Children are often described as blessings.
There are many couples who wish to have children but just can’t seem to get pregnant. Are you one of them?
What treatment options are out there for couples trying to conceive? Some fertility problems are more easily treated than others.
What can you expect from treatments and how long do they take to work?
Listen in to what Dr. Suja Roberts has to be say as to why a couple may have difficulty getting pregnant and how she can help couples that are having trouble getting pregnant.
Selected Podcast
Infertility: Aspirus Offers Hope
Featured Speaker:
Suja Roberts, MD
Dr. Suja [Sue-Ja, rhymes with gouda] Roberts is an Aspirus Medford Hospital OB/GYN with a special interest in infertility. She has a passion for women’s health and caring for all aspects of female reproductive health. Compassionate, kind, and approachable, she finds special joy in helping women achieve their dreams of motherhood, better health, and a better life. In her free time, Dr. Roberts enjoys reading, music, and spending time with her husband, grown daughter and golden retrievers. Transcription:
Melanie Cole (Host): Children are really a blessing, but there are many couples who wish to have children but just can’t seem to get pregnant. Are you one of them? Do you have questions about fertility treatments? My guest today is Dr. Suja Roberts. She’s an Aspirus Medford Hospital OB/GYN with special interest in infertility. Welcome to the show, Dr. Roberts. Tell us a little bit about how somebody would know if they are infertile or need to seek treatments, because sometimes there are other factors. We’re too stressed out or we think we can’t get pregnant. How do we know when it’s really time to seek treatment?
Dr. Suja Roberts (Guest): Thank you, Melanie. Let me thank you for having me on your show today. Yes, you’re right. Children are a blessing, and most of the times we get our blessings without trying too hard. But many times, as young couples start trying to get pregnant, sometimes they may encounter some difficulties, and they’re bad. Scientifically and traditionally, what we always would tell patients would be, “Okay, you’re young.” When I say young, I mean a couple of less than 35 years of age. And typically, if a couple have had unprotected intercourse for 12 months and have not been successful to become pregnant, that is the time that we recommend that they see a provider or talk to their provider about starting some kind of investigation or some kind of a baseline testing to see what’s going on. Now, if they are older, if the woman is about 34, 35 years old and has been trying to get pregnant and has not been pregnant for let’s say six months, then we do recommend testing right away, because as we all know, with women, our fertility takes a deep dive downwards once we hit that age, 35.
Melanie: When they come to see you and they’ve described how often they’re having unprotected intercourse and what’s going on in their lives, what’s the first thing you do for them? How do you test?
Dr. Roberts: First of all, it would be I’d take a detailed history about both of them, both the man and the woman. We take histories basically as to how is their health and do they have any medical problems. What was their past medical history? Have they had any surgeries on their reproductive organs? We always look at what medications they are taking, and then we take their sexual history, like how frequently are they having intercourse and do they have any problems. With the male, we ask questions about problems with erection, ejaculation, retrograde ejaculation. With the woman, we ask if she has any discomfort or problems or pain during intercourse. We also elicit a history about the woman’s menstrual history. Is she getting her periods regularly? We take all this history, and then we do proceed with a clinical exam of the woman. For the male, if there is an indication, we do recommend him to get a complete physical exam as well. Then we start off the evaluation basically with semen analysis because we need to make sure that the man has adequate number of sperms in his semen and all other parameters, which are normal. Then we do some testing on the woman’s blood, basically looking at her reproductive hormones and the status of her ovaries. If necessary, at some point, we do add another test where we look at the uterus and the fallopian tubes basically to make sure the anatomy is normal. I always like to tell my patients, when you take a hundred couples who are exactly in your shoes, and look at them to see what’s causing delay in getting pregnant, we see that in about 40 percent of the time, it’s female factor; 40 percent of the time, it’s male factor; 10 percent there’ll be both male and female factors involved; and in other 10 percent, everything is perfect and they just cannot get pregnant, which we call this unexplained infertility. Once we get this basic investigation or evaluation, then the treatment proceeds depending on if you find any underlying factor that’s causing this problem. Obviously, the treatment would be directed towards that.
Melanie: Outline for us, Dr. Roberts, some of the initial treatments starting with some of the more simple ones like Clomid if a woman has problems ovulating and what you do from thereon.
Dr. Roberts: Following the evaluation, if everything is normal, let’s assume that she is good and he is good and everything is looking good, it’s just taking a while for them to become pregnant, so we start off with what we call as home Clomid, where I do let the patients take a low dose of Clomid, which is typically 50 milligrams, from the third day of their cycle for five days, then start doing the ovulation prediction tests. Either they can do it with -- there are a number of ways a woman can determine whether she’s ovulating or not, and one of the common ones are over-the-counter urine sticks, where she dips the stick in her urine starting on the day 10 or day 11 of her cycle. And then once the stick or the ovulation prediction stick turns positive, then the couple will proceed with timed intercourse so as to increase their odds of getting pregnant. That would be the first step. With that, if there is no response to that, if she doesn’t get pregnant with three or four cycles of this home Clomid, we move on to increasing the dose of the Clomid. And once we increase the dose of medications, we do also add some form of a monitoring or what we call as follicle scan, where we actually take a look at the ovaries with an ultrasound to see if the woman is responding or if her ovaries are forming eggs. Then based on that, again, we can go in a stepwise fashion and tell them, “Okay, now you can go ahead and have timed intercourse,” or we can also induce ovulation with medications. Then the couple can have intercourse at home. In certain instances, they can also opt for in-office insemination, as well, as the case may be. This would be the minimally invasive, low-key treatment that can be done in most of the clinics. At some point, if there is no response or if there is no luck to these low-key measures, then a certain percentage of couples may need more advanced reproductive technology like in vitro fertilization and embryo transfer.
