Infertility is the impaired ability to become pregnant or carry a baby to term. Approximately 1 in 5 couples have trouble conceiving a child.
Both men and women and be infertile, so what are the fertility evaluation and treatment options for men and women?
Board Certified Ob/Gyn and Reproductive Endocrinology/Infertility, Dr. Jane Frederick, FACOG explains the effect of age on reproduction, as well as the latest advances in the causes of infertility.
Selected Podcast
Fertility 101: Your Diagnostic and Treatment Options
Featured Speaker:
Organization: Saddleback Memorial Medical Center
Dr. Jane Frederick, FACOG
Dr. Jane Frederick, FACOG has been Practicing in California since 1990, Dr. Jane Frederick is an internationally noted specialist in Reproductive Endocrinology and Infertility. She is the Medical Director of HRC Fertility in Orange County, where she developed a diverse clinical practice in reproductive surgery, IVF, and the genetic screening of embryos. Dr. Frederick is board certified in both Reproductive Endocrinology/Infertility and Obstetrics/Gynecology from the University of Southern California. A renowned speaker, Dr. Frederick has educated medical colleagues in the area of fertility preservation, and age and reproductive issues with numerous publications. She has held many posts with organizations active in the advancement of reproductive medicine including the Pacific Coast Reproductive Society (Past President), and the American Society of Reproductive Medicine. In addition, Dr. Frederick has received a variety of honors for her outstanding work in the field, and recently ranked among the top 10% in the nation from U.S. News and World Report.Organization: Saddleback Memorial Medical Center
Transcription:
Fertility 101: Your Diagnostic and Treatment Options
Deborah Howell (Host): Hello, and welcome. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell. Today's guest is Dr. Jane Frederick, an internationally noted specialist in reproductive endocrinology and infertility. Dr. Frederick is board certified in both reproductive endocrinology and infertility and obstetrics gynecology from the University of Southern California. A renowned speaker, Dr. Frederick has educated medical colleagues in the area of fertility preservation and age in reproductive issues with numerous publications. She's held many posts with organizations, active in the advancement of reproductive medicine, including the Pacific Coast Reproductive Society, past president, and the American Society of Reproductive Medicine. In addition, Dr. Frederick has received a variety of honors for her outstanding work in the field and recently ranked among the top 10 percent in the nation from US News & World Report. Welcome to you, Dr. Frederick.
Dr. Jane Frederick (Guest): Yes. Thank you. It's nice to be here.
Deborah: Well, we got a vast topic in front of us, it's fertility. We could go for three hours, but instead, let's just try for 11 minutes, all right?
Dr. Frederick: Okay. That sounds good.
Deborah: What is the prevalence of infertility today?
Dr. Frederick: Infertility is a topic that a lot of people have been talking about more. About one in eight couples are actually experiencing infertility in their inability to conceive. Oftentimes, I tell patients that it's important that you get information about what's available to you so that you can make choices about how to proceed if you're having troubles trying to get pregnant. I usually recommend that patients under the age of 35 try for one year, and if they're unsuccessful, then seek medical advice on what's happening and get some testing. If a patient is between 35 and 40—the female, that is—I recommend that she only try for six months and then seek help to find out what's going on. If a woman is over age 40, I recommend that she go straight to the specialist so that we can actually figure out why she's not getting pregnant and really focus on that window of opportunity, because as a woman ages, the number of eggs that we have, the number of good quality eggs goes down, and so we really want to capture that window of opportunity for a conception.
Deborah: Absolutely. It's so, so vital. Can you describe for us the basic fertility evaluation?
Dr. Frederick: Yes. A few things that I can actually do within a few weeks of having a consultation and that can really give us a lot of answers on why women and men are not having a pregnancy and why they're unsuccessful. The first thing I would do is measure a woman's hormone, an FSH level and an estradiol level on the early part of her cycle, on day three. That tells me whether she has a good number of eggs still left in her system. So it's a hormone level that I can do early in her cycle. Then, I would do an x-ray called an HSG. It's a type of dye test that allows me to know whether the tubes are open, whether her fallopian tubes can actually handle an egg and a sperm undergoing fertilization and then allowing the embryo to get to the uterus.
Deborah: Interesting.
