Where Do I Start?

Example:  Husband, age 46, and wife, aged 40 years (intended parents), try low-dose fertility drugs and intrauterine insemination, but surgery is unnecessary. After several failed in vitro fertilization cycles and two miscarriages, their infertility doctor recommends surrogacy.  The egg and sperm from the intended parents are implanted into a surrogate, and the intended parents create four normal genetically tested embryos. After two cycles of transferring an embryo to the surrogate that did not result in a pregnancy, they are rematched with a different surrogate, create another batch of embryos, and again get four normal genetically tested embryos.  This surrogate is a repeat surrogate, meaning she carried a successfully delivered surrogacy baby a year earlier. Their second surrogate miscarried after the first embryo transfer attempt, and the second and third attempts were also unsuccessful.

Comments: 

1. Typically, in a case like this, the infertility doctor will recommend that the Intended Parents switch from their eggs to eggs from a donor and try again with their surrogate.
2. BUT is this the right solution? Since infertility affects men and women almost equally, why automatically assume that the woman’s eggs cause the failures? Here is an alternative solution:
   • Intended parents should proceed to choose an egg donor.
   • Have the intended mother (now close to the age of 42 years) undergo another in vitro fertilization cycle and fertilize these eggs with donor sperm.
   • The intended parents have two batches of embryos: one with the intended father’s sperm and donor eggs and one with the intended mother’s eggs and donor sperm.
   • Implant the donor egg with the intended father’s sperm OR the mother’s eggs with donor sperm into the intended mother. In this case, there is no objective evidence that her uterus cannot carry a pregnancy.
   • If no pregnancy results, implant either embryo into a surrogate.
   • It may well be that these parents end up with one child from the intended mother’s egg and donor sperm and another child from the intended father’s sperm and donor eggs.
3. Since there is no conclusive evidence that the intended mother’s eggs are causing the failed cycles, creating embryos with the mother’s eggs may be necessary before her egg quality and quantity decline. It is regretful that some infertility doctors automatically conclude that the eggs cause the failures, and moving to an egg donor is recommended. 
4. If the intended mother fails to produce good-quality embryos, looking at egg donation and the intended father’s sperm is the appropriate solution.

Another option is to pursue adoption while fertility treatments are ongoing.  The intended parents can drop one of these options along their journey or create a blended family of much-wanted children.

Getting a second opinion has never hurt anyone.  No doctor is always 100% right in their diagnosis or treatment plan recommendation.  Doctors are human, too, and use their knowledge, training, and education to offer the best course of treatment.  However, medical opinions between doctors can be different, so it is recommended that a second medical opinion be sought before switching from using your genetic material.  Sometimes, medical treatment and treatment plans can change quickly, and before a patient has time to process fully, they can no longer use their genetic material to create their family.   For this reason, you should consider a consultation with a mental health professional to carefully go over all the options and the associated feelings these options cause to arise.

Thanks to technology, many options are available for all fertility issues.  Here are some statistics to help you better understand infertility:

• Ovulation disorders account for about 25% of infertility cases (World Health Organization). Fertility drugs can stimulate ovulation in about 80% of these cases.
• Clomid successfully releases mature eggs in roughly 80% of women who use it (Freedom Fertility Pharmacy), with 10-13% of these achieving a pregnancy.
• Women under the age of 35 years have a 15-20% chance of pregnancy (Merviel et al. – Fertility and Sterility), but women over the age of 40 years have less than 5% chance of pregnancy. For this reason, IUI is not recommended for women over the age of 40 years.
• At https://www.cdc.gov/art/ivf-success-estimator/index.html there is an In Vitro Fertilization Success Estimator, which is a tool for estimating your chance of having a live birth using in vitro fertilization based on experiences of women and couples with similar characteristics.
• Every year, 1.9% of all infants born in the United States are conceived using assisted reproductive technologies (Centers for Disease Control & Prevention).
• Of the 72 million women in the United States aged 15-49 years, for the years 2015-2017, 13% received infertility services.
• Percentage of egg retrievals resulting in live births: