Path to Parenthood

TREATING INFERTILITY

“Congratulations. You’re pregnant.” When Kathy Ratliff heard those magic words, she burst into tears. Announcement of a pregnancy is typically an upbeat and emotionally charged event. But for couples like Ratliff and husband Danny, the news was especially welcome. The Ratliffs had been diagnosed as infertile and needed help to conceive. Today the Ratliffs have two daughters, ages 3 and 6, both of whom were conceived with help from a local reproductive endocrinologist.

According to the American Society for Reproductive Medicine, infertility affects more than 5 million people in the United States or about nine percent of the reproDuctive age population. Brian M. Cohen, M.D., director of the Dallas-based National Fertility Center, says that approximately one out of every six or seven couples has difficulties getting pregnant.

“Infertility is basically a disease that means people can’t conceive,” says Celeste Barker, a registered nurse certified in reproductive endocrinology with the center. “We generally tell people that if they haven’t been using birth control and they’ve been with the same partner for more than a year and have not gotten pregnant, they statistically should have conceived.”

Beyond the simple definition of infertility lies dozens of different causes. In younger couples, the cause can include fallopian tube damage, blockage or congenital difficulties. Endometriosis, which is a thickening of the uterine lining, is also a cause of infertility in many couples.

Barker cautions that our society’s obsession with painfully thin bodies could also be a factor in an inability to conceive. “Low body fat is detrimental to fertility,” she says. “It decreases estrogen, Women who are body builders or who work out excessively are less likely to ovulate.” On the other end of the scale, extremely obese women can also have problems; such as an overload of estrogen and polycystic ovaries. Then there is the infertility that affects older couples that may have put off having children. According to Michael J. Putman, MD., medical director of the Baylor Center for Reproductive Health, a woman is born with all the eggs she’ll ever have. “They don’t replenish, but age as they get older, which is why the older a woman gets, the less fertile she is,” he says. “It has to do with aging of the eggs.” Infertility, however, is not just a “woman’s problem.” Men can be victims as well. “What surprises some couples is that 40 percent of the infertility problems I see may be male-related,” Putman says. Causes of male infertility can range from blood vessels that are too close to the testicles (where too much heat is generated) to sperm mobility prob- lems. There are also environmental factors. “Alcohol, tobacco and excessive heat, all of those can adversely affect a man’s sperm production,” Putman comments.

Another misconception is that infertility is an inability to conceive. Couples who get pregnant but miscarry regularly, or who have had one child biologically but can’t conceive another are considered infertile. Miscarriage is more common than we might think – according to National Fertility Center’s Cohen, miscarriages can occur in 15 to 25 percent of all pregnancies.

The first step an infertile couple needs to take is to consult a qualified reproductive endocrinologist who is board certified or board eligible in the field of reproductive medicine. Barker advises couples to ask about a doctors or center’s success rate with live births, Cohen suggests that couples seek help with infertility if they are under 35 years of age and have been trying to conceive for more than a year, or if they are over 35 and have been trying for six months.

The Ratliffs sought professional help because they had been trying to conceive for a couple of years with no success. After consulting with two OB/GYNs who were not certified in this area, they approached a board certified reproductive endocrinologist. Kathy Ratliff was diagnosed with endometriosis and polycystic ovaries. The problems were treated, and she became pregnant a year later.

Depending on diagnosis, treatment may range from hormonal therapy {to help stimulate ovulation), to artificial insemination (where sperm is directly injected into the vagina), to surgery, to in-vitro fertilization.

Because of extensive publicity about in-vitro fertilization (eggs are removed, fertilized with sperm, then replaced back in the woman’s uterus), many couples believe that this is the only method used to help conceive. Not so, says Dub Howard, M.D., medical director of Trinity Medical Center’s In-Vitro Fertilization Program and medical director of Reproductive Science Center of Dallas. “Only about 2 percent of couples who consult on infertility need anything as extreme as in-vitro,” he comments. “Most of our patients accomplish pregnancy with milder and less strenuous forms of therapy,” he commented.

Infertility can take a significant toll on a couple. As a result, “both individuals and their marriage take an emotional hit,” Howard says. “Often a professional counselor can help a great deal in alleviating the stresses involved with infertility,” he adds. In fact, National Fertility Center, Howard and Putman recommend counselors when necessary.

The good news is that, for the most part, fertility experts can usually help a couple conceive, as long as that couple is willing to be open and patient. However, Putman says, there can come a time for some couples where absolutely nothing has been effective, “That’s where you have to look at trying to do closure,” he comments. “You have to be careful that you don’t keep offering the carrot out there. Alternatives need to be discussed, such as adoption, donor eggs or not having children.”



PLANNING THE PREGNANCY

Most professionals are adamant that

pre-conception preparation be taken as seriously as pre-natal care. “We hope that our patients are seeing their obstetricians even before they become pregnant,” says Alice Murrow, RN, administrator with Women’s and Children’s Services at Baylor University Medical Center. For example, research has determined that taking folic acid prior to pregnancy has demonstrated efficiency in preventing birth defects.

