Q & A with Dr. John Frederick Payne, MD
Reproductive Endocrinologist & PREG Partner
Aggressive Treatment & Financial Aspects
On Infertility Awareness
Q & A with Dr. John Frederick Payne, MDWhen is a patient diagnosed with having fertility issues?
The percentage of couples that would be considered infertile is roughly one in seven of fertility age or 12-14% of the population. Couples would be given a diagnosis after one year of unprotected intercourse without being able to conceive during that time period or if a woman was over 35 years of age and/or had already achieved pregnancy in the past but after 6 mo’s of unprotected intercourse cannot conceive we would recommend a study.
The monthly pregnancy rate in couples varies in age, but in general, after a year half without conceiving there is a 2-3% decrease of conceiving naturally each month. And when people start to conceive about 50% of healthy women will conceive in the first two to three cycles and between 80-90% in the first six months. Then you’ve got a waiting period for the others in which 9/10 would’ve conceived in one year. At PREG we are evaluating the 10% who weren’t successful in that time period.
What are the reasons?
Causes of infertility can be broken down into female factors, male issues, unexplained factors or a combination. Under female factors, there can be tubal blockages, ovulatory dysfunction, diminished ovarian reserve, and uterine factors. In the male we’re talking about sperm production/distribution, which could indicate a blockage of some type; a lack of production of sperm/concentration along with motility, and a normal shape to achieve natural conception.
There can be multiple factors of sub-fertility that maybe one alone wouldn’t have been an issue but because of several factors, that are unexplained. For example, a patient could go through all of the tests and it seems normal. She is ovulating normally, the fallopian tubes are open, semen from her partner is normal and it would seem she could conceive but doesn’t.
In those cases we will discuss ovulation induction, Ovidrel trigger shots to force ovulation within a 36-hour window with time intercourse for two to three cycles. We followup to discuss if we need to continue with timed or increased complexity by adding IUI which would increase the chance of conception. There are other things we would continue to try to achieve conception, and these issues are about 20% of the cause, but the treatment plans we use for this group can be very effective.
Is there a higher degree of infertility among certain ethnic/socioeconomic groups?
Not really, it seems to be that infertility doesn’t discriminate into an ethnicity, socioeconomic, or geographic region, however, I would say there are subsets of patients where certain ethnicities are predisposed to certain conditions (like Caucasians have a higher incidence of endometriosis and fibroids are more common in African Americans) tubal disease is more common in younger women because STD’s and many have been more than sexually active (ages 25 and under) which can cause adhesions, scarring, and affect the fallopian tubes.
However, the biggest factor is still the woman’s age and that is the one thing that can’t be modified, we can’t make women younger no matter how much we wish we could. The earlier they come to us the more opportunity we have for success in whatever treatment we are discussing. If they are less than 30-years old there is a 25% chance of natural decrease, 15% monthly, but in a 35-year old woman it is 5-10% and at age 40+ it’s less than 5%. At the same time, the chance to conceive goes down the monthly chance of miscarriage increases because women’s eggs are the same age as she is and they divide abnormally more often as they age.
How do we get the word out for women to come for fertility evaluation earlier?
We try to work with OBGYN’s to help educate as well s other physicians to get the word out. Efforts through our society (The American Society of Reproductive Medicine), advertising, and social awareness campaigns to stress the importance of conceiving younger in life if possible. Certainly, with today’s society, education is more prominent, we have women with graduate and post-grad degrees, later in life marriages, working and doing more career-oriented jobs, they delay child-bearing trying to get the rest right and then the age factor hurts them because of the ovarian diminished reserve. It’s biological.
Women can do some things if they are getting older and consider oocyte or egg preservation which is essential ovarian stimulation with injections and egg retrieval with the exception of fertilizing the eggs and in the future thaw those eggs, fertilize them and when she’s ready, to transfer embryos to conceive. The more eggs we can freeze in a young woman and the higher the probability she will deliver.
How do we educate and get the word out about the options through IVF?
Well the first IVF conception was in 1978 in Europe and 1980 in America so this is still a very young science. Social media will do a lot in the future through Facebook, Instagram, and Resolve. Resolve is an institution that works with patients with infertility offering many different resources, support groups, and information. Resolv.org offers a ton of information about infertility. Through social media, you can reach so many people and emerging generations use it so much more than Boomers, e
Do you think in the future that IVF and other infertility options will be more pervasive and known for the public?
I think yes and no, the population is aging so we do see older patients but also see they are well educated, researched been online and know the basics of our evaluation and treatments. They also are coming in because there is an increase in insurance coverage for evaluation and treatments and so as that becomes more prominent. Cost is the biggest thing that keeps patients from coming and go up in time, but the coverage seems to be increasing for many patients. Five to ten years ago many may have not had coverage or access to it and in some states mandates for employers to provide coverage for infertility evaluation and treatment is now law. So the insurance is getting better and increasing on many fronts.
Our goal when we see these patients is that in the one out of seven (the 14% of the population) is to do a thorough evaluation and look for causes and try to start with treatments that make sense are less invasive and expensive and work our way up in an expedited manner giving each one a chance to conceive. We try to find the easiest and least expensive way of achieving our goal of “one baby at a time”.
Dr. John Frederick Payne, MD
Reproductive Endocrinologist, Partner,
Third-Party Reproduction Director at PREG
PREG
