Hi, my name is Sue Pascoe and I am a staff writer at the Palisadian Post, which
is a weekly newspaper newspaper in the Pacific Palisades [Los Angeles, CA], and I do the monthly
"Healthy Column"
and uh... I'm nothing healthy right now, but [Sue Laughs]
anytime one of our readers has an issue about fertility, about
miscarriages, about anything to do with reproductive, I go to speak to one of the
top fertility specialists in the United States, Dr. Ingrid Rodi, to help me
clarify, so that I am able to explain to our readers what's going on.
and today
I'm wondering -
'What do you do if you're infertile? What - How do you know if you're infertile?'
and
I thought maybe Dr. Rodi could help us.
well um -
the first thing that
that couples need to know is that when they're considering
getting pregnant
they should consult their
family doctor or gynecologist
for preconception counseling. That means going in before they actually get
pregnant
to determine if there are any changes in the medications that they need, or if they have
any medical problems that might
complicate their pregnancy
and if there are any genetic
mutations that they're at risk for
and
the gynecologist will go over all those things and
give them the go-ahead -
Start her on
vitamins and on
folic acid -
SP: Oh so you should be taking vitamins even before you conceive?
IR: Yes, at least about
three months before.
There's also- SP: But it used to be so easy! Couldn't you just go and get pregnant
and that was it? Why do I have to go see my doctor before i even try?
IR: Well, you know, you want to optimize,
you know the
the chance that
the pregnancy is going to be
as easy as possible and that the baby's going to be as healthy as possible.
and once -
you know - the couples have been given the go-ahead
IF the woman is under thirty,
they're usually -
it's usually suggested that they try for a year.
SP: Okay, now by 'trying for a year' -
What does that mean?
IR: That means either - SP: I mean how many times am I having sex a week? What are we
talking here? IR: Right. That means either
just having sex regularly, meaning
three to four times a week
or using an ovulation prediction kit
which tells her
when she's going to ovulate.
So- SP: Okay, so
we've all seen it on TV - 'Honey! Honey! I'm ovulating! Come home quick!' Is that
really accurate?
IR: Well it's very helpful.
Especially if couples
are frequently out of town
and they're really trying to maximize
the timing,
then the kit is very helpful.
SP: Okay, so then
I'm under thirty and I'm having sex regularly or I'm using an ovulation kit - now
there is an old wives tale too, that after you have sex, if you're a woman you should put
your feet up -
does that actually have any truth to-
IR: No SP: Oh, okay so - IR: As long as everything is where it is supposed to be
you don't have to do anything. SP: You don't have to lay down for another hour, okay.
[Sue snaps her finger] Drat. Okay so now I'm under thirty and having sex regularly for a year
and i haven't gotten pregnant.
IR: Okay, so then, the couple comes back.
Or - if the woman is trying to get pregnant on her own - she comes back
and we look for for those areas which are considered deal breakers so
you need to be ovulating
SP: Why wouldn't I be ovulating? Doesn't every woman ovulate?
IR: Not every woman ovulates, and not every woman ovulates regularly.
SP: Oh, really? IR: So- SP: So if I'm one of those people that doesn't have a period
every month, would I be one of those 'irregular ovulators?' IR: Yes.
SP: Is that normal?
No, it's normal to have a period every month.
And if a woman is having a period
where the interval is more than five weeks
then she may ovulate but she doesn't ovulate regularly.
or at least not
or at least not every four weeks.
can you as a doctor
change that then? So that she can ovulate more regularly?
IR: Yes, there are medications we can give her to ovulate more regularly,
- in most cases.
okay so one of the things is then, if I come in, having that problem, you
check for regular ovulation.
IR: Right, the next thing we need to know is
if the man has sperm
and whether he has an adequate number of sperm.
And we do a semen analysis for that.
SP: Okay,
so,
what would be adequate number?
IR: Well- SP: I thought it only took one?
IR: Yeah, it only takes one, BUT uh... they have a long way to swim all the way from the cervix all the way up
to where fertilization occurs.
so you need actually more than one.
IR: You need about- SP: Or you need a SUPER super sperm to get the job done. spurted
IR: Right so you need - the normal semen analysis would have
twenty million
per CC.
and the usual volume is about-
at least two CCs per ejaculate.
SP: Okay, now so when you say 'CC' - how are we talking - a teaspoon full? Or
are we talking a pin head? What are we talking?
IR: Several drops certainly
SP: Several drops, okay.
IR: So that's measured in the lab
so they measure that.
SP: Okay so my partner who might not be thrilled about this will go to a lab
and produce a little
petrie dish full of semen to be looked at. IR: Exactly.
and then we also need them to be swimming
in the forward direction.
SP: No backstrokers?! IR: No backstrokers, well as long as they go forward [both laugh]
so we look at
both the count,
the motility, and how many of them look normal.
So one of the things that we're looking at is
whether the,
whether the sperm
have normal heads
SP: [pointing at diagram] One's a two header.
Some of the sperm have two heads?
IR: some of them have two heads and -
SP: Will that give you twins, if you have two heads?
