Expecting Miracles
Advances in reproductive care help couples overcome infertility and realize the dream of starting or adding to a family.
For as long as she could remember, Janice Perkins* had four things on her “to do” list: get into an elite college, where she could earn an advanced degree in her chosen field of study (engineering); get a well-paying job that would enable her to travel, buy a nice house, and enjoy a comfortable life; find the right person with whom to share her life; and have children, preferably a boy and a girl, if possible.
She had crossed off the first three items on her list by her 30th birthday. But when it came to starting a family, though, she just wasn’t ready.
“I got engaged at 27, married at 28, and we felt like our lives were just getting started,” says Perkins, a Paoli native. “We both wanted kids eventually, and we knew it was something we had to plan for. Once you hit your early 30s, time flies. By the time we really started thinking about it, and when we started trying, I was 37. You can probably guess, but it didn’t go as planned.”
As her 38th birthday came and went, a creeping suspicion became a realization: Perkins and her husband were having problems getting pregnant. It was time to meet with a fertility specialist.
Perkins’ experience rings true for an increasing number of Americans, according to fertility experts such as Divya Shah, M.D., MME, assistant professor of clinical obstetrics and gynecology for the University of Pennsylvania Perelman School of Medicine.
“Culturally, we are seeing some individuals delay marriage and child bearing until their late 30s and early 40s, which have a significant impact on fertility,” Dr. Shah says. “Epidemiologically, the most common causes of infertility are male factors (primarily abnormalities seen on semen analyses), and female factors related to ovulatory dysfunction.”
Infertility refers to the inability to get pregnant after one year of trying, or six months if a woman is 35 or older. By the numbers: About 10 percent of women in the United States between ages 15 and 44 have difficulty getting pregnant or staying pregnant, according to the U.S. Centers for Disease Control and Prevention.
But the problem affects more than women alone, according to Hayley Eichlin, DNP, APRN, WHNP-BC, a nurse practitioner with Reproductive Medicine Associates of New Jersey, which has fertility clinics in or near the Greater Philadelphia Area.
“The public awareness of male infertility is still shockingly low,” she says. “People typically believe it’s a woman’s problem, but men are almost equally susceptible.”
Also, a significant number of patients present with what Dr. Shah refers to as “unexplained infertility,” meaning there are no obvious red flags. While these issues may cause frustration in the fact that someone’s struggles cannot be precisely explained, Dr. Shah sees a silver lining: “I always emphasize that the absence of any insurmountable obstacles can be an overall positive in terms of prognosis.”
In recent years, technological advances have had a significant impact on fertility clinics’ ability to help clients achieve the dream of starting a family. These include preimplantation genetic testing, also known as PGT, and oocyte vitrification, also known as egg freezing.
“With PGT, we’re able to grow embryos to the blastocyst stage—five or six days of life—and biopsy a small number of cells,” Dr. Shah says. “With this technology, we can avoid passing along certain genetic disorders and identify embryos that may be more likely to result in a live birth.”
Vitrification used to be considered experimental, performed only in situations where young or un-partnered women were faced with conditions such as cancer that posed an immediate threat to their fertility. That, however, has changed.
“As the technology has improved, the applications have extended far beyond that to include elective egg freezing for individuals who are not yet ready to conceive,” Dr. Shah says. “It is important to note that oocyte vitrification is not a guarantee of future fertility, but can provide additional assurance for individuals who choose to undergo the procedure.”
More to Come
While fertility treatment has grown exponentially in recent years, multiplying a couple’s or individual’s probability of one day having a child, experts expect more progress in the years to come.
For its part, RMANJ is using its groundbreaking research capabilities to better understand the factors that influence fertility. One of these research projects involves the reproductive tract “biodome,” according to Jason M. Franasiak, M.D., FACOG, HCLD-ALD, lead physician and lab director of RMANJ’s newly opened office in Marlton, N.J. Essentially, this research will explore how the microbes living within the human reproductive tract may affect reproductive outcomes.
“This is a special, special place to work,” Dr. Franasiak adds. “Being able to identify areas in which we can help people build families is incredibly rewarding.”
As for Janice Perkins, she was ultimately able to cross off the last item on her “to do” list. Meeting with a fertility specialist helped to identify the source of the reproductive problems she and her husband had been facing. Through in vitro fertilization, Perkins got pregnant and carried the baby to term. She’s now the mother of a happy, healthy girl.
“Everyone has ideas of what they want out of life,” she says. “For me, one of my goals was to have two kids. The first time I held [my daughter], I thought: This is enough. This is everything I could possibly want.”
Positive Signs
Social media abounds with images of young parents doting over swaddled newborns. While such images are likely to amass plenty of “likes” and “shares,” they may generate a much different reaction from those who struggle to accomplish what seems to come so easily to everyone else. For these individuals, Eichlin has a message: “You are not alone.”
Throughout history, infertility has borne a certain amount of stigma, treated as something to be ashamed of and kept to oneself. Those who go through it often experience anxiety, depression, and feelings of isolation, which, in turn, can strain even the closest personal relationships. That’s why Eichlin refers to it as “a silent struggle.”
“People find themselves not wanting to go to a picnic or family get-together because they fear other people will ask when they’re going to start having kids,” she says. “It can be psychologically disabling. Couples need to know that they are not the only ones who are going through this struggle.”
The stigma may be starting to fade, however, driven in part by more accurate portrayals of infertility in entertainment media and by public figures such as Michelle Obama coming forward to talk about their own struggles. Likewise, Eichlin says more people are sharing their personal stories through social media and other platforms.
“By reading or listening to someone else’s story, other people who are going through this feel like they’re not alone, and that’s super important,” she says. “It’s almost like it gives people permission to talk about it, and that can feel as though a huge weight has been lifted.”
Dr. Shah has noticed a shift, too.
“No one likes to feel that they are the only ones having difficulty conceiving, and considering that the prevalence of infertility is about 10 to 15 percent, chances are they know someone else who has struggled with it, too,” she says. “Even if people aren’t immediately forthcoming about their own reproductive challenges, once they hear about the struggles of others, they do seem more willing to come out of the woodwork and say, ‘I went through something like that, too.’”
* Name changed to protect privacy
