Reproductive Medicine Clinic Helps Hopeful Parents-To-Be

Welcoming children into their lives is the hope and expectation of many people; however for millions of prospective parents in the U.S., these expectations are replaced by disappointment as they find themselves unable to conceive.

For Laura and Rob (the names of the couple have been changed), the disappointment had become familiar. Already suffering from endometriosis, Laura, age 26, was aware that becoming pregnant might be difficult. After trying for a year to conceive, the couple was referred to the Reproductive Medicine Clinic at the Medical College of Wisconsin. “The clinic provides a place that is sensitive to the needs of couples with infertility,” says Dr. Estil Strawn, Jr., Associate Professor of Obstetrics and Gynecology and Medical Director of the Reproductive Medicine Clinic. The clinic’s specialty areas include endometriosis treatment, artificial insemination and such high-tech procedures as in vitro fertilization and egg donation, as well as finding alternatives to hysterectomy.

The Reproductive Medicine Clinic is unique, according to Dr. Strawn, because of the expertise of its staff. “The clinic offers counseling and treatment by individuals who have a concentrated and dedicated background in reproductive endocrinology and infertility treatment,” he says, and provides couples with access to a rich variety of literature and resources that are not available at other facilities.

Dr. Strawn’s experience indicates that women who have been attempting to become pregnant for over one year, or women over 35 who have been attempting for six months, are good candidates for treatment at the clinic. In addition, couples in which the male partner has a known history of reproductive problems or the female partner has had pelvic surgery should consider visiting the clinic if the they haven’t been able to conceive after six months.

Multiple Factors Can Inhibit Conception
Their first time at the clinic, Laura and Rob gave a complete history of their previous testing and treatments and were thoroughly evaluated by the clinic staff. Because infertility factors are distributed fairly evenly among men and women, both partners usually are examined. To design a treatment plan, the medical staff must first determine whether the source of the problem is related to ovulation, sperm, the union of the egg and sperm, implantation of the embryo in the uterus, or a combination of these factors.

There are several common reasons that one or more of these issues may be present.

• Hormonal imbalances can prevent ovulation in women, resulting in irregular or missed menstrual periods. In men, such imbalances can affect sperm production.
• Sperm count may be low or sperm may be abnormal in size, shape or movement.
• If a woman’s fallopian tubes have been blocked or damaged, this can prevent the sperm from reaching the egg or hinder the embryo from implanting in the uterus.
• Endometriosis, in which cells from the uterine lining accumulate on the ovaries and other pelvic organs, can cause infertility
• A woman’s cervix may be shaped in such a way as to prevent sperm from reaching the uterus, or cervical mucus may be inhospitable to sperm.
• As couples age, fertility declines, especially in women.
• Injury or disease of the reproductive organs can lead to infertility.

Many Treatment Approaches Available
The first procedure that Laura underwent was a laparoscopy, a minimally invasive operation in which a surgeon inserts flexible tubes and a tiny video camera into the abdomen. This allows for examination and surgical procedures to be performed through small incisions. In Laura’s case, laparoscopic procedures relieved the menstrual pain she experienced due to endometriosis, but she was still unable to become pregnant. Dr. Strawn then recommended that she begin hormone therapy to induce ovulation. Six months passed with no resulting pregnancy. After further consultation, the couple decided to take the next step and try artificial insemination.

Four more months passed, with the requisite two-week waiting period after each of five attempts at artificial insemination. But once again, Laura and Rob did not conceive. With options and resources becoming restricted, it was time for them to choose between further hormone treatments or proceeding to more high-tech options. Because results of previous treatments seemed to point to a problem with her fallopian tubes rather than ovulation, Laura and Rob decided that the best use of their limited resources was to choose in vitro fertilization.

Feeling “anxious, but very confident,” Laura began the series of shots that would build up her uterine lining, followed by other injections to stimulate the development of eggs. On a Friday morning visit to the clinic, an ultrasound showed that Laura’s eggs were ready, and eleven were retrieved to be fertilized in the laboratory with Rob’s sperm. Nine of the eggs were fertilized; this was enough so that some embryos could be frozen to repeat the procedure, if necessary, without the expense of the preceding procedures. Two days later, Laura and Rob returned to the clinic, where two embryos were transplanted in Laura’s uterus.

During the two-week wait to ensure that the embryos had implanted successfully, Laura returned to the clinic several times for blood tests to measure the increasing concentration of hormones in her body. In a few more weeks, Laura and Rob were able to observe a single fetus through ultrasound, and more importantly, to see the beating heart of their baby girl.

Good Health May Help Promote Fertility
Although many times the issues leading to infertility are beyond a patient’s control, the RMC staff recommends a number of ways for both women and men to protect and enhance their ability to become pregnant. Women should have annual pelvic exams and pap screenings and do breast self-examination. Men should have a routine annual exam as well. Overall good health of the mother is a factor in a healthy pregnancy, specifically in the areas of regular exercise and a proper diet that includes a variety of grains, fruits and vegetables, plenty of water, and limited caffeine. Both women and men should avoid cigarettes and alcohol, and should find out about the side effects of any medications they are taking. Women attempting to become pregnant should take a multivitamin containing folic acid to lower the chance of neural tube defects occurring in babies, while men might consider taking supplements of Vitamins C and E and Zinc.

Not every couple that has difficulty conceiving will face a struggle like that of Laura and Rob. It is important to remember that a high percentage of women become pregnant without any reproductive treatments or therapies at all, and of the couples who do need assistance only a small percentage require the more sophisticated procedures like in vitro fertilization. For Laura and Rob, there is no question that the long journey they took with the Reproductive Medicine Clinic was worthwhile. On November 3, 2001, Rob and Laura, now 30, were overjoyed by the birth of their first child.

This article includes information from the Froedtert & The Medical College of Wisconsin Reproductive Medicine Clinic.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.