*Risa and Eli, a couple married for two years and in their twenties, were anxious to start a family, but found themselves unable to conceive. *Chana, engaged at 39, was worried that at her age it would be difficult to get pregnant. *Miriam, a widow, had three children from her first marriage. Ten years after her husband passed away, she remarried. She was now 37 and her new husband, *Avi was 40. They wanted a child of their own, but close to a year into their marriage, she had not become pregnant – what to do?
Reproduction research done by the National Infertility Association shows that 7.3 million people in the United States, representing 12% of women of childbearing age, are affected by this problem. Infertility is defined, for women under the age of 35, as an inability to conceive after one year of trying to have a child. When a woman passes the age of 35, if she is trying unsuccessfully to get pregnant for six months, she should seek help. Besides having difficulty in conceiving, part of the problem for women of this age may also include the inability to carry a pregnancy to live birth. It also may not be her fault. Statistically, the causes for infertility are attributed equally to the female partner, the male partner, or a combination of both partners, or they may be unexplained.
Dr. Michael Feinman, a fertility specialist in the Los Angeles area, has been in practice since 1986, was recently awarded the honor of “Physician of the Year” by the Puah Institute, a worldwide organization that specializes in a unique support system for couples dealing with infertility issues. Its services include halachic supervision for procedures, fertility education for rabbis, medical professionals and laymen, and sensitive and discrete couple counseling. Dr. Feinman explained that the frequently quoted 12% rate of infertility might be a bit misleading. He commented, “The actual statistic is not really known, because of the delayed age at which so many women decide to attempt childbirth.” In other words, while our subject Chana may have problems conceiving at age 39 or 40, she may not have had fertility issues had she begun trying to conceive at age 27.
Here are statistics that are important for couples to keep in mind: A couple between the ages of 29-33 with a normally functioning reproductive system has only a 20-25% chance of conceiving in any given month (1) After six months of trying, 60% of couples can conceive without medical assistance (2). If a couple is still having difficulty conceiving after a year or is at an advanced age, most can be successfully treated.
Results for IVF have been improving. According to the Society for Assisted Reproductive Technology (SOART), in 2008, in vitro fertilization was successful 34% of the time as opposed to 14% in 1989. This is great news for very difficult cases, but while IVF may be the best known form of fertility intervention, 85-90% of fertility issues are solved through other treatments or procedures, including counseling and medications. Only 3% of fertility challenges are resolved by IVF.
Dr. Feinman has found that about 1/3 of his patients do have some IVF coverage from their insurance, but it does not cover all procedures. In his practice, the Huntington Reproductive Center Medical Group, an IVF cycle will cost $9,000-$10,000. To help patients, his practice has a discounted prepay program for two rounds of IVF, so if the first round does not work, it makes the second round much less expensive. There are also groups that provide unsecured loans specifically for people needing funds in order to have IVF treatments. Some medical practices may have payment plans available.
While there are many cases where the cause of infertility can go undetermined, there are some known causes of infertility that are controllable by the individual. That means that, with some effort, they may be able to avoid the heartache and expense of infertility issues. Dr. Joshua Klein, a reproductive endocrinologist and fertility specialist who leads Reproductive Medicine Associates (RMA) of New York in Brooklyn notes that “There is little doubt that in many cases, lifestyle issues, such as being under- or over-weight, smoking or substance abuse, and other toxic exposures, can be a partial or primary cause of difficulty achieving and maintaining a healthy pregnancy. Fortunately, with appropriate social and medical support, many of these issues can be addressed and the negative effects can be minimized or reversed.”