Melanie: Because we don’t have a lot of time, Dr. Roberts, give us a quick overview of in vitro fertilization and when you would tell a couple it’s time to stop. Because they have a lot of hope. This is a very difficult thing to go through. When do you say, “Okay, now I think you’ve tried everything”?
Dr. Roberts: That’s a very interesting but a very difficult question. As a doctor, I encounter these patients, and it’s hard for somebody to say, “Well, stop now,” because they are not ready for that answer. Anyway, in in vitro fertilization, most of the centers have their criteria for couples to be eligible to enter into this program. There is an age limit. There is a limit on the body mass index. So, there are strict criteria that will guide the couples to tell them whether they’re eligible to enter into this program or not. Now, in vitro is where the woman’s ovaries are stimulated to produce more eggs and at the right time, when the eggs are of size, when they’re ready for fertilization, these eggs are aspirated out of their ovaries and basically in a petri dish, in the lab, the egg is allowed to get fertilized by the sperm. There are many different technologies. We don’t have to go into that detail. But once a fertilization happens in the petri dish, in the ovary, as soon as a certain stage, the embryo is actually picked up and it’s loaded into a little tube, and it is injected into the woman’s womb, where it implants and hopefully grows and becomes a fetus. That’s in a nutshell what IVF ET involves. Like I said, it’s a very expensive procedure, and financial constraints oftentimes guide patients to stop after they have tried maybe two or three cycles. But again, like I said, if you are older -- again, I can say if you’re 40 years old, I cannot say don’t try because there are couples who are in their 40s and they do want to get pregnant and they are aware of all the risks involved. As long as they are willing to take the risks involved and also the costs, they do go into this procedure.
Melanie: In just the last minute, Dr. Roberts, if you would, give your best advice to those listening that are considering infertility treatments and why they should come to Aspirus and speak with you about this.
Dr. Roberts: I always advise my patients to be aware of this time limit or age limit and also would like to remind that after a certain age, a woman’s fertility takes a deep dive down. So do not wait for too long. If you’re under 30, you wait for about 12 months of unprotected intercourse, and if you don’t get pregnant, please come in and get evaluated. If you’re older than 30, if you’re not getting pregnant within six to seven months of trying, please see your provider and go ahead and get evaluated.
Melanie: Thank you so much. It’s really great information. You are listening to Aspirus Health Talk. For more information, you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Children are really a blessing, but there are many couples who wish to have children but just can’t seem to get pregnant. Are you one of them? Do you have questions about fertility treatments? My guest today is Dr. Suja Roberts. She’s an Aspirus Medford Hospital OB/GYN with special interest in infertility. Welcome to the show, Dr. Roberts. Tell us a little bit about how somebody would know if they are infertile or need to seek treatments, because sometimes there are other factors. We’re too stressed out or we think we can’t get pregnant. How do we know when it’s really time to seek treatment?
Dr. Suja Roberts (Guest): Thank you, Melanie. Let me thank you for having me on your show today. Yes, you’re right. Children are a blessing, and most of the times we get our blessings without trying too hard. But many times, as young couples start trying to get pregnant, sometimes they may encounter some difficulties, and they’re bad. Scientifically and traditionally, what we always would tell patients would be, “Okay, you’re young.” When I say young, I mean a couple of less than 35 years of age. And typically, if a couple have had unprotected intercourse for 12 months and have not been successful to become pregnant, that is the time that we recommend that they see a provider or talk to their provider about starting some kind of investigation or some kind of a baseline testing to see what’s going on. Now, if they are older, if the woman is about 34, 35 years old and has been trying to get pregnant and has not been pregnant for let’s say six months, then we do recommend testing right away, because as we all know, with women, our fertility takes a deep dive downwards once we hit that age, 35.
Melanie: When they come to see you and they’ve described how often they’re having unprotected intercourse and what’s going on in their lives, what’s the first thing you do for them? How do you test?