Dr. Frederick: This dye test also tells me whether the uterus is normal in shape and whether it can hold a pregnancy. The third test that I would run to rule out a male factor is to look at a sperm analysis, the semen analysis. It's a very simple test that we can order and get results back in a very short period of time. Those three parameters, those three tests will give this couple a lot of reasons why they're unsuccessful, and it will allow me to give them some options for treatment. So that can be done within the first few weeks of having a consultation.
Deborah: You get right on it. I love that. Okay. So how does age itself affect reproduction?
Dr. Frederick: Well, age is very important in its effect on reproduction, because as women, we are born with a finite number of eggs. As we progress, those eggs don't regenerate. It's not like the male, where he can regenerate sperm every 72 days. Women are actually born with a finite number. So we know that our best years of conceiving a healthy child are when we're in our twenties, but most people are not thinking about children until they're 30 and 40.
Deborah: Right.
Dr. Frederick: And we know that there's a lot of data showing that as women get over age 35, we start to see a significant drop in the number of eggs. And as we get over age 40, we see even a more significant drop in the number of eggs in our body. It's not only the number that goes down; it's also the quality of eggs that goes down.
Deborah: Right.
Dr. Frederick: So at the same time, we see an increased number of miscarriages as women get into their forties and a higher risk of genetic issues, such as a Down's baby, for example, that may impact the health of that child. So I'm always encouraging women to think about their biological clock and to seek health as early as they can when they know they're ready for a conception.
Deborah: That's right. So let's talk a little bit now about the treatment options for female infertility.
Dr. Frederick: Well, we have lots of treatment options for female infertility. So if the tubes are blocked, for example, I can do a type of surgery called a laparoscopy, and I can go in and actually open up the tubes to allow the eggs to better fertilize with the sperm. If the uterus has a polyp or a fibroid or some abnormal growth or scarring in it, I can do a procedure called a [hysteroscopy], an outpatient procedure that allows me to actually take out the tumor or the polyp and allow that uterus to be more normal and function normally. If the patient is not ovulating or if she has a polycystic ovarian disease where the periods are very irregular and the hormone levels are off-balance, I can actually give medications like Clomid or injectable medicines that really help to allow that patient to ovulate on a more regular basis, and that allows me to synchronize when she's having intercourse so that she can better have a successful conception.
Deborah: Outstanding.
Dr. Frederick: For the male factor, if the sperm is low or motility is low, meaning it's not moving as quickly as it should, there's the procedure called artificial insemination. An artificial insemination allows me to get the moving sperm and put them right into the uterus, very close to the opening of the tube, so the egg and sperm have time to meet at the right time.
Deborah: Excellent.
Dr. Frederick: So that would be options that we could do. They're very low-tech options. The high-tech option would include in vitro fertilization, and I would reserve this for patients who have been trying many years or were unsuccessful with the artificial insemination or the low-tech option. That's where I actually can fertilize the egg in a test tube and I can get it to grow, become an embryo, and then transplant the embryo back into the uterus so she can have a successful conception. Many of my couples are couples that have undergone recurrent miscarriage. They get pregnant but miscarry a lot, or they suffer from a genetic disease where they don't want to pass on the genetic disorder to their children. So there is a procedure called pre-implantation genetic diagnosis. This allows me to actually evaluate genetically each embryo by taking a cell from the embryo, testing it genetically, and then only put back the unaffected embryo or the healthy embryo that's free of any type of chromosomal abnormalities. So this has greatly helped increase the chance that the patient will have a successful conception.
Deborah: Incredible that you can learn all that from one cell, just amazing. I remember the Life Magazine where test-tube babies were on the cover and it was like, "Oh, my goodness. What are we doing?" And now it's just a norm. It's really helping so many people.
Dr. Frederick: Yes, a lot of options out there. It's nice that it speaks more of a standard of care now and that everybody should be able to access this type of care.
Deborah: All right. We have less than two minutes, but I did want to ask you about fertility preservation.
Dr. Frederick: This is where I have patients that come in, for example, who are cancer patients that have wanted to preserve their fertility before they're going to be undergoing chemotherapy. We are able to freeze an egg now, just like we are able to freeze sperm. We can actually freeze an egg as this woman is preparing to undergo her chemotherapy and radiation therapy. I've been able to successfully do that for patients who have been able to come back now after they are cancer survivors and be able to utilize that egg in my lab that's been frozen for many years, and they can still have a successful conception.
