SAN FRANCISCO — Ob.gyns. and family physicians play a critical role in educating patients and their partners about infertility, doing a basic workup, and knowing when to refer them without delay to a specialist, according to Dr. Charles Miller.
Receiving factual information from a trusted source will go far to combat deeply entrenched myths and misconceptions about infertility, said the Naperville, Ill., infertility specialist and surgeon during Perspectives in Women's Health sponsored by OB.GYN. NEWS.
“We are not reaching them,” he said. “Despite Redbook and Oprah and Marie Claire … Time magazine, Newsweek, and U.S. News and World Report, we're just not getting there.”
Dr. Miller said he was “shocked” to learn from a recent national survey sponsored by the National Infertility Association RESOLVE that the majority of women could not define infertility and believed the No. 1 cause of the problem was stress.
Among the facts women need to know:
▸ Infertility is defined as failure of a woman 35 or younger to become pregnant in 1 year, or in 6 months if the woman is over 35.
▸ Fecundity rates decline quite precipitously after the first six cycles of attempting to achieve pregnancy.
▸ There are 7.7 million couples experiencing infertility in the United States today.
▸ One in three U.S. couples aged 35–39 years will not be able to achieve pregnancy without treatment.
▸ The risk of Down syndrome and other chromosomal abnormalities increases sharply as women age: estimated to be 1 in 11 live births and 1 in 8 live births, respectively, in a woman who delivers at age 49.
▸ The live-birth rate for in vitro fertilization in women over the age of 40 is approximately 10%–15% at most centers.
Dr. Miller pointed out that the age-related decline in fertility has been documented since the 17th century. “This is nothing new. This is not because of STDs, not because of more fibroids, not because of diet. This is because of egg production.”
Most of the causes of infertility are physical, not psychological, he said.
Among female factors, ovulatory factors are responsible for infertility in about a third of patients, uterine and tubal factors combine to contribute to about 40% of cases, and endocrine factors are responsible for about 17%.
Varicocele is most commonly behind male infertility, but idiopathic factors, obstruction (14%), and other causes, including infections, medications, and immunologic problems, are also factors.
Debate rages about whether immunologic concerns are a major contributor to infertility. Dr. Miller called the issue “probably the raciest part of our field.”
He said he believes anticardiolipin antibodies probably do hamper fertility, but the role of other antiphospholipid antibodies is less clear.
“There are physicians who will work this up to the hilt, and there are groups of physicians who will ignore it,” he said.