Plan for Someday

One in eight couples struggles with fertility problems.¹

Approximately 40 percent of fertility problems are due to a female factor and 40 percent are due to a male factor. In the balance of the cases, fertility problems result from problems in both partners or the cause of the infertility cannot be explained.²

In some cases, patients can take actions to prevent fertility problems. Lifestyle choices, such as improving one’s diet and quitting smoking, can enhance fertility. However, many causes of fertility problems cannot be prevented.²

• Age: Fertility decreases with age in both men and women. A woman’s fertility peaks in her mid-to-late 20s, starts to decrease in her late twenties and drops dramatically at age 35. A man’s fertility begins to decline after age 35.^3,4
• Medical History: Certain medical conditions or histories, including a history of STDs or abnormal menstrual cycles, could be a factor.
• Lifestyle Choices: Smoking, excessive alcohol use, poor nutrition (either under-nutrition or obesity) abnormal levels of exercise and excessive stress can all contribute to fertility problems.⁵

• Women under the age of 35 who have been actively trying to conceive for one year without getting pregnant need to realize that this could mean there is a problem.
• Women over the age of 35, however, should speak with their doctors if they’ve been trying for six months with no success. This is because fertility dramatically declines as a woman reaches her mid-to-late 30s.
• Regardless of her age, any woman having irregular menstrual cycles who cannot conceive within six months should see her doctor.

Many fertility problems can be treated by an OB/Gyn without an extensive fertility evaluation. An OB/Gyn can conduct a basic fertility work-up. However, if a problem is found during an evaluation or for more complex fertility issues, individuals should seek out help from a fertility specialist, known as a reproductive endocrinologist.²

The process begins with a consultation. The consultation is followed by a full physical exam for each partner and basic fertility testing:

• Men usually have a semen analysis done first to look at the number, shape and movement of the sperm.
• For a woman, the doctor will run blood tests, and possibly an ultrasound, to determine whether she is ovulating normally.⁵

There are a number of methods to treat fertility problems, including medicine, surgery and assisted reproductive technology. A reproductive endocrinologist takes a number of things into consideration when recommending a specific treatment plan.

A reproductive endocrinologist (RE) is an obstetrician/gynecologist (OB/Gyn) with advanced education, research and professional skills in reproductive endocrinology and infertility. REs complete at least two additional years of specialized training in reproductive endocrinology and infertility at an approved fellowship program, following their training in obstetrics and gynecology.⁶

This specialization is important in the constantly evolving field of infertility, where physicians must be aware of new tests, drugs and procedures. REs can treat both men and women, and some REs have subspecialties, such as in reproductive surgery (for fibroids or endometriosis). The RE will provide the couple with a range of treatment options, cutting-edge therapies and direct access to services that will be needed throughout treatment at his/her office or center.

In IVF, a man’s sperm and a woman’s eggs are combined in a laboratory dish, where fertilization occurs. Some of the resulting embryos are transferred into the woman’s uterus to develop naturally.⁷

The average cost of an IVF cycle in the United States is $12,400. Similar to other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment, and the cycle may need to be repeated to achieve success.⁷ Schering-Plough offers a discount program for patients paying for medications out-of-pocket. For more information, patients should ask their physician, nurse or pharmacist.

• From 1985 through the end of 2006, almost 500,000 babies were born in the United States as a result of reported assisted reproductive technology (ART) procedures.⁷
• IVF currently accounts for more than 99 percent of ART procedures.⁸
• The average live delivery rate for IVF in 2005 was 31.6 percent per retrieval - a little better than the 20 percent chance in any given month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term.⁸
• In 2002, approximately one in every hundred babies born in the US was conceived using ART; that trend continues today.⁸

The degree of services covered depends on where a person lives and the type of insurance plan. Fourteen states currently have laws that require insurers to either cover or offer to cover some form of fertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia.⁸