The Quest for a Family
New techniques and research offer advanced fertility options for prospective parents.
For those who want children and can’t have them on their own, time is the enemy. But so is cancer. And money. And war.
For those who fear an imperfect genetic history, it seems they must forge the steeliest of nerves in order to be successful. So many things can go wrong in the quest for a family, despite the high-tech world of fertility treatments and genetic counseling that hold promise for those who have been disappointed by old-fashioned measures.
Take, for example, Jim and Kristin Parrish, both in their late 20s, who had been trying casually for years to get pregnant with no results. In 2012, they became serious about the prospect and started to chart everything with regard to monthly fertility.
“I was supposedly ovulating every month, but nothing ever happened,” Kristin says. They would go on to feel the normal pressures of trying, but failing, to have children, they say — the stress, the hope, the disappointment.
Eventually, the couple decided to seek professional help and went to Kristin’s gynecologist to start preliminary testing in order to diagnose any infertility issues. “We left the doctor’s office and looked at the price tag of it all,” Kristin says. “It was going to cost at least $1,000 just to start preliminary testing.”
“At that point, we were already at the end of our rope,” Jim says. “The cost, the invasion of privacy, the constant checkups — it just seemed like too much. And we thought we could really put our time and resources into other options for having children.”
The couple, who live in Nebraska, in 2014 ultimately decided to abandon traditional methods for having children and pursue adoption. This past January, they adopted a newborn son from a teenage mom in Dearborn with the help of a national adoption agency.
“We were never afraid of adoption,” Jim says. “It was always an option for us.”
Jim and Kristin’s quest for a child ended happily, minus the cost and uncertainty of fertility treatments. This is an exception to the rule, says Dr. Brad Miller, an infertility specialist in metro Detroit, who added that there aren’t any statistics detailing how many people decide to adopt versus those who exhaust all their options for having a biological child first.
Whatever the decision, Miller says, there are many advanced fertility options today that can help women get pregnant, or help couples eliminate genetic defects in order to produce healthy children. Miller says education and research are key.
Miller is a board-certified reproductive endocrinologist and the co-founder of Reproductive Medicine Associates of Michigan in Troy. He sees his role in fertility medicine as part science, part therapy, as he often must counsel patients on the chance of having children when infertility issues are at play. Age is usually the biggest hurdle, since the number of viable eggs, and the health of embryos, decreases significantly after 35. “We often see women who come in who are 40 who look and feel like they are 30. But the older your body gets, the chances of having a live birth decrease significantly despite how good you look or feel,” Miller says.
Still, for some, infertility just can’t be explained definitively, regardless of age, Miller says. Michelle Wager, a current patient, is a U.S. Army veteran who suffered severe mental and physical trauma in the Iraq War after she and her team were hit with a roadside bomb. Since then, various doctors have speculated that the “shock” to her system has made it extremely difficult for her to have children. In fact, Wager went into a state of menopause in her early 30s for four years. Now, at 40, Wager wants to get pregnant and is hoping Miller can help.
“It’s hard to deal with, because I just want to be a mom,” Wager says. “It’s such a hard pill to swallow.”
Reproductive Medicine Associates uses a clinical metrics report to help its patients understand at the outset their personal chances for success using different fertility treatment options. For example, on a recent report for one of Miller’s patients, a 43-year-old woman who had been trying for 24 months to get pregnant naturally and had experienced one miscarriage, learned how she could maximize her chances with medication and IUI (intrauterine insemination) versus the more expensive IVF (in vitro fertilization) option.
According to the woman’s report, she has a 10 percent chance of having a baby with four cycles of IUI and oral medication, a process in which medication stimulates egg production and an egg is subsequently artificially inseminated once it reaches the womb. However, with IVF — the more expensive procedure where an egg is inseminated outside the womb and later transferred in the hope that the embryo will implant itself within the uterus — the woman has a 41 percent chance of success.
If she were to wait until age 46, her chance of getting pregnant with IVF would go down to less than 5 percent.
The important thing to keep in mind, Miller says, is that everyone’s circumstances are different. Establishing a baseline fertility report for continuing with treatment, he says, is a good way to set realistic expectations and choose the most efficient options for getting pregnant.
CCS: The New Gold Standard
When an embryo is healthy and free of genetic abnormalities, it has a better chance of developing into a fetus and resulting in a live birth for someone who is struggling to have a child. In 2010, a new method called comprehensive chromosome screening made it possible to detect chromosomal errors in embryos and will become the “standard of care” within the next decade, Miller says.
What makes for the healthiest embryo? When sperm fertilizes an egg, the resulting embryo should have 23 chromosomes from the mother and 23 chromosomes from the father. Unfortunately, many embryos often end up with more or less than the combined 46 chromosomes and are at risk for genetic abnormalities — as well as at risk for being miscarried.
During the CCS process, DNA is tested from an embryo that has at least 100 cells. The doctor and patient can then identify which embryos should be considered for IVF based on an accurate determination of which embryos have the correct number of chromosomes.
The process can save time and money, Miller says, by giving people a better chance for expensive IVF treatments to work the first time around.
One of Miller’s current patients is in her early 30s. She is engaged to be married and wants to have children — and by all accounts, she should be able to do it on her own without the doctor’s help. What the patient is concerned about, Miller says, is passing along a family history of disease. Not cystic fibrosis, or sickle cell anemia, or spinal muscular atrophy, three of the most common genetic illnesses — but cancer.
The patient is a carrier of one of the genes that causes breast and ovarian cancer. Statistically, she has a 60 percent chance of developing breast cancer by the time she is 70, as well as a 40 percent chance of developing ovarian cancer.
She doesn’t want her child to have the same fate, so Miller in January extracted 30 eggs from the woman, which will be frozen and later tested for the genetic markers for breast and ovarian cancer. When she is ready to have children, she will receive IVF with embryos that are free of genetic markers for cancer.
“This is cutting edge,” Miller says of the ability to check embryos for genetic markers for cancer. “We’ve been testing for things like CF and SMA for a long time,” he says, adding that other diseases like cancer will become normal to screen for as genetic science evolves.
Did you know?
• Men who are missing the vas deferens, the tube that transports sperm from the testes, may have the same gene mutation that causes cystic fibrosis. The condition is responsible for up to 2 percent of all cases of male infertility. It is still possible for men with this condition to father children with the help of a fertility specialist.
• A woman who is 20 years old has a 1 in 1,667 chance of having a baby with Down syndrome and a 1 in 526 chance of having a baby with chromosomal abnormalities. By the time the woman turns 40, her chances increase significantly to 1 in 106 and 1 in 65, respectively.
• In vitro fertilization can work if you stick with it: 1 in 4 couples stop trying before they’ve maximized their chances, and 48 percent who discontinue IVF would have likely gotten pregnant with two more cycles.