Fertility 101: Your Diagnostic and Treatment Options

MemorialCare Health System, excellence in healthcare presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

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 a 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 & World Report. Welcome to you, Dr. Frederick.

Jane L. Frederick, MD: Yes, thank you. It's nice to be here.

Deborah Howell (Host): Well, we've got a vast topic in front of us. It's fertility. and we could go for three hours, but instead let's just try for 11 minutes, all right?

Jane L. Frederick, MD: Okay, that sounds good.

Deborah Howell (Host): What is the prevalence of infertility today?

Jane L. Frederick, MD: Well, 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. And 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 trouble 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. And 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, you know that 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 Howell (Host): Absolutely. It's so, so vital. Can you describe for us the basic fertility evaluation?

Jane L. Frederick, MD: Yes, there are 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 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. And 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 in the sperm undergoing fertilization and then allowing the embryo to get to the uterus. And 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, a semen analysis, a very simple test that we can order and get results back in a very short period of time. And 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 Howell (Host): Boy, you get right on it. I love that. Okay, so how does age itself affect reproduction?

Jane L. Frederick, MD: Well, age is very important in its effect on reproduction because as women, we are born with a finite number of eggs. And 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 20s. But most people are not thinking about children until their 30s and 40s. 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. And it's not only the number that goes down, it's also the quality of egg that goes down. So at the same time, we see an increased number of miscarriages as women get into their 40s and a higher risk of genetic issues such as a Downs baby, for example, that may impact the health of that child. So I'm always encouraging women to think about their biological clocks and to seek help as early as they can when they know they're ready for a conception.

Deborah Howell (Host): That's right. So let's talk a little bit now about the treatment options for female infertility.

Jane L. Frederick, MD: 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 egg 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 hysteroscope. An outpatient procedure allows me to actually take out the tumor or the polyp and allow that uterus to be more normal and function normal. If the patient's not ovulating or if she has 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 then allows me to synchronize when she's having intercourse so that she can better have a successful conception.

Deborah Howell (Host): Outstanding.

Jane L. Frederick, MD: And 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 a procedure called artificial insemination. And artificial insemination allows me to get the moving sperm and put them right into the uterus, very close to where the opening of the tube is, so the egg and sperm have time to meet at the right time. 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 for many years or were unsuccessful with the artificial insemination or the low-tech option. And 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 preimplantation genetic diagnosis. This allows me to actually evaluate each embryo genetically by taking a cell from the embryo, testing it genetically and then only putting 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 a patient will have a successful conception.

Deborah Howell (Host): 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 norm. It's really helping so many people.

Jane L. Frederick, MD: Yes, a lot of options out there. It's nice that it's become more of a standard of care now, and that everybody should be able to access this type of care.

Deborah Howell (Host): Right. We have less than two minutes, but I did want to ask you about fertility preservation.

Jane L. Frederick, MD: 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. And 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. And 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 has been frozen for many years, and they can still have a successful conception. And 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 30s 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 backup insurance option down the road. That's right.

Deborah Howell (Host): Thank you so much, Dr. Frederick. Unfortunately, we're out of time, but we want to thank you for being with us today.

Jane L. Frederick, MD: Thank you for having me.

Deborah Howell (Host): 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.