Can't Get Pregnant? What to Do Part 2Mar 27, 2014
You’ve been trying for over a year to conceive a child but it’s just not happening. Dr. Kirtly Jones talks about the next steps to take and what specialists are available.
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Interviewer: You've been trying to get pregnant. We've already covered what does "trying" exactly mean, and some things you can do for the first year. But after that, if you need specialist help, what options are out there? We're with Dr. Kirtly Parker-Jones with University of Utah Hospital. Let's talk about some specialists that can help people that are having trouble conceiving.
Dr. Jones: Okay. So, let's say you've been trying for a year. And we talked about what trying is, and who should seek help before one year. But for recap, if you aren't having periods regularly, don't wait a year. And, if you already know that you've had operations in your pelvis maybe for an ectopic pregnancy or for an ovarian cyst, or if you know that you or your husband have had chemotherapy or some kind of thing which will lower your sperm count or your fertility, don't wait a year.
But let's say you have regular periods, and you're having regular sex two to three times a week, no history and it's been a year. Who do you see? Certainly the family docs and your nurse practitioner should be able do what I call level 1 fertility counseling and therapy. If your periods are regular, meaning every 24-35 days, you don't need to do a temperature chart, you don't need to do any hormone levels. But there are some things like thyroid, so they might check your thyroid to make sure that's okay. And your nurse practitioner and your family doc can do that if that if they're interested. They can actually also order a hysterosalpingogram, an x-ray to show that your tubes are open. So, that's often done by a radiologist in a hospital. It's almost never done by a family doc. It's sometimes done by OB/GYNs. So the first line person could be your nurse practitioner, your family doc, or your regular OB/GYN. If they find that you're not ovulating, and they give you some fertility pills like a drug called Clomid or clomifene. If you're not pregnant in six months on clomifene, or if you've been in the hands of your family doc or your OB/GYN for six months and you're not pregnant, especially if it's been a year . . . So you've tried a year with no help, you tried a year with investigations and a max at one year, then you're going to see a specialist. The specialist can do things like ovulation induction to make extra eggs with insemination. Now maybe your OB/GYN can do that, give you drugs to make extra eggs, and somewhere prepare the sperm so that it can be put into your uterus on the day that you ovulate. Your family doc won't do that and your P.A. probably won't do that. So your OB/GYN can do that, but when you are in the hands of a specialist they have different tools in their toolbox. So they have super ovulation with insemination. If the sperm count's really low, you probably should have been in the hands of a specialist right away. If your tubes are blocked, you should be in the hands of a specialist right away. And if your family doc or your OB/GYN can't get you to ovulate, you should be in the hands of a reproductive endocrinologist. So let's talk about that tools box that the reproductive endocrinologist has. They often have, if they can IVF, in vitro fertilization. In vitro fertilization is very successful if the program is a good program. What other tools do the reproductive endocrinologists have? Well, they usually have access to donor sperm. They may have access to donor eggs. They also have things like they have technology in their office to look inside your uterus. Something called a sonohysterogram, looking for polyps or other things inside your uterus. So, the reproductive endocrinologist has more tools, fancier tools, and more success in their toolbox. What are we talking about successes? If you go to a specialist and the specialist is a reproductive endocrinologist, well, it turns out that about 80% of women, couples, about 70-80% of them will get pregnant within a year, year and a half, if they can access those tools. So, that's an important thing to know is they have tools that your OB/GYN doesn't have. So, reproductive endocrinologist often, not always, has access to really good surgical techniques to help the tubes and treat endometriosis, has an IVF program that can bypass the tubes if surgery isn't going to be a choice. A really good IVF program also has access to donor sperm or insemination and ICSI, intracytoplasmic sperm injection, if you need to stick an egg in the sperm. A really good program is going to access to donor eggs. And a state-by-state basis, they'll have some kind of options regarding finding a surrogate. That is a very short discussion on a topic that we could talk about forever.
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