Fertility Treatment: why “the numbers” don’t add up

Most of us have learned to rely upon numbers. Their dependability, their consistency, their ability to communicate an unemotional truth is something that most of us have come to value. However, as a fertility specialist that counsels patients on a daily basis, I’ve come to realize how subjective numbers can be misinterpreted by people wanting to have a child. The same numbers that may discourage some; serve as a source of hope for others.

The most glaring example from recent history is the case of the “octomom.” None of us was present when she was counseled so we can only guess what was or was not discussed between her and her doctor. However, based upon the low success rate of the center that she was treated at, the odds of her accepting 6 frozen-thawed embryos and them resulting in 8 babies was calculated at 1 in 3.4 trillion. Yet we all know how that worked out.

Let’s consider a less dramatic example. The estimated chance of achieving a pregnancy for a very fertile couple on a given month is roughly about 15%. A common strategy to improve upon this for couples that experience infertility is to promote ovulation induction. Despite its popularity, studies show that this treatment either doesn’t result in pregnancy for most couples or it results in an adverse outcome.  What makes ovulation induction an appealing option to couples is the perception that it is less costly. In reality, studies are consistently demonstrating that it delays the initiation of pregnancy and results in higher treatment costs due to repetitive cycles. Furthermore, the Centers for Disease Control and Prevention along with the March of Dimes just published a report that about one out of every four multiple pregnancies are due to the use of approach. Advanced treatment options such as In virtro fertilization provide us with the ability to dramatically improve pregnancy success rates and outcomes.

The process of IVF allows for more effective management and also makes it easier to prevent twins and higher order pregnancy by performing single embryo transfers and freezing extra embryos for future pregnancy attempts. Better still, the information that is gained from a single IVF attempt can be diagnostic. Therefore even when a cycle fails it can provide closure or offer new information that can be used to redirect treatment. So what seems like the most costly treatment can actually save you both time AND money.

Here are some steps that you can take to protect yourself from making decisions that don’t add up right:

  • Create a “family building plan” rather than focusing on just getting pregnant—In my book, Perfect Hormone Balance for Fertility I provide a series of questions that you and your partner should consider. Some treatments are more effective than others in reducing the risks of multiple pregnancies while others are more likely to be effective quicker—a key to success for couples wanting to have more than one child or those in their later reproductive years.
  • Ask your doctor what your prognosis is in words like “excellent, good, fair or poor” rather than as enticing numbers—Since statistics are calculated based upon groups of people, they don’t apply to an individual cycle. Instead, they can often be misleading. By using words to express your chance of success, you’ll get a much more accurate estimate of your chance for becoming pregnant.
  • Encourage your employer, insurance coverage and legislators to make fertility treatment part of their covered benefits package—As insurance options are being evaluated, consider switching coverage to meet your needs. A recent study demonstrated that plans that paid for IVF coverage can cost less than an extra $1 per month. If you’re not currently offered a plan with fertility coverage, request it of your employer.

Take charge of your fertility treatment; steps you can take optimize your success

One of the most frustrating aspects of trying unsuccessfully to have a baby is the sense that you’re not in control of your own destiny. Most of us take for granted that our health will accurately reflect our fertility. Therefore, why shouldn’t we be able to conceive whenever we decide the timing is right? At least that’s the common perception. The repeated success of friends and family often makes it even more exasperating. I know this. Not only do I treat couples trying to become pregnant on a daily basis but my wife and I went through fertility treatment on our own. During our treatment, we were repeatedly annoyed by the lack of individualization of our treatment protocol by my colleagues whom we’d entrusted our care to. Worse still was the way our input was disregarded even though we’re as fully informed of the science behind the treatment as they were.

My wife and I chose to redirect our approach to treatment; both personally and professionally. After all, I didn’t want my patients to experience the same frustrations that we endured. The results or our action was dramatic; we now have a daughter and we manage a fertility treatment center that empowers patients. We remain fully committed to helping other couples take control of their fertility treatment as well regardless of where they go for treatment. Here’s what we recommend:

  • Get informed—Although it is important that expose yourself to as much information as possible, it is best to consider the source as well as how old the material is that you’re reading. In other words, not everything you read is accurate. Some is outdated and much of it may be true but not apply to you. Seek information that is verifiable. Look for reputable sources and references to specific research studies.
  • Ask questions—Once you feel comfortable with your knowledge base, write down questions. Don’t be shy about asking your doctor very specific reasons why the do or do not recommend a specific course of action if it is appealing to you. It’s best for your doctor to earn your trust through such encounters rather than expect it based upon their title or reputation.
  • Create a fertility plan—This is a unique concept that I don’t think enough people do for themselves. Take the time to consider your options and periodically re-evaluate your goals. Just like writing a business plan or creating an itinerary for a planned vacation plan your course of action. There is nothing that can be more empowering than to actually be in control. If you need some assistance with this, check out pp, 127-129 and pp 285-287 in my book PERFECT HORMONE BALANCE FOR FERTILITY.
  • Analyze your diet and lifestyle—Consider the steps that you and your partner can take outside of the doctor’s office to boost your chance of pregnancy. This can involve matters like losing weight, taking a prenatal vitamin or evidence-based supplement or finding ways to lower your stress level. Bottom line is that success begins at home.
  • Consider a second opinion—If you’re not comfortable with the plan proposed to you, consider meeting with another board certified reproductive endocrinologist. There is typically more than way to achieve success. You should be able to form a partnership with your doctor that you’re both comfortable with. Therefore you shouldn’t feel committed to seeking treatment that you’re not comfortable with since there are other options.