa. After unsuccessfully trying to have another child again naturally, she and her husband decided to explore their options at a fertility clinic. And that’s when they heard about Genesis.

“You don’t know what to expect, but it was very personal — not just medical. It was such a struggle and the staff at Genesis understood how difficult it was for us,” says Melissa, while trying to hold back tears in a video clip of her personal journey.

The centre provides not only diagnosis and treatment but also a great deal of emotional support from their medical staff, which, in addition to Dr. Yuzpe, includes Dr. Jason Hitkari, Dr. Sonya Kashyap and Dr. Beth Taylor, as well as nursing and professional counselling staff. Melissa underwent a treatment called superovulation combined with intrauterine insemination (IUI). Specific medications that cause egg growth in a woman’s ovary resulted in Melissa producing two eggs. Then, her partner’s sperm was prepared in the laboratory and placed into her uterus at the time that she was ovulating. If that treatment had failed to result in a pregnancy then they could have turned to in-vitro fertilization (IVF), which has a very high success rate in young women.

After the first round of superovulation, Melissa became pregnant with her son, Jason.

“He’s our miracle baby whom we’re very grateful for; we’re finally complete,” says Melissa, adding that other women facing similar situations as hers should not hesitate to explore their fertility treatment options. “It can put you on the right path,” she says.

THE START OF YOUR FERTILITY JOURNEY
Number one on Yuzpe’s list of suggestions regarding fertility relates to when it’s time to seek medical advice.

As a general rule, “when the woman is under 37 years of age and is having regular intercourse for a year, or for six months if the woman is 37 years old or more, and nothing has happened, then it is time to make an appointment with the doctor,” says Yuzpe. The first step is to see their family doctor who can do some preliminary testing and decide if the couple needs to be seen by either a gynecologist or a fertility specialist. The family doctor may also be very helpful in counselling, correcting lifestyle issues, and in discussing many of the myths and facts that surround the entire fertility process.

Most family doctors are very capable and comfortable in conducting preliminary screening tests to see if there’s a fertility problem that can be identified. These initial tests include checking to see if the woman is ovulating, if her fallopian tubes are open and what the male partner’s sperm is like. “Sometimes,” says Yuzpe, “there are some very obvious causes that the family physician will pick up quickly, simply by taking a history, such as identifying those women who have very irregular periods. Such women are likely not ovulating.”

CAUSES OF INFERTILITY
Among the identifiable causes of infertility, half are related to the female, about 35 to 40 per cent to the male and 10 to 15 percent to a combination of both male and female factors. However, the age of the female partner is also a major factor.

“Women need to know that the longer they wait to become pregnant, the less their chance of having a healthy, live birth,” says Yuzpe. “A woman at the age of 40 has half the likelihood of getting pregnant compared to a woman at 35. Five years may not seem like a lot, but her chances are reduced in half during that five-year span.”

The doctor also notes the risk of miscarriage increases from 15 per cent at age 35 to 40 per cent or more at 43 and 44. In addition, the risk of a genetic abnormality in the infant increases significantly with increasing maternal age. “It doesn’t matter how young you look or feel, the eggs in the ovary continue to age independently and that’s what affects fertility.”

Yuzpe cautions that the glamorization of older parenthood — delaying plans to start a family until the woman is in her mid- to late forties — often doesn’t tell the whole story. “The media has glamorized pregnancy in the older woman. Many of the movie stars and celebrities they write about have used egg donors but they don’t necessarily reveal that,” he says. “They also have endless amounts of money to pursue their goals whereas the average couple doesn’t.”

He continues, “Women must have the right to decide when they want to get pregnant, but at the same time, they must realize the risk that this delay carries. Once they are informed, then the decision is theirs to make, but then, at least, it’s an informed decision.”

LIFESTYLE ISSUES
A person’s lifestyle habits may also affect their fertility. Smoking, weight issues (very low weight and obesity), recreational and illicit drugs, and anabolic steroids are very important factors. “And then,” Yuzpe says, “the standard question is: What about stress?

“The trouble with stress is that it’s very difficult to quantitate and then relate it to fertility. Everyone should try to avoid stress as much as possible, but that isn’t always easy. Not being able to conceive in itself is extremely stressful.” That, he says, is where the clinic has found some relaxation techniques, such as yoga or acupuncture, to be helpful.

Then there are the lifestyle concerns, like men wearing tight underwear, that we often hear about. The data to support that particular issue is a lot weaker, says Yuzpe. “When there is an identifiable abnormality in [the] man’s sperm analysis, then we’d say, okay stay out of the hot tub, don’t wear tight underwear. We can say it, but proving we’re going to make things any better is difficult.”

NEW TREATMENTS
Depending on the cause of the fertility problem, there are a number of fertility treatment options available. Aside from providing their patients with a complete range of standard fertility treatments for both the male and female including in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI — for male infertility) and donor insemination, Genesis offers several leading-edge procedures and treatments. For the past five years they have been pioneers in Canada in the replacement of a single embryo in women under the age of 35 undergoing IVF treatment. This significantly helps to reduce the risk of multiple pregnancies while minimally, if at all, affecting the chance of becoming pregnant. This is important since twin pregnancies are associated with an increased risk to both the fetuses and the mother compared to a singleton pregnancy.

Another new technology available at Genesis is freezing of a woman’s eggs or oocytes. This procedure has become available to women who are going to have either chemotherapy, radiation or some kind of surgery that is going to prevent them from getting pregnant in the future. “A major concern with freezing eggs, however,” says Yuzpe, “is that the pregnancy rate still isn’t very high but it’s their only hope of trying to preserve their own fertility.

“On the other hand, if it’s a matter of freezing eggs today because it’s not a convenient time for a woman to get pregnant” — what Yuzpe calls “social egg freezing” — “this is not an area that we promote or recommend until the research studies that we are currently conducting prove that we can do this safely and effectively”.

Pre-implantation genetic diagnosis (PGD) is relatively new and is a very important and specialized treatment that Genesis provides. This treatment enables couples who carry a genetic abnormality to avoid transmission of the disease from a parent to an offspring. If passed on, these conditions could result in future serious illness or even death. Huntington’s disease, muscular dystrophy and cystic fibrosis are examples of the more than 200 genetic diseases that can be tested and thus eliminated. More than 25 healthy babies have now been born as a result of PGD at Genesis. ”This is not making designer babies; this is treatment for prevention of serious or life-threatening disease,” says Yuzpe.

THE FINAL MESSAGE
If you think you have a fertility problem, if you haven’t gotten pregnant within a year of trying or sooner if the female partner is over 37 years of age, see your family doctor. Fertility rates decline and miscarriage and genetic risks to the infant increase with maternal age, so be sure to make a conscious and informed decision regarding the right time for you to start trying to get pregnant. One in seven to eight couples will have some difficulty in getting pregnant, so if you do experience a problem, remember that you’re not alone and there is usually help available. Be your own advocate and get help early. •