OBSTETRIC S Many Options Available to Address Many effective options are available for women and couples having difficulty conceiving, and UCLA fertility experts urge women and their partners not to delay in seeking consultations to address potential concerns. An estimated 10-to-15 percent of couples in the United States are considered infertile — defined as not being able to become pregnant despite frequent unprotected intercourse for a year or more — and the percentage rises with the age of the female, notes UCLA reproductive endocrinologist Daniel Dumesic, MD. Many possible causes exist. Among women, Dr. Dumesic says, a common cause of infertility involves damage to the fallopian tubes, including infections from sexually transmitted diseases or as a result of previous abdominal surgery. Common issues also include absence of ovulation — typically signaled by menstrual cycles more or less frequent than every three-to-five weeks, and often easily corrected through medication. In other cases, the problem is traced to the male, often stemming from low sperm count or poor sperm function due to a variety of possible, and often correctable, factors. Infertility “The important thing is that if there are any doubts, people should err on the side of coming in sooner rather than later, because you don’t want to wait so long that fewer options are available to you.” One of the most dramatic changes in the fertility field in recent years is the ability to successfully freeze women’s eggs for later use. “A woman who is otherwise fertile but faced with a disease process or a treatment such as chemotherapy that will render her infertile can have her eggs frozen to save her reproductive capacity for later in life,” says Ingrid Rodi, MD, director of fertility services at UCLA Medical Center, Santa Monica. The technology is now also being applied more widely. “Women who are planning to delay conception until their late 30s, early 40s or beyond should consider freezing eggs,” says Mousa Shamonki, MD, UCLA reproductive endocrinologist. He notes that the process has brought the egg-freezing survival rate from approximately 70 percent to more than 90 percent. The procedure is considered very safe, and the medicines are well tolerated, but it can be costly, and there is the chance the frozen eggs won’t yield a viable embryo. Advances in genetic screening are improving the ability of fertility experts to detect problems in the embryo, Dr. Shamonki adds. Better techniques make the process less likely to harm the embryos and more likely to yield complete information, which can help couples in excluding unhealthy embryos. In general, women up to age 35 with no known cause of infertility are advised to consult with a specialist after a year of unsuccessfully trying to conceive. When the woman is older than 35, or the couple has known issues, the UCLA experts recommend seeking an evaluation after six months without success, or sooner. “The important thing is that if there are any doubts, people should err on the side of coming in sooner rather than later, because you don’t want to wait so long that fewer options are available to you,” Dr. Shamonki says. Vital Signs Winter 2014 Vol. 61 3