Chapter 1

Where, Oh Where, Can My Baby Be?

IN THIS CHAPTER

Understanding infertility

Exploring the odds of getting pregnant

Looking at infertility causes

Realizing why getting pregnant can be hard today

Adding up the costs of infertility

If you're reading this book, the odds are good that you want to have a baby. You may actually have been trying to have a baby for a while without success, and maybe you're becoming frustrated, annoyed, and a little scared - are you ever going to have the family you've dreamed of?

We want to help make this process easier for you - less stressful and more successful. In this chapter, we tell you the official definition of infertility (it may surprise you!), give you statistics on infertility today, show you how to shake your family tree for genetic problems, and talk about the cost of infertility - the emotional cost as well as the monetary cost. Where possible, the authors have relied upon the principles of evidence based medicine and The American Society for Reproductive Medicine guidelines. The authors have also used their extensive clinical experience to bring some practical advice. In the end, there is no one way to address a person's fertility issues. Furthermore, things change rapidly, so an initial game plan may need modification as the process develops.

Defining Infertility

Infertility as defined by the experts may surprise you. According to guidelines established by infertility specialists, you're not considered to be infertile until you've been trying to get pregnant for one year if you're under age 35. That means that trying to get pregnant last week and not having signs of pregnancy this week does not mean that you're infertile. If you are over the age of 35, you can breathe a sigh of relief in that you only have to try actively for six months before an investigation as to why you haven't conceived can begin - and may be covered by insurance. However, some states that mandate insurance coverage use the one-year rule (especially for certain age groups) and will not provide benefits until you hit the one-year mark.

However, since the modern world is one of immediate gratification and answers that seem to appear at the speed of Google, it can be hard - if not downright impossible - to try to get pregnant for a full year without getting impatient, discouraged, or just plain panicked. There's nothing wrong with going to see your gynecologist to talk about why you're not getting pregnant after just a few months; in fact, your coauthors, being fairly impatient people themselves, would consider you to be a candidate for sainthood if you could wait a year - or even six months! - without talking to your doctor.

Looking at Infertility Statistics

Most women know that the older you get, the harder it is to get pregnant. But what about race, socioeconomic status, geography, and heredity as fertility factors? In the next sections we look at how infertility affects different groups.

Making babies: An inefficient process at best

You may think of Mother Nature as a pretty efficient woman, and for many women that is true. One common misperception is that a woman has a 20 percent chance of conceiving each month she tries. That is simply not true. The chance of conceiving depends upon a woman's age and how long the woman has been trying to get pregnant.

Unfortunately, as you go through this book, you will hear way too much about how age reduces a woman's chance of conceiving. We all wish this weren't true, but aging is an inevitability of life. Common sense should tell you that a 44-year-old woman has less of a chance of conceiving than a 24-year-old woman. But a subtlety of infertility is that there are actually three sub-groups within any group of people who start to try to achieve a pregnancy. The majority do not have a problem achieving a pregnancy, a small group are sterile, and an intermediate group are subfertile, meaning they will conceive, just not within the one-year time frame or without technology helping.

Women with normal fertility will conceive quickly. Some estimates place the chance of conceiving in the first month of trying as high as 40 percent. After three months, 65 percent of women who conceive naturally are pregnant, and by six months, 85 percent are pregnant. After that the chance of achieving a pregnancy gets less and less each month because those not getting pregnant easily have a greater chance of being subfertile or sterile. This is true regardless of age. So a 40-year-old female with normal fertility will get pregnant quickly. It's just that by age 40 as many as 40 percent are functionally sterile. Looking at 100 women under age 35 trying to get pregnant, the breakdown looks like this:

• Eighty-five will be pregnant within one year.
• Ten more will be pregnant after two years of trying without medical intervention.
• Five won't get pregnant without some help from the medicine man or maybe not at all.

High-tech infertility treatments, such as in vitro fertilization (IVF), claim a success rate of about 50 percent for those under age 35. But people using IVF have the diagnosis of infertility, and even if they use IVF multiple times, some will never achieve a pregnancy. Estimates of the cumulative live birth rate for women under the age of 35 is about 85 percent, meaning that if women under the age of 35 try multiple cycles of IVF, 15 percent will never conceive and have a child that is genetically theirs.

Age and infertility

If you're over 35, you're in good company; 26 percent of all first-time moms in the United States are over 35! Despite this, Mother Nature doesn't make it easy to get pregnant past age 35. There is also an exceedingly higher rate of women who begin having children in their 40s and even 50s, but keep in mind, unlike the tabloids would like you to think, many of these women may require the intervention of an donor egg and/or surrogacy . but more on this later! However, a number of women do begin or continue to have children without help through their early to middle 40s. We discuss the impact of age in greater detail in Chapter 7.

For example:

• By your late 30s, you have a 10 percent chance of getting pregnant in any given month, and 17 percent of those who do will miscarry.
• If you're over 40, the pregnancy rate per month slips to 5 percent, with 34 percent of those miscarrying.
• By age 45, your chance per month of conceiving is less than 1 percent, and 53 percent of those will miscarry.

Race and infertility

Does your racial background affect your chance for pregnancy? There is a slight difference in infertility rates, with Hispanic women under 35 experiencing a 7 percent infertility rate, Caucasians a 6.4 percent infertility rate, and African American women recording a 10.5 percent rate of infertility. These differences may be due to socioeconomic factors, such as poverty, poor nutrition, or lack of physician care, rather than strictly racial issues.

High-tech treatments and infertility

If you're already frantically reading your insurance booklet and shaking the piggy bank in hopes of finding a few spare thousand dollars to pay for high-tech infertility treatments, you may take comfort in the following statistic: Only around 3 percent of infertile couples end up doing high-tech treatment like in vitro fertilization to get pregnant (You can find everything you need to know about IVF in Chapters 15 to 18.)

But IVF has been a boon to those seeking to conceive. Since the first IVF baby (Louise Brown in 1978 in England), over 6 million babies have been born through IVF. That number is expected to explode to 200 million by the end of this century. Considering Dr. John Rinehart's look back to the early days of success, IVF has come a long way: "In the early days of IVF, success was so rare that we would buy a bottle of champagne for each woman who delivered a baby. Today, it would take a vineyard to supply that much champagne."

Shaking Down the Family Tree

It may seem silly to look to your family tree for signs of infertility that could be inherited; after all, you're here, so how could your parents have had fertility issues?

Putting together a family birth history

Most of us don't ask our parents about their road to parenthood until we're trying to become parents ourselves. But you may be surprised to find out that it took your parents a number of years to have you or your siblings. It's also possible that people in your family tree may be adopted or the product of artificial insemination, issues that often weren't discussed a few decades ago.

While family lines that are completely infertile tend to die out in a generation (for obvious reasons), some families may be subfertile, with less than average sperm counts or ovulation issues, and still manage to have a child or two.

Ask the most talkative member of your family for a family "birth history." You may be surprised by what you discover. And remember, sometimes a vehement denial, such as "there's never been any problem in our family," may be a clue to dig a little...