We talked to Dr. Laura Meyer, a Reproductive Endocrinologist with Illume Fertility to discuss what infertility is, what causes infertility, what some of the treatments are, and what types of parenting paths are available.
The Meaning of Infertility
Infertility is defined as trying to conceive for a year or more without success if the woman is under 35 years old, and for six months or more if the woman is over 35 years old. infertility is a retrospective diagnosis. If you don’t get pregnant it doesn’t mean you won’t get pregnant on your own or you won’t get pregnant on your own, it just means that a couple has been trying for a certain amount of time and it hasn’t happened yet .
Who Does a Reproductive Endocrinologist Treat?
Reproductive Endocrinologists (REs) see patients for a variety of reasons. There are usually four types of people who go to a reproductive endocrinologist.
- A subset of people who may go to an RE are those who have tried to conceive on their own (as mentioned above) but have not succeeded and want to know why, and what we can do to help them achieve their goal of having a baby.
- A second subset of people who may find themselves talking to an RE are those who may not have been trying very long, but already know they will need help. This may mean they are aware of risk factors for infertility, such as when a woman has an irregular cycle and does not ovulate in a predictable way. Or, women may enter because they were able to get pregnant, but they had trouble staying pregnant and had repeated pregnancy losses.
- A third subset of people know they need our help to have a baby because they are same-sex and need a sperm donor or egg donor or gestational carrier – or some combination. While others know they need help raising their families because they’ve had a difficult pregnancy, problems with their uterus or have a medical history that dictates the need for a gestational carrier or an egg donor.
- A fourth subset of people who see RE is for fertility preservation, usually in the form of a woman who wants to retrieve and freeze her eggs until she’s ready for family planning.
There are many different reasons why people find their way to a Reproductive Endocrinologist. Our job then is to get to the bottom of what brings them, what is happening, how we can best treat them.
Causes of Infertility
When a patient contacts us, we bring them in to discuss the issues and create a workup tailored to their specific situation.
For example, for people who are trying to conceive on their own and haven’t been successful, we can do a semen analysis and check the sperm, make sure the fallopian tubes are open, and check their hormones and look at their anatomy – these are things we will do first to help determine what is going on.
Similarly for people who face repeated pregnancy loss, there are some things we can check that could be causing it. Most pregnancy losses are due to abnormal pregnancy genetics – usually chromosomal abnormalities – but there are also other causes so there is a study to see what other causes are.
Figuring out the cause of the loss and loss will determine what the course of treatment will be.
Infertility Treatments
For some, less invasive treatments may work. This involves completing a cycle with an oral medication and pairing it with an intrauterine insemination, where we take a sample of the sperm and place it directly in the uterus relatively close to where it needs to go to help in- optimize the chances of getting pregnant.
Other people may need more invasive treatments such as IVF.
What is IVF?
What does IVF mean? in vitro fertilizationmeaning egg fertilization occurs through sperm in vitroor in the laboratory, instead of in vivoor the body. IVF is a process in which a woman takes injected drugs to stimulate the ovaries to produce many eggs at the same time (as opposed to the single egg that matures naturally each month). When the eggs are mature, instead of ovulating them in her body, she will have egg retrieval – a minor surgical procedure – to remove those eggs from the ovaries and fertilize them in the laboratory to create embryos. Those embryos can be cultured in the lab, usually for about five or six days until they reach the blastocyst stage, where they can be transferred or frozen or genetically tested (or some combination of those).
There are several variations to this, including transferring embryos at the Day 3 stage, or some women will retrieve eggs and then freeze them to preserve their fertility.
What is Third-Party Reproduction?
Third-party reproduction is a term used when an additional person is involved in creating the pregnancy; it may be a sperm or egg donor or a gestational carrier.
Some individuals and couples know from the start that they need third-party reproduction. Others will know the need early, depending on their circumstances. For IVF in general, success rates mainly depend on the age of the woman at the time she did it, and the number of eggs she retrieved. So as a woman ages, and her egg quality and quantity decline, her success rates decrease. This may lead to his use of a egg donor. (Editor’s note: You can learn more about things to consider before using an egg donor in our related blog post.)
For the case of surrogacy, some people know right away that they will need this family building method. This includes LGBTQIA+ populationas well as women who do not have a uterus or have had gynecological cancers or endometriosis, or women who have had difficulty conceiving and giving birth and it is not safe for them to carry again.
We have patients who try to get pregnant on their own and don’t see success, or try IVF and either don’t succeed or get pregnant and suffer multiple losses. These patients may find themselves needing a gestational carrier to continue. This is a smaller percentage of patients; it’s more common for people to come in knowing they need a replacement.
Making the decision to switch to third-party reproduction is not a straight path. We will talk to patients individually and talk about what has happened so far, what the options are for next steps, and the likelihood of success with different routes. The RE’s job is to give patients as much information as possible so they can make a decision that they feel most comfortable with.
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Dr. Laura Meyer is a reproductive endocrinologist at Illume Fertility. Dr. Laura Meyer is double board certified in Reproductive Endocrinology and Infertility and Obstetrics and Gynecology. After graduating from NYU School of Medicine, he completed his residency and fellowship at New York Presbyterian Hospital/Weill Cornell Medical Center. Prior to joining Illume Fertility in 2020, he was an Assistant Professor at the NYU School of Medicine, practicing in Westchester and Fairfield counties in Connecticut.
