Creating a baby and bringing it safely into the world is no easy task. Learn about the latest techniques physicians are using to make happy parents and beautiful babies.
You’d think it would always be naturally easy to start a family, but there’s a reason that babies are tiny miracles. The process of pregnancy, from conception to birth, is a delicate one, and there can be plenty of challenges along the way. Fortunately, modern medicine addresses many of them.
Even though nearly half of all pregnancies in the United States are unplanned, it’s important to take precautionary steps before, during and after a pregnancy, to ensure the delivery of a healthy new life.
Women of all ages should consider the potential risks and hazards of their health care decisions before a pregnancy, says Dr. Jack Lenox, a board-certified gynecologist at Lenox Healthcare for Women, 1235 N. Mulford Road, Rockford.
Lenox strongly recommends a pre-pregnancy screening, performed as part of a wellness visit. Further testing, with hormone levels, lab tests and ultrasounds, can help to identify patients with a higher risk of complications during pregnancy.
“Women who are contemplating pregnancy should be encouraged to undergo a comprehensive preconception evaluation and counseling,” Lenox says. “Although most pregnancies result in good maternal and fetal outcomes, evaluating certain medical problems, such as diabetes, hypertension, thyroid disease, pulmonary disorders and mental health problems, is a good idea, to make sure optimal control is present before conception.”
For example, women with depression and other mental health problems are at risk for postpartum depression. Pre-pregnancy screenings may also lead to valuable pregnancy strategies, such as modifying smoking or alcohol consumption, in addition to maintaining a healthy diet.
“Women who are overweight or underweight can benefit from nutritional counseling,” Lenox says. “The data is clear that starting folic acid at least one month before pregnancy reduces the incidence of neural tube defects such as spina bifida.”
Preconception interviews can identify couples who are at risk for hereditary abnormalities, so that appropriate referral for genetic counseling can be made. Additional tests during pregnancy may help to identify potential genetic abnormalities.
“Women should also be counseled regarding the effect of age on pregnancy outcomes,” Lenox says. “The risk of chromosomal abnormalities, such as Down syndrome, increases after the age of 35. Other complications of pregnancy more common in women older than 35 include gestational diabetes and hypertension. As more women delay childbearing to later ages, these issues are important to address, and could be discussed during preconception counseling.”
Following a gynecologist’s tests and pre-screening, a patient may be referred to a fertility specialist, who can step in when conception has not occurred naturally.
Diagnosing infertility has its own inherent challenges, says Dr. Todd Deutch, a board-certified reproductive endocrinologist and infertility specialist at Advanced Reproductive Center, 435 N. Mulford Road, Rockford. Deutch talks to prospective parents about the how, when and why of conception.
“People don’t always know when to seek help from a specialist,” he says. “And frankly, infertility is a situation that’s still not often talked about in public. Infertility is a very personal subject. Educating patients and informing them of the available resources is an ongoing effort.”
In the medical community, “infertility” is defined as one year of attempted pregnancy without success, for women younger than 35. Women over 35 should seek help if they have been trying for six months without success.
“About 85 percent of women under 35 will conceive on their own, within one year of trying,” he says.
However, some couples should talk with a specialist sooner, Deutch says. Women with a history of irregular menstruation, past pelvic infections, pelvic surgery, ectopic pregnancy, as well as cancer or chemotherapy treatment should talk with a specialist as soon as they start trying to conceive. There are also several signals for potential issues with a male partner.
“With men, an already-known low sperm count, failure to produce children in prior relationships, chemo or radiation therapy, and low testosterone are indicators of possible male fertility problems,” Deutch says. “Men with these conditions should seek assistance from a specialist from the outset.”
As part of the infertility exam, Deutch requests a thorough medical history, to find any potential factors. He also recommends a range of tests, which could help a fertility specialist to identify potential causes. There are many different reasons a couple may have difficulty conceiving.
“Low egg numbers is a common contributing factor which can sometimes lead to infertility,” says Deutch. “Each woman is born with a given number of eggs. Lower number and quality are directly related to aging. While there is no perfect test to determine a woman’s egg count, we have several methods to get a general idea.”
Blood tests such as the follicle-stimulating hormone level are traditionally used to evaluate egg quantity, although ultrasound is increasingly used. Deutch says that ultrasound testing allows him to count the number of follicles – the little fluid sacks that eggs grow in – and observe whether the woman’s uterus is healthy and appropriately shaped. Ultrasound also allows him to see any fibroids or polyps in the uterus.
If low egg count isn’t a culprit, then physicians may also consider closed Fallopian tubes as a possible source of infertility. To diagnose this condition, a contrast dye is injected and X-ray is used to examine the Fallopian tubes. When it comes to the male partner, a semen analysis typically determines whether there are male fertility issues. “On average, 40 percent of the time there is a female factor, 40 percent a male factor, and 20 percent it’s both a female and male factor,” Deutch says.
