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Guest Post — Working with a Reproductive Endocrinologist

 

As acupuncturists, we frequently see patients who would also benefit from a consultation with a REI specialist. However, sometimes there may be hesitation to take this next step due to the unknown. What will happen during the visit, and what does taking this step mean in the bigger picture of your journey to conceive? While every practice is slightly different, here are 5 things you should know, courtesy of Dr. Kara Ehlers at Vios Fertility Clinic in Wauwatosa…

  • When should you seek consultation with a fertility specialist?—Many couples feel they will be able to have a successful pregnancy if they just keep trying. While that may be true in some cases, if the woman is less than 35 and has not conceived within a year of attempting pregnancy or if she is over 35 and has not conceived in 6 months, it is recommended they have an infertility evaluation. Women are born with approximately 2-3 million eggs, by puberty they have around 250,000 and continue to lose eggs each month (even if they are on birth control). In her early to mid 30’s, a woman will have approximately 25,000 eggs. The age of the woman and her eggs is the biggest indicator of success when it comes to fertility treatments; which means that fertility treatments work best the sooner they are started. It is recommended couples seek care IMMEDIATELY if there is a known or suspected issue with the woman’s tubes, if she does not have regular periods, or if there is a known or suspected issue with the male partner’s sperm.

  • What to expect at your first appointment?—During your first visit at Vios Fertility, we will review the history of both partners and discuss your family planning goals. In order to get pregnant naturally, a couple needs four key components: eggs, sperm, a healthy uterus, and open fallopian tubes (a path for the eggs and sperm to come together). Any of those components could be the reason for the difficulty conceiving and in about 25% of cases, multiple components contribute to the issue. At the initial consultation, we review the recommended tests to evaluate all the components which include a combination of blood work and ultrasounds for the female partner and a semen analysis for the male partner. We also recommend checking some overall health labs, including a blood count among other tests.

  • Choosing the right fertility treatment—After all the testing is complete, we have the couple return to review the results and discuss potential treatment plans. Many patients worry that seeking consultation with a fertility specialist means they will have to do in vitro fertilization (IVF), but IVF is actually only required for a small number of fertility patients. IVF does give the highest pregnancy rates in a given cycle and can also be combined with genetic testing of the embryo to ensure the “best” embryo is transferred to the uterus. For these reasons, IVF is frequently recommended for couples where the female partner is in her late 30s or early 40s or if the male partner has extremely low sperm counts. However, most couples will be able to conceive with less invasive therapies such as oral medication with or without inseminations (using a catheter to put sperm into the uterus to get it closer to the egg). It is important for a couple to complete a full fertility evaluation to determine the best treatment option. For example, if it is determined that a woman’s tubes are severely damaged and blocked, inseminations will not work for her as healthy tubes are vital to enable the egg and sperm to meet in the body. In some cases, it may be recommended to consider using donor sperm or donor eggs to achieve a pregnancy.

  • How treatments may make you feel—Fertility treatments are usually well tolerated by patients and most women will have fewer side effects with the fertility medicine than they do with pregnancy. Medications to help “grow” the egg can be either oral or injectable depending on your treatment plan. Oral medications can be associated with hot flashes and mood swings, but most women do not find them bothersome enough to stop the medication. The most common side effect with injectable medications is pain or redness at the site of the injection. Injectable medications can also cause similar symptoms to pregnancy like headaches, nausea, mood swings, and pelvic discomfort. While having mild symptoms can be normal, if you experience any debilitating symptoms or anything you find concerning, it is important to reach out to your clinical team immediately to discuss your symptoms and whether what you are experiencing is expected or needs further evaluation.

  • Outcomes and success—Chance of successful pregnancy depends on many factors including: diagnosis, woman’s age, method of treatment, length of infertility, and if donor eggs or sperm is being used. Humans are very inefficient reproducers. In the best-case scenario, i.e. a young, healthy 20-something couple, there is about a 20% chance of getting pregnant each month. In couples with an infertility diagnosis using insemination, there is roughly a 6-15% chance of pregnancy each month. In any given month, IVF has the highest chance of pregnancy because the sperm and egg are combined in the laboratory and the embryo is observed for 3-5 days before transfer to make sure it is growing as expected. The Society for Assisted Reproductive Technology (SART) has developed a calculator to help predict a patient’s chance of successful pregnancy with IVF. The calculator can be accessed via the SART website at https://www.sartcorsonline.com/Predictor/Patient. Using the calculator, one can see the chance of having a baby per cycle can be 50% or higher for a 24-year-old female patient with a partner who has a low sperm count, but could be 5% or less for a woman in her early to mid-40s.

 

If you have been struggling to conceive, my advice would be to seek consultation with a fertility expert sooner rather than later. As eggs are lost every month, it is important not to fall into the trap of “waiting it out.” Taking the first step toward fertility evaluation/treatment can be intimidating and overwhelming, so at Vios, we offer a $99 limited fertility check-up called the Vios Fertility Pulse which consists of testing for ovarian reserve and a semen analysis. Checking ovarian reserve (how many eggs are left) and sperm counts can be a great initial step toward fertility treatment. At Vios, we focus on patient centered care and have an excellent team in place to guide you on every step of your journey. You are not alone!

 
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