Pregnancy, labor, and delivery are an age-old process. The joy of these events have been renewed time and time again. For many women, who will have only one or two full-term pregnancies in their lifetime, each pregnancy is a life-shaping event. For most individuals, it is a time of complete awe and wonderment. For others, it is the culmination of many years of effort against unfavorable odds.
As a reproductive endocrinologist, I am often asked to give my opinion on whether or not someone might have difficulty becoming pregnant. I like to review with couples that fertility declines with advancing maternal age and given our new technology, we can help many couples who were previously thought to be hopelessly infertile. Many women are unaware that their fertility decreases by half from the ages of 35 to 40 years old and the occurrence of having a child affected with Down's Syndrome increases from 1 in 365 to 1 in 100 deliveries. Given this information, many women in their early thirties might reconsider delaying having a child. For others who have difficulty conceiving, there are now new therapies that have made pregnancy more likely. For instance, the development of in vitro fertilization has allowed women with blocked or absent fallopian tubes to conceive. The next major step forward was the cryopreservation of embryos, allowing couples to conceive more than once after their original in vitro fertilization cycle. New developments like intracytoplasmic sperm injection (ICSI) improved the chance of conception for couples with a severe male infertility factor. Future developments will be the perfection of oocyte freezing and widespread availability of prenatal genetic diagnosis for different medical conditions and the prevention of miscarriages. There will be new ethical decisions to be made and becoming an informed patient will help make these complex decisions easier to make.
For many couples, I inform them that physicians can now help almost everyone conceive. The conception, however, depends on three major factors. The first is how much you can undergo emotionally and physically before you conceive. For some, the tests and treatment are associated with discomfort and they are psychologically draining. Couples may want to reevaluate their desire for children and would rather change their goal, rather than becoming further depressed or stressed. The second major variable is that treatment may be determined by one's financial situation or whether or not they have insurance coverage for infertility therapy. Often couples need to perform procedures repeatedly their chance of conceiving is low for that given therapy. Often the increased financial burden leads them to stop therapy. The third and last factor is determined by the flexibility of the couple to consider other treatment options. For some couples with an extreme male infertility factor, the husband will not accept donor sperm, leaving the couple with only one option: to perform in vitro fertilization with intracytoplasmic sperm injection. Similarly, some couples will not consider the use of donor oocytes and continue less successful therapies until they have exhausted their financial resources. These three factors ultimately play some role in the couple's ability to conceive.
For many of you, you've already begun the process to conceive by reading this book. The following chapters will help you with the basics to achieve a pregnancy. If you're concerned you'll have trouble, then reading this book will help you in advance before you see your physician. The more educated you can be about the subject of fertility, the less likely you will be surprised or unprepared to deal with possible future events. The author of this book, Robin Elise Weiss, is well prepared to introduce you to the topic of planning for your baby. Best wishes on the journey and feel free to make choices that are right for you and your family.
Steven T. Nakajima, M.D.
Associate Professor and Director
Division of Reproductive Endocrinology and Infertility
University of Louisville School of Medicine