Dr. Roberts: First of all, it would be I’d take a detailed history about both of them, both the man and the woman. We take histories basically as to how is their health and do they have any medical problems. What was their past medical history? Have they had any surgeries on their reproductive organs? We always look at what medications they are taking, and then we take their sexual history, like how frequently are they having intercourse and do they have any problems. With the male, we ask questions about problems with erection, ejaculation, retrograde ejaculation. With the woman, we ask if she has any discomfort or problems or pain during intercourse. We also elicit a history about the woman’s menstrual history. Is she getting her periods regularly? We take all this history, and then we do proceed with a clinical exam of the woman. For the male, if there is an indication, we do recommend him to get a complete physical exam as well. Then we start off the evaluation basically with semen analysis because we need to make sure that the man has adequate number of sperms in his semen and all other parameters, which are normal. Then we do some testing on the woman’s blood, basically looking at her reproductive hormones and the status of her ovaries. If necessary, at some point, we do add another test where we look at the uterus and the fallopian tubes basically to make sure the anatomy is normal. I always like to tell my patients, when you take a hundred couples who are exactly in your shoes, and look at them to see what’s causing delay in getting pregnant, we see that in about 40 percent of the time, it’s female factor; 40 percent of the time, it’s male factor; 10 percent there’ll be both male and female factors involved; and in other 10 percent, everything is perfect and they just cannot get pregnant, which we call this unexplained infertility. Once we get this basic investigation or evaluation, then the treatment proceeds depending on if you find any underlying factor that’s causing this problem. Obviously, the treatment would be directed towards that.
Melanie: Outline for us, Dr. Roberts, some of the initial treatments starting with some of the more simple ones like Clomid if a woman has problems ovulating and what you do from thereon.
Dr. Roberts: Following the evaluation, if everything is normal, let’s assume that she is good and he is good and everything is looking good, it’s just taking a while for them to become pregnant, so we start off with what we call as home Clomid, where I do let the patients take a low dose of Clomid, which is typically 50 milligrams, from the third day of their cycle for five days, then start doing the ovulation prediction tests. Either they can do it with -- there are a number of ways a woman can determine whether she’s ovulating or not, and one of the common ones are over-the-counter urine sticks, where she dips the stick in her urine starting on the day 10 or day 11 of her cycle. And then once the stick or the ovulation prediction stick turns positive, then the couple will proceed with timed intercourse so as to increase their odds of getting pregnant. That would be the first step. With that, if there is no response to that, if she doesn’t get pregnant with three or four cycles of this home Clomid, we move on to increasing the dose of the Clomid. And once we increase the dose of medications, we do also add some form of a monitoring or what we call as follicle scan, where we actually take a look at the ovaries with an ultrasound to see if the woman is responding or if her ovaries are forming eggs. Then based on that, again, we can go in a stepwise fashion and tell them, “Okay, now you can go ahead and have timed intercourse,” or we can also induce ovulation with medications. Then the couple can have intercourse at home. In certain instances, they can also opt for in-office insemination, as well, as the case may be. This would be the minimally invasive, low-key treatment that can be done in most of the clinics. At some point, if there is no response or if there is no luck to these low-key measures, then a certain percentage of couples may need more advanced reproductive technology like in vitro fertilization and embryo transfer.
Melanie: Because we don’t have a lot of time, Dr. Roberts, give us a quick overview of in vitro fertilization and when you would tell a couple it’s time to stop. Because they have a lot of hope. This is a very difficult thing to go through. When do you say, “Okay, now I think you’ve tried everything”?
Dr. Roberts: That’s a very interesting but a very difficult question. As a doctor, I encounter these patients, and it’s hard for somebody to say, “Well, stop now,” because they are not ready for that answer. Anyway, in in vitro fertilization, most of the centers have their criteria for couples to be eligible to enter into this program. There is an age limit. There is a limit on the body mass index. So, there are strict criteria that will guide the couples to tell them whether they’re eligible to enter into this program or not. Now, in vitro is where the woman’s ovaries are stimulated to produce more eggs and at the right time, when the eggs are of size, when they’re ready for fertilization, these eggs are aspirated out of their ovaries and basically in a petri dish, in the lab, the egg is allowed to get fertilized by the sperm. There are many different technologies. We don’t have to go into that detail. But once a fertilization happens in the petri dish, in the ovary, as soon as a certain stage, the embryo is actually picked up and it’s loaded into a little tube, and it is injected into the woman’s womb, where it implants and hopefully grows and becomes a fetus. That’s in a nutshell what IVF ET involves. Like I said, it’s a very expensive procedure, and financial constraints oftentimes guide patients to stop after they have tried maybe two or three cycles. But again, like I said, if you are older -- again, I can say if you’re 40 years old, I cannot say don’t try because there are couples who are in their 40s and they do want to get pregnant and they are aware of all the risks involved. As long as they are willing to take the risks involved and also the costs, they do go into this procedure.
Melanie: In just the last minute, Dr. Roberts, if you would, give your best advice to those listening that are considering infertility treatments and why they should come to Aspirus and speak with you about this.
Dr. Roberts: I always advise my patients to be aware of this time limit or age limit and also would like to remind that after a certain age, a woman’s fertility takes a deep dive down. So do not wait for too long. If you’re under 30, you wait for about 12 months of unprotected intercourse, and if you don’t get pregnant, please come in and get evaluated. If you’re older than 30, if you’re not getting pregnant within six to seven months of trying, please see your provider and go ahead and get evaluated.
Melanie: Thank you so much. It’s really great information. You are listening to Aspirus Health Talk. For more information, you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.