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Understanding Infertility, IVF, and Surrogacy in 2024




We had the opportunity to engage with Dr. Amelia H, a reputable Reproductive Endocrinologist affiliated with Affirm Fertility. Our conversation revolved around understanding infertility, its causes and treatments available, and the different paths toward parenthood.


UNRAVELLING INFERTILITY


Infertility is recognized when a couple has been actively trying to conceive for a year or more without success if the woman is under 35 years old and for six months or more if she is over 35. Infertility doesn't necessarily imply permanent incapacity to conceive; it represents that a couple hasn’t achieved conception within an expected timeframe.


PATIENTS SEEN BY A REPRODUCTIVE ENDOCRINOLOGIST


Reproductive Endocrinologists (REs) cater to patients with varying concerns. Generally, four types of people approach an RE. 


* The first category includes those who, despite trying, have not been able to conceive and seek to understand why.

  

* The second group comprises individuals who, even though they haven't been on the conception journey for too long, are aware that they require assistance due to known infertility risk factors or recurrent pregnancy losses.

  

* The third segment consists of individuals or couples that require a sperm or egg donor or a gestational carrier because of their specific circumstances - be it same-sex relationships, medical history necessitating a carrier or donor, or even previous difficult pregnancies.

  

* The fourth subset includes women exploring fertility preservation by retrieving and freezing their eggs for future family planning.


The role of an RE then becomes to understand the reason behind their visit and determine the best treatment course.


TRACING THE CAUSES OF INFERTILITY


For every patient who walks through our doors, we conduct an examination catered to their individual situation. This could range from semen analysis, checking fallopian tube patency, reviewing hormonal status, to inspecting their anatomical structure. For cases of recurrent pregnancy loss, we perform a specialized workup as most pregnancy losses owe to abnormal genetics of the embryo – majorly chromosomal abnormalities. The cause of infertility and loss ultimately determines the treatment path.


OPTIONS FOR INFERTILITY TREATMENTS


For some, lesser invasive treatments like pairing an intrauterine insemination with a cycle using oral medication may be effective. This enhances the chances of conception by placing the sperm directly into the uterus. However, others might require more complex treatments like IVF.


UNDERSTANDING IVF


IVF( In vitro fertilization) signifies fertilization happening in the laboratory rather than in the body. This process entails a woman taking injectable medications to stimulate simultaneous maturing of multiple eggs. The matured eggs are then retrieved through a minor surgical procedure and fertilized with the sperm in the lab to create embryos. These embryos are usually cultured in the lab for about five to six days to reach the blastocyst stage. They can then be transferred or frozen or genetically tested or any combination of these. There are variations to this, including egg retrieval for freezing to preserve fertility.


EXPLORING THIRD-PARTY REPRODUCTION


In some instances, an additional person becomes integral to the pregnancy process; this could be through a sperm/egg donor or a gestational carrier – termed as third-party reproduction.

Some may be aware from the outset that they require third-party reproduction, while others may get to know about this need during the journey. The success rates for IVF are predominantly contingent on the female's age at the time of IVF and the number of eggs retrieved, decreasing with age and receding egg quality and quantity. This may lead some to consider the aid of an egg donor.


Many know from the beginning that surrogacy will be their method for family building – this includes the LGBTQIA+ community, women without a uterus, women who have suffered from gynecological cancers or endometriosis, or even women with a history of troublesome pregnancies. A smaller percentage of people may require a gestational carrier after unsuccessful attempts at conceiving naturally or experiencing multiple losses through IVF.


Decision-making regarding third-party reproduction is not straightforward. Conversations need to be had with patients regarding their experiences, possible next steps, and the likelihood of success in diverse situations. The role of an RE is to supply them with adequate information for them to make the decision they are most comfortable with.
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