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Infertility Facts and Fiction
Jeffrey A. Keenan, M.D., F.A.C.O.G.
As in any field of medicine, the specialty of infertility is shrouded with misconceptions and fallacies.
Whose Problem?
Fiction: One of the oldest, prevalent fallacies is that infertility is a female problem. Research shows that infertility is primarily male-factor related in 40% of cases, and that the male factor plays a role in another 20-25% of cases.
Fact: A semen analysis is a vital part of every infertility evaluation, even if the wife has known problems.
Hope for Males
Fiction: A more recent misconception is that male factor infertility cannot be treated. While it is often true that the sperm count, motility, morphology, etc., cannot be substantially improved, a significant number of individuals can benefit with medical or surgical therapy.
Fact: The advent of the ICSI (Intracytoplasmic Sperm Injection) procedure allows virtually any husband with functioning testicles to become a father, regardless of the sperm numbers.
Endometriosis
Fiction: The role of endometriosis in infertility and the treatment of this condition still is greatly misunderstood. Previously, we believed that Stage I and II endometriosis did not cause infertility, and that treatment of minimal or mild endometriosis was not helpful. More recently, data shows that surgical treatment of low stage endometriosis may be beneficial in helping achieve a pregnancy. More importantly, many physicians and patients are still of the opinion that the only way to treat endometriosis is with a complete hysterectomy. The obvious consequence of this is that many women have been permanently denied the ability to conceive and bear children as a result of overly aggressive management of this disease.
Fact: It is rarely necessary to perform a hysterectomy for endometriosis in a woman who desires to preserve her fertility. Even Stage III and IV endometriosis can be treated with conventional therapy, and pregnancy rates of 40-50% can be obtained.
"Conventional Wisdom"
Fiction: Fertility specialists still receive many questions regarding the role of stress and anxiety in fertility. "Conventional wisdom" is that pregnancy will occur if a couple goes away for a romantic weekend, if a couple "just learns to relax," or if they have an alcoholic drink before intercourse, etc. A corollary notion is that pregnancy will occur soon after adoption.
Fact: Recent data indicates that significant amounts of stress and anxiety may play a role in a minority of couples with infertility. For these couples, medical and/or psychotherapeutic intervention may be helpful. However, many couples with objectively identifiable high stress levels conceive without such interventions.
Choosing Your Physician
Fiction: Being treated by a general Obstetrician/Gynecologist is the same as receiving treatment from a Reproductive Endocrinologist.
Fact: General Gynecologists typically receive only four to six months of training in infertility during their residencies. Following this, they typically may see one or two infertility patients per week. This is in stark contrast to Reproductive Endocrinologists who have an additional two to three years of infertility training and research experience following residency. Most of these physicians then specialize in infertility care, with 60-90% of their patients being seen for such treatment. This often translates into a more efficient, less expensive evaluation, and a more successful outcome.
Moral Choices
Fact: There is extreme diversity in the moral and ethical values of all physicians, including infertility specialists. Most infertility specialists are technically very competent. However, I have found that many are extremely cavalier in their attitudes toward the embryo and other "respect life" issues.
Opinion: As Christian patients, I urge you to "pin your doctor down" about his/her opinion on these issues. Does your doctor suggest, recommend, or perform fetal reduction? Does your doctor discard embryos? If so, are these only nonviable embryos? Many of these issues will be very relevant to Christian couples undergoing fertility treatments. Unhurried communication with your physician and his or her office staff are important. Education and open communication will help you achieve optimal treatment and outcomes.
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