Deborah: That is awesome.
Dr. Frederick: Also, there are a lot of single women seeking out my treatment now, and these are women who may not have a partner yet and they are still in their thirties wanting to have a successful conception with their own egg, and I am actually encouraging women to think about freezing their eggs when they're young so that when they are ready at age 40 to have a baby, they still have this back-up insurance option down the road.
Deborah: That's right.Thank you so much, Dr. Frederick. Unfortunately, we're out of time, but we want to thank you for being with us today.
Dr. Frederick: Thank you for having me.
Deborah: I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness, brought to you by MemorialCare Health System. Bye-bye.
Fertility 101: Your Diagnostic and Treatment Options
Deborah Howell (Host): Hello, and welcome. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell. Today's guest is Dr. Jane Frederick, an internationally noted specialist in reproductive endocrinology and infertility. Dr. Frederick is board certified in both reproductive endocrinology and infertility and obstetrics gynecology from the University of Southern California. A renowned speaker, Dr. Frederick has educated medical colleagues in the area of fertility preservation and age in reproductive issues with numerous publications. She's held many posts with organizations, active in the advancement of reproductive medicine, including the Pacific Coast Reproductive Society, past president, and the American Society of Reproductive Medicine. In addition, Dr. Frederick has received a variety of honors for her outstanding work in the field and recently ranked among the top 10 percent in the nation from US News & World Report. Welcome to you, Dr. Frederick.
Dr. Jane Frederick (Guest): Yes. Thank you. It's nice to be here.
Deborah: Well, we got a vast topic in front of us, it's fertility. We could go for three hours, but instead, let's just try for 11 minutes, all right?
Dr. Frederick: Okay. That sounds good.
Deborah: What is the prevalence of infertility today?
Dr. Frederick: Infertility is a topic that a lot of people have been talking about more. About one in eight couples are actually experiencing infertility in their inability to conceive. Oftentimes, I tell patients that it's important that you get information about what's available to you so that you can make choices about how to proceed if you're having troubles trying to get pregnant. I usually recommend that patients under the age of 35 try for one year, and if they're unsuccessful, then seek medical advice on what's happening and get some testing. If a patient is between 35 and 40—the female, that is—I recommend that she only try for six months and then seek help to find out what's going on. If a woman is over age 40, I recommend that she go straight to the specialist so that we can actually figure out why she's not getting pregnant and really focus on that window of opportunity, because as a woman ages, the number of eggs that we have, the number of good quality eggs goes down, and so we really want to capture that window of opportunity for a conception.
Deborah: Absolutely. It's so, so vital. Can you describe for us the basic fertility evaluation?
Dr. Frederick: Yes. A few things that I can actually do within a few weeks of having a consultation and that can really give us a lot of answers on why women and men are not having a pregnancy and why they're unsuccessful. The first thing I would do is measure a woman's hormone, an FSH level and an estradiol level on the early part of her cycle, on day three. That tells me whether she has a good number of eggs still left in her system. So it's a hormone level that I can do early in her cycle. Then, I would do an x-ray called an HSG. It's a type of dye test that allows me to know whether the tubes are open, whether her fallopian tubes can actually handle an egg and a sperm undergoing fertilization and then allowing the embryo to get to the uterus.
Deborah: Interesting.
Dr. Frederick: This dye test also tells me whether the uterus is normal in shape and whether it can hold a pregnancy. The third test that I would run to rule out a male factor is to look at a sperm analysis, the semen analysis. It's a very simple test that we can order and get results back in a very short period of time. Those three parameters, those three tests will give this couple a lot of reasons why they're unsuccessful, and it will allow me to give them some options for treatment. So that can be done within the first few weeks of having a consultation.
Deborah: You get right on it. I love that. Okay. So how does age itself affect reproduction?
Dr. Frederick: Well, age is very important in its effect on reproduction, because as women, we are born with a finite number of eggs. As we progress, those eggs don't regenerate. It's not like the male, where he can regenerate sperm every 72 days. Women are actually born with a finite number. So we know that our best years of conceiving a healthy child are when we're in our twenties, but most people are not thinking about children until they're 30 and 40.
