My Fertility Plan Blog: Your Conception Action Plan

The REAL Cost of Infertility

Infertility is something none of us expects or plans for.  It hits us at our very core…emotionally, physically, spiritually and financially.  No matter who you are or where you are on your fertility journey, you will spend more time, money, and energy than you ever anticipated when building your family once you are faced with difficulty conceiving.

Unfortunately, many outside infertility circles have a hard time understanding the impact infertility makes.  Let us help inform and educate others about the high costs of infertility.  Please leave us a post about  WHAT HAS INFERTILITY COST YOU?  Since all of these posts are anonymous, be as open and honest as you can about all that you have paid throughout your experience with infertility.

We look forward to reading your posts and sharing them with others so we can finally change people’s attitudes and perceptions about the real price of infertility. 

Money, Money, Money

Ever watched “Say Yes to the Dress?” We confess, we’ve seen it a few times. One of the things they say is important - from the very beginning, know how much money you have available to spend. After all, if you walk in the door, start trying on dresses and fall in love with a $25,000 and your entire wedding budget is $20,000, you’re going to be mighty disappointed.

As weird as it sounds, fertility treatment isn’t that different. Since most fertility treatments are not covered by insurance, the fact remains that treatments are affected by available cash. As such, we encourage patients to talk to their health care providers about their budgets and how their financial situation was going to impact the types of medical decisions they made.

A fertility doctor, whom we have the deepest respect for, recently said to us that he did not feel it was appropriate to tell patients to talk to their doctors about money. After all, he explained, “the cost of treatment should have no bearing on medical decisions. As a doctor, I make the best treatment recommendations regardless of cost or the patient's financial situation.”

In an ideal world, we agree. But even fertility doctors are beginning to see the impact of limited dollars affecting fertility treatment decisions.

ASRM recently reported:

• More than half (58 percent) of couples diagnosed as infertile who opted not to pursue treatment said cost was the primary reason;

• About 7 percent of couples who had leftover embryos in cold storage discarded the embryos from October 2008 to March 2009, a number that was almost three times higher than six months prior. The theory is that couples were no longer able to afford a frozen embryo transfer, or not able to afford the costs of freezing the embryos.

We encourage you to make medical decisions based on what’s best for you and your family. We wish the sky could be the limit when it comes to your family building. We really do. But, the reality is that almost everyone must face financial limitations. Infertility can be draining. At My Fertility Plan, we want you to be healthy…emotionally, physically, and financially.

Should You Wait Until Financial Storms Pass?

This just in from Integramed's Conception e-newsletter:

Can We Wait to Get Pregnant?

By Michael Soules, M.D.

In these difficult economic times many couples, who otherwise would be attempting to get pregnant now, are asking themselves whether they can wait to get pregnant and not jeopardize their chances to have a baby. The answer is: it depends.

If the couple's medical history indicates a likelihood of infertility then it is best not to wait. Some clues that could indicate a fertility problem are:

• Irregular menstrual periods.
• Menstrual pain that is becoming progressively worse.
• A prior sexually transmitted infection in either partner.
• Too many past episodes where lapses in contraception didn't result in a pregnancy.

For the female partner there is a loss of fertility potential as she gets older. On average a woman's peak fertility is in her late 20's; decreases somewhat to age 35; and decreases sharply after 35.

Percent	20-24	25-29	30-34	35-39	40-44	45-49
Pregnant the First Year	48%	43%	40%	35%	17%	4%
Eventually Pregnant	94%	91%	85%	70%	36%

_{Fig 1. This is a figure from a famous study by Menken (Science; 23, 1389; 1986) who reported on the birth rate of normal couples in populations who did not use contraception and kept good birth records. Whether it is the "eventually pregnant" or the "pregnant the 1st year" curve, note the steep slope after age 35.}

However, these are average ages for a population of women. When it comes to an individual woman, her fertility may be better or worse than the population average for her age. In other words, two women who are the same chronological age may very well be quite different in terms of their fertility potential.

The ovary has a functional age wherein it ages to extinction at menopause. There is a wide range for normal menopause from age 42 to 58 years which reflects wide variation in ovarian aging amongst women. Considering the fact that fertility is moderately to severely compromised beginning 10 years prior to menopause, a woman in her mid 30's could already be infertile or still have a number of fertile years remaining.

Women over 30 who want to delay conception should be advised to assess their functional ovarian age (ovarian reserve) in order to make an informed decision. We recommend using two approaches (endocrine and anatomic) to estimate ovarian reserve.

Endocrine: a cycle day 3 FSH and estradiol level are measured with simple blood tests.
Anatomic: an ovarian ultrasound examination wherein the number of small follicles present (antral follicle count) gives a good approximation of the current total number of eggs in both ovaries (approximately 800,000 at birth; 0 at menopause).

While fertility still decreases with age even with normal ovarian reserve, it wouldn't be unreasonable to wait 6 to 18 months to attempt conception if her reserve is normal and she is younger than 38 years old. After age 38, it is not a good idea to delay conception if pregnancy is at all possible.

There are only minimal age issues in terms of sperm production and fertility in normal men until they are truly elderly. However, young men of reproductive age can have abnormal sperm production that does get worse as they age if they have other medical conditions. The best example would be a relatively common male fertility problem wherein there is a subtle dilatation of the veins (varicocele) draining one or both testicles. In this case the testicular damage increases over time and sperm production becomes further compromised as the man gets older.

The simplest way to check to see if there are any sperm problems is to have a semen analysis. Figure 2 is a side-by-side comparison of semen analysis results from a normal fertile man compared to a man with a varicocele

FIG2	Normal	Varicocele	Range
Volume (ml)	3.5	2.8	3-5 ml
Concentration (x106/ml)	64	16	20-250
Motility (%)	57	35	≥50%
Rapid & Linear (%)	18	4	≥15%
Morphology	39	11	≥30%

_{Fig 2. Normal semen analysis (left column); Semen Analysis from a man with a varicocele (right column). A man with a varicocele generally has decreased count, motility and morphology as seen here.}

For a couple who wants to seriously consider postponing their fertility, it is recommended that the female partner have an assessment of her ovarian reserve and the male partner have a semen analysis. Ideally, both of these tests would be performed and/or interpreted by a reproductive endocrinologist or an Ob/Gyn physician who has this expertise.

For some, waiting it out through tough times may be an acceptable option. Others may feel pressed to make hard choices.

Dr. Michael Soules established his practice in reproductive endocrinology at the University of Washington in 1980. He now leads the fertility expert team at Seattle Reproductive Medicine.

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