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Climbing Mount Everest

Climbing Mount Everest

I believe the current criterion is that if a heterosexual couple has unprotected sexual intercourse for at least 12 months with no resulting pregnancy, then the couple is considered infertile. Recently I have seen a number of women who have been labeled infertile for any number of reasons. In those women's lives, there is nothing more psychologically distressing. Infertility stresses the most central relationship of their life, it disturbs their daily activities, it reduces their ability to focus at work and often times there is estrangement from family and friends. It is an uncomfortable situation all the way around. Not to mention sexual intimacy leaves their relationship, only to be replaced by forced mechanical scheduled coital adventures with its sole purpose being insemination, fertilization and implantation of a viable egg into the uterus. Forget love and all that jazz.

What's emerged over the past half century is the specialty area of fertility medicine. In these clinics, men and women undergo a large battery of tests evaluating their anatomy and physiology related to their collective fertility. Ultimately a diagnosis is rendered and a therapeutic adventure commences dependent on the clinical findings. Sometimes surgery is performed to repair a defect or open a fallopian tube, remove a vaginal cuff or remove a large ovarian cyst. Sperm needs a clear path to the unfertilized egg. Men are also evaluated to make sure their ejaculate has at least ten million motile healthy sperm. If there is a lack of the ability of the woman's ovaries to mature its follicles adequately, medication and hormones are used to strongly persuade the woman's ovaries to behave. Sometimes it works so well that a woman carries twins or triplets, but sometimes the treatment fails miserably. If the couple is unable to conceive a viable embryo, there is always the next step: artificial insemination.

Artificial insemination sounds like a relatively simple, non-stressful proposition emerging from ideas proposed in the famous novel Brave New World by Aldus Huxley. Just as a woman ovulates, a physician injects a syringe full of healthy sperm into the uterus through the cervical os (opening). It may be a sample of her partner's sperm if it is healthy enough to make the journey through the peaks and valleys of the uterine cavity and fallopian tubes or the sperm could come from a donor stored at a local sperm bank.

The injection occurs in the doctor's office under sterile conditions, no mood lighting here. The woman's legs are propped up and her vaginal canal is exposed to assure that the catheter attached to the syringe is properly placed to maximize the benefit of the injection. Not much romance associated with this method of insemination. It is a pure and simple stress filled procedure that most men would never participate in. What's the rate of success? Who really knows.

If artificial insemination does not work, the next step would be to harvest the woman's eggs and gather the male's sperm, mix them together in a Petri dish and let nature take its course. Once the eggs are fertilized by the sperm, the embryonic complex is subjected to pre-implantation screening. If the fertilized eggs pass the tests and have no apparent genetic defects, they are implanted into the woman's uterus. Let us suppose that the male's sperm will not penetrate the female's eggs, then they are injected into the egg. A solely unnatural act.

Some women get pregnant after some relatively simple adjustments of their hormones, but others make a much more extraordinary attempt that involves the most innovative scientific techniques. They become a participant in an advanced science fair project. I liken it to an attempt to climb Mount Everest.

The entire process of in-vitro fertilization (IVF) is extremely stressful. It is not paid for by medical insurance, so it is a huge financial drain. Maybe it is a twenty to thirty thousand dollar investment or more. Some couples undergo the procedure two or three times. That really adds up financially with no guarantee of having a healthy, hearty child. Most IVF clinics are in major metropolitan medical centers. Travel expenses as well as room and board add up too. The real stress is in the process itself. Weeks of painful injections of synthetic hormones and hormone suppressors, many times mood swings accompany each hormone injection. Daily blood draws and sonograms gives rise to the important questions: How many follicles? How big are they? Are they viable? What's the hormone levels? The emotional roller-coaster effect is outrageous. At the end of this phase of IVF, if there appears to be enough ovarian egg maturation for harvest, a surgical procedure is performed to retrieve the eggs from the pelvis. If the harvested eggs are not adequate, the adventure begins again and again until the desired results is achieved. When all is favorable and the eggs and sperm are united, then the artificial insemination procedure takes place.

What's the success rate? Poor, really poor. These advancements in modern medicine rarely work. Funny thing, we do not know how many natural sexual encounters end up in pregnancy in the normal American population. So how can anyone compare IVF to the natural rate of successful pregnancy? And there is no question that these clinics fudge their success rates. Most decline to publish their rates citing that they treat the most difficult cases and their clinic's rates are not comparable to other clinics that perform similar procedures because they take only the hardest, most complicated cases. Bottom line, going through one of these grueling IVF cycles has a very low rate of success. I often wonder if women have a better chance of being struck by lightning than getting pregnant by IVF. That is about one in a million.

The stress of the procedure has plenty to do with the low success rate. It's no time to have a picnic in a monsoon. The research on this aspect of IVF is vague. Women get updates about how well or how poor their body is responding to treatment. Because they are informed in a real time fashion, it skews the data. Women with the better response have less stress than women who have a poor response. Women who go through repeatedly unsuccessful IVF procedures probably are the most stressed of all. It is no time to get pregnant running from a tiger in the jungle.

I assume that if studies showed a definite correlation between the perceived stress of the procedure and failure rate of IVF, the only thing that would occur would be the doctor advising the patient, "Try to relax and stay calm throughout the procedure because stress has been shown to decrease the chances of successful IVF."

Perhaps we should suggest that women who seek IVF climb Mount Everest or successfully complete the Iron Man contest. I think the area of research that should be the highest priority in this area of medicine should be in eliminating the cause of the initial stress in the first place: Infertility. But where's the money in that?

Doc
Posted by Amanda Sanders at 8:17 AM
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