Columbia Hospital in Piano offers pregnancy planning seminars that touch on everything from finding a quality OB/GYN, to the huge change in lifestyle that a baby can bring. According to Cheryl Gaudet, RNC, Columbia Piano’s “Planning a Pregnancy” workshop has been very popular. “There have been about 40 couples at each one,” says Gaudet, director of Women’s and Children’s Services at the hospital.

Doug Kelly, is director of Newborn Nursery and Special Care Nursery at Trinity Medical Center, believes thai where a mother should give birth can never be decided too soon. Part of that decision, he says, involves a couples philosophy on birth. Do they want the whole process to take place in one room? Or do they feel comfortable with the mother going into labor, giving birth and recovering in separate rooms? ’’That’s all a matter of personal preference,” he says.

One of the most important issues to research when choosing a birthing facility is what services are available for ill newborns. “Parents need to know what kind of intensive care treatment the hospital offers,” says Kelly. ” If there’s no natal ICU on the premises, they need to know what procedure the hospital implements for transferring the baby to a qualified NICU.”

Another decision that can be important to the soon-to-be parents is how extensive they want their hospital network to be. For example, Columbia has medical centers scattered throughout the Dallas/Fort Worth area, all of which offer access to a variety of birthing rooms and resources. “With Columbia,” says Gaudet, “you have access to a whole network of people, “

Having such a network can be helpful in the event of an emergency. A woman giving birth to a pre-term baby in a Columbia-owned hospital in a small town can be airlifted via helicopter to a level three nursery based in Piano, Medical City Dallas or Plaza Hospital in Fort Worth.

Ratliff, who gave birth at both Trinity Medical Center and at Piano Presbyterian Hospital, suggests couples also examine how staff interacts with patients and their families. “When I was giving birth the first time at Trinity, my family and friends kept wanting to come in and visit me,” she recalls. “It was getting to the point during the labor when I didn’t need that. The staff was very good about keeping them away without hurting any feelings.”



A FAMILY AFFAIR

Preparing for a birth these days involves more than telling a family the good news, then shopping for baby furniture. Many experts are finding that helping other family members prepare for the event can help ease the newborn into family life with minimal disruption. “I think we’re more conscious of involving the entire family unit during the birth, and the need for bonding of parents and the baby,” says Sharon Grabsky, RN, director of Obstetrics for Doctors Hospital.

Baylor and Columbia Piano offer classes to help siblings and fathers adjust to a new baby. In addition, says Baylor’s Murrow, grandparents need a crash course in baby education. “A lot has changed about understanding what infants and mothers need,” she explains. “One common theme we hear is that the new mom has information on how to care for her baby that her mother may not agree with. That can create conflict.”

Today’s hospitals are taking a more active role in encouraging family participation. Birthing rooms at Baylor, Doctors Hospital, Trinity and the Columbia system are no longer the sterile-looking rooms of old. In many cases, they might look better than the mother-to-be’s own bedroom, with wooden floors, canopied beds and Laura Ashley linens. Modern childbirth facilities, Gaudet says, offer a comfortable ambiance combined with state-of-the art medical requirements,

Even if the baby spends time in intensive care, many hospitals encourage family visits rather than rigidly restricting hours as they might have done in the past. Some of the larger ones, such as Columbia, also offer support groups with other parents who have been through the harrowing process of having a child in a neo-natal unit or incubator.

Mothers have more control over how they give birth than ever before. It used to be that they were put under anesthesia when they went into labor, and when they awoke, found their stomachs miraculously flat and their babies in a separate nursery. The difference today, believes Doctors’ Hospital’s Grabsky, is that the mothers are much more informed and can make better decisions about their own birth. “They’re more prepared for their birthing experience.” she says.

In addition to deciding where and when to birth, choices also include whether or not to have drugs. “That decision can extend from no drugs all the way to an epidural (which numbs the pain of contractions) or a light anesthetic,” Murrow says. A birthing mom even has a choice when it comes to epidurals. These days lighter epidurals are available so the mother can still take an active part in the birth without suffering in pain.

Hospitals are also proving to be more flexible immediately after the birth. “The mother may want die baby with her all the time,” Grabsky says. “Or she may want to send it back to the nursery occasionally. Whenever we can, we support what the mother wants to do.”

A BTTER BIRTH EXPERIENCE

In general, having a baby today is a better experience than it was even a decade ago. Whether a couple is attempting to conceive or is giving birth, indifference and impersonal attitudes are, more often than lot, things of the past. For Gaudet, who has children in college, the whole birthing process is a huge – and welcome – change from when she became a new mom. “When I gave birth to my kids, it was basically here’s the baby, you’re out the door,” she says. “Today hospitals are more supportive of people.”