IR: they typically don't do much of anything.
and some of these have two tails.
so you really want- SP: This one looks like a pointy head
he's not a good swimmer then either.
IR: No, all of these -
this is the normal one [points] and all of these are not so good.
SP: So could one of them make it up there or probably not? IR: Probably not.
This is the
best way to get up there.
okay, so if you go in then and you find out that
the problem is the sperm
then what do you do? IR: Then there are specialists
who evaluate the male and see
if there's anything they can do to improve the situation
if not then we sometimes have to
treat the
woman to compensate for the problems in the man. One of those treatments is
insemination
'Artificial insemination' or 'in Vitro Fertilization.'
SP: Okay so now
so I'm sorry to sort of goad this, but I haven't heard much about
what - how can a man
improve? I mean what -
just not be as stressed as much? Would that
make better sperm? IR: Well, one of the
things the male
fertility specialist will look at is whether he's on any medications that
have a bad effect on the sperm.
Men who
smoke marijuana
often have sperm that are pretty slow swimmers so- [Sue Laughs]
SP: And they get munchies on the way up, I'm sure.
IR: Yeah - it's not enough for contraception
so I don't mean to suggest that marijuana is contraception, but it may slow them down.
so they have an
evaluation of their hormones
and a physical exam
and if all of that turns out to be normal, we can
inject the sperm into the egg
during in vitro fertilization.
SP: Okay, so now we've gone through:
a possible ovulation problem, a possible sperm problem,
what else might you evaluate me for? You find out that I am ovulating fine, the sperm
seems to be fine, and we are still not getting pregnant.
IR: So you really need the
fallopian tubes to be open.
SP: Oh, can you ovulate even if the fallopian tubes are not open? IR: Yes.
So the fallopian tubes need to be open because the eggs come from
the ovary,
fertilization occurs in the fallopian tube, and then the embryo
goes down
to the uterus.
And if the fallopian tubes are blocked,
you can ovulate, but you can't fertilize the egg.
SP: Where does the egg go then, if they are blocked? IR: It just disintegrates.
SP: and then that means sperm can never get to the egg. IR: Right.
SP: What causes blocked fallopian tubes?
IR: There are a number of causes - a woman could have a ruptured appendix,
and that infection can cause
a blockage of her
fallopian tubes. She could have a
sexually transmitted disease,
such as, chlamydia or gonorrhea
and that could block a tube.
She could have endometriosis, and have a blockage as a result of that.
So it is very important to find out whether the fallopian tubes are open
because otherwise
you can't get pregnant on your own.
SP: What if you find that they are blocked? Then what do you do?
IR: In some cases you can open them, but in the majority
of the cases you undergo in Vitro Fertilization
which can bypass the fallopian tube so we
remove the eggs,
fertilize them in a dish, and then we put them into the uterus. So, we bypass
the fallopian tubes.
SP: Okay, so what else could be a problem then?
IR: Those are the major ones, those are the ones that
we call 'Deal Breakers' because
you know, if you don't have sperm, if you don't ovulate,
and if you have blocked fallopian tubes - those are
serious problems.
SP: How about - Say, I am 45 now.
I have been ovulating, I am 45, I look very youthful, I have kept myself in
great shape,
I've got a younger partner, so his sperm is fine,
we know the fallopian tubes [are fine] -
Why would not be getting pregnant then?
IR: Well because we know that
it takes
more eggs
or more cycles, or more trying
to actually get to the one egg that's going to be normal
because with age the percentage of eggs
that are affected by
all kinds of abnormalities goes up.
SP: But I am so youthful!
i mean I can do a triathlon, I can do - I mean why would my eggs i didn't even any why would why eighties
not be as youthful as I appear to be, even though I am thirty-five?
IR: We're not sure but we think it was an
evolutionary advantage
not to have babies in our forties and fifties. So-
SP: Are you saying that even if I can keep my biceps relatively good, there is
no exercise to keep these eggs young?
IR: No,
the only thing you can do is not smoke cigarettes
and not get radiation or chemotherapy to your ovaries. Those things ACCELERATE the loss of
fertility
but otherwise, your ovaries are on their own time clock.
SP: They sort of every year get older, no matter what's going on with my life.
IR: Right. SP: Okay, so then that
probably would be a key thing that you would ask too, if I come in - is my age.
IR: Yes.
SP: And if I'm 50?
Can I still get pregnant then?
IR: If a woman is 50,
her uterus may be able to carry a pregnancy
but the likelihood that she would be able to get pregnant with her own eggs is very remote -
less than one in a thousand -
so in that case some women will carry
either
an embryo that was made from a donated egg
or a donated embryo, from a younger woman.
And that is often a very
good solution
for a couple where the woman is already
past fertility.
SP: When you say "past fertility,"
what age are we sort of looking at?
IR: Well, at 38 it is 50/50.
and at 47 it is basically 100%.
SP: So if I want to get pregnant without using a donated egg, then I really should do
it before 38.
IR: Yup -
to start trying
and some women who
want to postpone childbearing, will either freeze their eggs or freeze embryos
for later use.