Tuesday, October 26, 2004

"IN PURSUIT OF PREGNANCY "

By Jamie Lampros for The Standard Examiner

After using birth control for five years, Sarah and Allen Jackson, of Syracuse, decided in 1999 they wanted to start a family. But things didn't work out as easily as they expected.

"My cycles were always really long when I wasn't on birth control, so I knew there might be some issues," Sarah Jackson said. "By January 2000, we decided to go and see the doctor because I was still not pregnant."

After having some blood work done, Jackson learned she wasn't ovulating and was sent to a fertility specialist in Salt Lake City.

"We went to see him the following month," Jackson said. "He looked through our records and said that our problem was minimal and he was very confident that he could help us achieve a pregnancy."

Thus began the cycle of shots, ultrasounds and a plethora of office visits. After six cycles of

inseminations, one miscarriage and more tests, the Jacksons were told they would have to undergo invitro fertilization to achieve pregnancy.

"That is a $10,000 to $15,000 process with only a 20 percent chance of success," Jackson

said. The couple decided to take a break.

According to the University of Utah's Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, there are an estimated 2 million to 4 million couples in the United States who suffer some form of infertility, with all of its emotions and frustrations. That equals out to about one in seven couples ages 30-34.

Between the ages of 35-39, the risk increases to one in five couples and to one in four couples between the ages of 40-44.

The Jacksons didn't want to join those statistics,

but they also didn't know how they could afford to do otherwise.

In 2001, the couple heard about another option, called NaPro, that teaches women how to chart their cycles. By March 2002, the Jacksons' daughter Isabella was born. In April 2004, their son Christian was born.

More alternatives

According to Dr. C. Matthew Peterson, professor and director at the University of Utah clinic, new and advanced technology is more readily available to help diagnose and treat infertility than in years past.

Couples may not be talking about the problem so much in public, but they are seeking treatment today more than they were 20 years ago, Peterson said.

"Infertility is not more common but is more commonly recognized and treated than in the past," he said.

Infertility is defined as the inability of a couple to achieve conception after one year of unprotected intercourse or the inability to carry a direct pregnancy to live birth.

Approximately one-third of known causes of infertility are attributed to the male, one-third attributed to the female and one-third attributed to a combination or an unexplained cause.

The method used by the Jacksons, NaProTechnology, is a treatment approach to infertility that has been developed over the past 10 years at Creighton University and the associated Pope Paul VI Institute for the Study of Human Reproduction.

"The basis for NaProTechnology is teaching a couple to be experts in tracking the biomarkers of their own fertility with the Creighton Model FertilityCare System," said Dr. Joseph B. Stanford, a family physician and researcher for the Department of Family and Preventive Medicine at the University of Utah.

"Somewhere around 200 doctors nationwide have been trained, so it is still pretty hard to find in many places," Stanford said. "It is different than many current infertility treatments because it is based on trying to restore the natural reproductive functioning, rather than bypass it with things like artificial insemination or invitro fertilization."

NaPro doesn't involve medical procedures, other than an initial physical exam and a monthly blood test to check hormone levels. After an evaluation to rule out more serious problems, such as tubal blockage or very low sperm count, the couple tracks the woman's fertility cycle to determine whether it's normal and to find out the best day to try to conceive.

"Men with low sperm count or hormone levels can also receive medication," Stanford said.

Stanford said there have been a couple of studies that suggest NaPro is probably at least as successful as invitro for most couples.

Four years of frustration

Curtis and Melody Linton, of Salt Lake City, have been trying to conceive for the past four years, with no success.

"It's been a long and annoying process," 29-year-old Curtis Linton said. "We went through a string of doctors while we were living in California and felt like we were just being passed around. In the process, we found that there are a lot of doctors out there who know a little about infertility and very few who know a lot."

Guy Cox, a certified midwife at Circle of Life Women's Center in South Ogden, said that many times a simple workup will find the problem with infertile couples.

"A lot of times, the woman just isn't ovulating or the man has a low sperm count and needs a boost," he said. "We do insemination procedures and some other workups, but when it's something more complicated, we usually end up referring our patients to the university."

Peterson said some of the main reasons for infertility include endometriosis, tubal damage, failure to ovulate, coital problems and sperm problems.

Postponement of pregnancy after marriage is another factor that has led to a decline of fertility as couples are waiting longer to try to conceive.

Dr. Scott Swift, an Ogden gynecologist, agrees.

"Some women are doing their careers first and putting off giving birth for a little while longer," he said. "When you start getting closer to 40 years old, a lot of women aren't getting pregnant. Some still do, but a lot don't."

The threat of STDs

Sexually transmitted diseases are another reason some women can't get pregnant.

"We're treating more chlamydia and other STDs earlier, which can lead to infertility," Swift said. "Usually if we can't get the couple pregnant after two to three months, we send them down to Salt Lake."

There may be two factors at work in the Lintons' case. Melody Linton has suffered with endometriosis, a painful, chronic disease that occurs when the tissue that lines the uterus is found outside the uterus. Curtis Linton's sperm is also unable to penetrate an egg because of an unknown enzyme problem.

Diagnosing infertility can be time-consuming and costly. Procedures include pelvic examinations, blood hormone studies, infectious disease screening, fertility testing, imaging studies, semen analyses, testicular biopsy and retrograde ejaculate analysis and diagnostic surgery with laparoscopy.

Treatments include ovulation induction with fertility medications, invitro fertilization and intracytoplasmic sperm injection (ICSI).

"Our ability to treat male factor infertility though ICSI has grown logarithmically and helped many couples who previously could only consider adoption or donor insemination," Peterson said.

As a research institution, Peterson said the clinic is able to conduct clinical investigations and can offer institutional review board-approved studies to patients who wish to participate.

"Infertility treatments are expensive, and we understand the financial difficulties patients face undergoing therapy," he said. "We are responsive to those concerns and work individually with patients to address these concerns."

Costs depend on the situation of the couple and the treatment they choose to follow and can end up being as high as $10,000. The Lintons said they could adopt a child for that much money.

"It's a huge amount of money, and I personally struggle sometimes with the fact that it costs so much, but yet there are so many kids up for adoption," Curtis Linton said. "Having children is a blessing, and some people are so desperate to have their own that they never stop trying. But it's a gamble. You don't know whether or not it's going to work this time or next time or ever."