The good news is that whatever the problem, physicians like Deutch can help most patients to realize their dreams of becoming parents. “There are many different treatment options, ranging from pills to more complex treatments such as in vitro fertilization [IVF],” Deutch says. “I take pride in carefully evaluating each individual patient, so I can help them to conceive in the least complicated and most cost-effective way possible.”
Diagnosing infertility is often challenging enough, but sometimes the treatment options are just as complex. Compassion, sensitivity and understanding are as much a part of helping couples as are medical remedies, says Dr. Jacek Graczykowski, board-certified reproductive specialist and program director for Reproductive Health and Fertility Center, 973 Featherstone Road, Rockford. By the end of the initial contact, he says, women patients are often in tears.
“We walk them through the reproductive process and then discuss the best treatment options,” Graczykowski says. “Infertility treatment is considered elective. We help the couple to make decisions based on their comfort level, but at the same time, there are so many variables that need to be taken into consideration.”
Beyond the risks, benefits and potential outcomes, religion influences the choices that couples make.
“If the couple is Catholic, for example, their religious convictions may mirror Catholic doctrine which teaches against fertilization outside the human body,” Graczykowski says. “We can do artificial insemination, but we cannot use donor sperm or eggs.”
Mormon couples, on the other hand, can opt for nearly all of the possible treatments, including IVF. However, they’re prohibited from using eggs and sperm other than their own.
“With Protestant couples, there are no prohibitions on treatment, but their beliefs on when an embryo becomes a human being differ from the law,” Graczykowski says. “Protestants believe life begins at conception. The law states that a fetus becomes a legal human being at 20 weeks of pregnancy or when the fetus weighs 500 grams or more. Below that weight, it is considered tissue. What’s the difference legally? If a fetus weighs 501 grams and is lost through miscarriage, we fill out a death certificate. At 499 grams, we fill out a pathology report.”
Embryos are a complicated subject, he says. People are concerned about preserving embryos they consider living human beings, but at the same time, the body naturally discards those that are not viable. In nature, the female risks her health and life to reproduce, so nature makes certain that the result is a healthy, perfect child that will live to adulthood.
“Plus, there is the misconception that embryos are thrown away, or that IVF involves destroying viable embryos,” Graczykowski says. “That is not necessarily true. We do see arrested development with IVF embryos because many embryos are imperfect and cannot survive to adulthood. We can freeze embryos and keep them to use as needed. If a couple decides they don’t want more children, they can donate the surplus embryos to couples who need them.”
But by far, the most influential aspect of infertility is the emotional stress it places on the couple. “American culture is family-oriented,” Graczykowski says. “Parents and grandparents put pressure on couples to produce children. Siblings and friends proudly show off baby photos, not knowing how much they are hurting the childless couple. And American children are constantly told that, if they want to accomplish something, to go out there and get it. That’s not so easy to do when it comes to conceiving a child.”
Graczykowski says it is not unusual for him to see women who have become alienated, are depressed or filled with anxiety, or feel they have somehow lost control of their bodies and lives.
“Suddenly, the young woman who has done everything right in the past has failed, in her opinion,” he says. “We sponsor a patient support group led by Marie Epling, a licensed clinical social worker who specializes in infertility and pregnancy, to help women and couples cope.”
Financial considerations are still another challenge. Graczykowski says the State of Illinois is one of only 15 that mandate insurance coverage for infertility, under specific guidelines. Because one IVF cycle costs an average of $10,000 to $15,000, financial support is important.
“Employers are required to provide infertility insurance to cover fertility treatment including four IVF cycle treatments,” Graczykowski adds. “After one live birth, it covers an additional two treatments. The exceptions are for companies with fewer than 25 employees, self-insured companies, out-of-state employers and a history of sterilization in the man or woman. Medicaid and Medicare do not cover infertility.”
Even with the best efforts, conception may fail. When that happens, Graczykowski says his job is to guide couples toward a sensible decision. “We never tell them ‘no,’” he says. “But when we have exhausted all options, we try to help them avoid a gambler’s mindset, betting on just one more spin of the wheel. We gently talk to them about other options, including adoption. But it’s all up to them to come to a conclusion.”
The Centers for Disease Control estimates that 10.9 percent of American women between the ages of 15 and 44 are impaired in their ability to conceive and carry a child to term. Nearly 6.7 million women who want to have a child will need help from specialists. Fortunately, with today’s advanced treatments and specialized guidance from reproductive specialists, more couples than ever before can welcome their own small miracles into the world.