Deborah: Right.
Dr. Frederick: And we know that there's a lot of data showing that as women get over age 35, we start to see a significant drop in the number of eggs. And as we get over age 40, we see even a more significant drop in the number of eggs in our body. It's not only the number that goes down; it's also the quality of eggs that goes down.
Deborah: Right.
Dr. Frederick: So at the same time, we see an increased number of miscarriages as women get into their forties and a higher risk of genetic issues, such as a Down's baby, for example, that may impact the health of that child. So I'm always encouraging women to think about their biological clock and to seek health as early as they can when they know they're ready for a conception.
Deborah: That's right. So let's talk a little bit now about the treatment options for female infertility.
Dr. Frederick: Well, we have lots of treatment options for female infertility. So if the tubes are blocked, for example, I can do a type of surgery called a laparoscopy, and I can go in and actually open up the tubes to allow the eggs to better fertilize with the sperm. If the uterus has a polyp or a fibroid or some abnormal growth or scarring in it, I can do a procedure called a [hysteroscopy], an outpatient procedure that allows me to actually take out the tumor or the polyp and allow that uterus to be more normal and function normally. If the patient is not ovulating or if she has a polycystic ovarian disease where the periods are very irregular and the hormone levels are off-balance, I can actually give medications like Clomid or injectable medicines that really help to allow that patient to ovulate on a more regular basis, and that allows me to synchronize when she's having intercourse so that she can better have a successful conception.
Deborah: Outstanding.
Dr. Frederick: For the male factor, if the sperm is low or motility is low, meaning it's not moving as quickly as it should, there's the procedure called artificial insemination. An artificial insemination allows me to get the moving sperm and put them right into the uterus, very close to the opening of the tube, so the egg and sperm have time to meet at the right time.
Deborah: Excellent.
Dr. Frederick: So that would be options that we could do. They're very low-tech options. The high-tech option would include in vitro fertilization, and I would reserve this for patients who have been trying many years or were unsuccessful with the artificial insemination or the low-tech option. That's where I actually can fertilize the egg in a test tube and I can get it to grow, become an embryo, and then transplant the embryo back into the uterus so she can have a successful conception. Many of my couples are couples that have undergone recurrent miscarriage. They get pregnant but miscarry a lot, or they suffer from a genetic disease where they don't want to pass on the genetic disorder to their children. So there is a procedure called pre-implantation genetic diagnosis. This allows me to actually evaluate genetically each embryo by taking a cell from the embryo, testing it genetically, and then only put back the unaffected embryo or the healthy embryo that's free of any type of chromosomal abnormalities. So this has greatly helped increase the chance that the patient will have a successful conception.
Deborah: Incredible that you can learn all that from one cell, just amazing. I remember the Life Magazine where test-tube babies were on the cover and it was like, "Oh, my goodness. What are we doing?" And now it's just a norm. It's really helping so many people.
Dr. Frederick: Yes, a lot of options out there. It's nice that it speaks more of a standard of care now and that everybody should be able to access this type of care.
Deborah: All right. We have less than two minutes, but I did want to ask you about fertility preservation.
Dr. Frederick: This is where I have patients that come in, for example, who are cancer patients that have wanted to preserve their fertility before they're going to be undergoing chemotherapy. We are able to freeze an egg now, just like we are able to freeze sperm. We can actually freeze an egg as this woman is preparing to undergo her chemotherapy and radiation therapy. I've been able to successfully do that for patients who have been able to come back now after they are cancer survivors and be able to utilize that egg in my lab that's been frozen for many years, and they can still have a successful conception.
Deborah: That is awesome.
Dr. Frederick: Also, there are a lot of single women seeking out my treatment now, and these are women who may not have a partner yet and they are still in their thirties wanting to have a successful conception with their own egg, and I am actually encouraging women to think about freezing their eggs when they're young so that when they are ready at age 40 to have a baby, they still have this back-up insurance option down the road.
Deborah: That's right.Thank you so much, Dr. Frederick. Unfortunately, we're out of time, but we want to thank you for being with us today.
Dr. Frederick: Thank you for having me.
Deborah: I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness, brought to you by MemorialCare Health System. Bye-bye.