Special Delivery
Local couples struggling with infertility go to great lengths to have a family of their own—and find it’s well worth the fight
by Leigh Stuart

Beth and Pat Coleman knew they wanted a family and wasted no time trying as soon as they got married. Yet, after two years, they had still seen no results. That’s when they had the good fortune to begin work with the specialists at Abington Reproductive Medicine in Abington.

The couple did their homework and began the fertility process by researching their options, including those regarding finances and insurance coverage. They were willing to be “as aggressive as necessary to get fast results,” Pat says. With the help of Stephen G. Somkuti, M.D., they formulated a plan.

“Dr. Somkuti was fantastic with the information he shared, including what he wanted to do and how he would work with us,” Beth says. Pat agrees, adding, “He did a great job of filling in our knowledge gaps.”

The doctor’s first step was to gather information, checking on facets of reproductive success by completing blood work and determining the number and viability of Beth’s available eggs.

Results from these tests indicated something strange—namely, that Beth was pregnant. Unfortunately, Beth explains, these results indicated that her hormone changes were the result of a “chemical pregnancy,” meaning pregnancy hormones were present in Beth’s body but the embryo could not properly attach to the uterus, a situation that would lead to problems down the line.

“For them to then explain to us that if [the embryo] did develop, it would be a problem,” she says. “They were so nice about it. Especially to me, a hormonal woman, they were really, really great about that.”

Knowing this now to be the case, Beth and Pat proceeded with their reproductive journey by pursuing a course of intrauterine insemination, or IUI, which is perhaps more commonly known as “artificial insemination.”

This proved to be a positive decision, as Beth did get pregnant from this treatment, but sadly, she miscarried. At that point, Beth recalls, Dr. Somkuti suggested an even more aggressive approach for Beth and Pat, both of whom turn 40 years old this year.

They next tried in vitro fertilization, or IVF, a means of assisted reproduction that has been in existence for more than 30 years but has seen increased success as technology and time have advanced. The process involves a number of steps, the first of which is typically to coax a woman’s ovaries to produce more eggs through the use of fertility drugs. Those eggs are then retrieved through a minimally invasive surgery and fertilized. Three to five days after the fertilization, the egg is placed back in the womb.

“Humans are pretty inefficient when comes to reproduction,” Dr. Somkuti says. “As we age, the reproductive system, unfortunately, in women goes and you get an accelerated loss or attrition of eggs.” He explains that even if a woman experiences no physical challenges, a woman’s chance of getting pregnant is still a slim 20 percent when she is under the age of 35. The number drops to 12 percent at age 40 and a staggering 1 percent at age 45.

Isaac Sasson, M.D., of Shady Grove Fertility Center, which has local offices in Bala Cynwyd and Chesterbrook, also assists individuals in building families. He says that IVF is a “remarkably successful treatment,” yielding, in best-case scenarios, a 50 percent delivery rate.

There are also risks, of course, as there are with any medical procedure, but Dr. Sasson says IVF involves what are generally considered to be low-risk procedures. Couples experiencing difficulty conceiving often have more than just potential physical obstacles to overcome; psychological, emotional and financial difficulties arise as well.

Couples can feel particularly “alone” when experiencing reproductive difficulties. Dr. Somkuti explains that fertility problems are hardly rare, and that couples experiencing such difficulties should not feel isolated in their situation. “The most recent data has suggested as many as one in six couples experience fertility problems in their lifetimes,” he says.

“The doctor needs to be acutely aware of the emotional stress that [difficulty in conceiving] puts on you as a person and your relationship,” notes Dr. Sasson, adding that couples cannot let anger or feelings of inadequacy break them down. “Couples come into our office in love and in a relationship and we want them to stay that way.”

Luckily, many fertility centers, including Shady Grove Fertility and Abington Reproductive Medicine, offer psychological resources to help couples as they face these myriad issues. Dr. Somkuti strongly encourages people to take advantage of these mental health resources. “[Infertility] can be one of the most stressful things a couple can go through,” he says. “Something that seems so easy for other folks to achieve can cause anxiety, depression and relationship problems for others.”

He notes that support groups, many of which meet on a regular basis at respectable reproductive centers, can help people to “vent their feelings” and reinforce that patients are not alone in their struggles. He adds, “The less stressed you can be, the better it is for you.”

The Colemans experienced many of these problems when trying to conceive, but persevered by utilizing the vast resources available to couples in their situation. They advise other couples to ask their doctors all the questions they can and to not consider infertility as “some big, dark, scary problem” that should make individuals feel embarrassed about. Pat, in fact, compares fertility difficulties to common injuries as simple as a sprained ankle: “If you need help, you go to a pro.”

For couples such as the Colemans, who persevere and ultimately succeed despite fertility challenges, the rewards are immeasurable. For them, after two years on their own, and eight months of trying with the help of Dr. Somkuti, they finally earned their greatest joy. Two weeks after their eighth month working with Abington Reproductive Medicine, they saw the first ultrasound images of their little girl, Charlotte.

Better known around her house as “Charlie,” Charlotte recently turned 21 months old. A “daddy’s girl” with “curly hair, like Shirley Temple,” Charlotte instantly became the love of her parents’ lives. “She’s our sweet success,” Pat says.

There will soon be even more joy around the Coleman house. As of press time, Beth confirmed she is 15 weeks pregnant.

Built to Last
How to prevent injury to the “vulnerable” female frame

Nicholas DiNubile, M.D., is encouraged by the number of young female athletes participating in competitive sports these days. At the same time, he is troubled—and, in some ways, fascinated—by the uptick in females visiting his Havertown office bearing serious yet largely preventable injuries.

“I’m seeing a lot of knee injuries in female athletes playing basketball or soccer or lacrosse,” says Dr. DiNubile, who has become one of the region’s leading orthopedic surgeons, known for his expertise in mending knee injuries and other areas of sports medicine. “Females are five to seven times more likely to tear an ACL. There’s a clear difference, and they are more likely to re-tear it.”

He sees a few factors at work, including differences in the female frame that make it somewhat vulnerable. When girls’ bodies change upon entering puberty, for example, they inadvertently alter their landings when they jump; they land stiff legged, thereby exposing them to potential injury. Through neuromuscular training, however, they can learn proper form to protect themselves from getting hurt.

“I really feel we’re doing a lot of females a disservice by sending them out there by not giving them the proper training,” he says. “We have to look at it differently and approach it differently, and incorporate more preventive work. … A lot of young girls don’t put the time into training as they should. Women who want to compete probably have to do a little more work [than males].”

For more than 30 years, Dr. DiNubile has been an orthopedic consultant to the Pennsylvania Ballet. In that time, he says, he “can count on one hand” the number of elite dancers who have torn an ACL. Because these dancers start training at a young age, they develop strong cores, hips and gluteal areas, all of which can help prevent injuries to other parts of the body. “There’s something in dance that almost seems to immunize them from injury,” he says.

Other challenges to the female athlete stem from issues with bone density. “The roots of osteoporosis are in a person’s youth,” he says. “You reach peak bone mass in your late 20s, and everything after that is losses. If you haven’t saved enough you won’t withstand the losses enough.” He recommends doing without carbonated soft drinks, which some sources suggest can weaken bones.

These dynamics have inspired Dr. DiNubile to pen a book about the female frame, though such a book would likely differ from his bestselling “FrameWork” series. “What I like about the female frame is that it has unique issues,” he says. “It looks different, it’s shaped different, and sometimes—like during the menstrual cycle—it’s more vulnerable. … It’s essential for boys and girls to be active and be involved in sports. My goal is to make it as safe as possible, and it’s a risk you can lower and manage.” —Bill Donahue