We recently talked with Hal C. Danzer, MD, a board-certified gynecologist and obstetrician and co-founder of the Southern California Reproductive Center, about advances in the treatment of infertility. In addition to his private practice, Dr. Danzer serves on UCLA’s Reproductive Endocrinology and Infertility Fellowship Program, and is also Assistant Clinical Professor in the Department of Obstetrics and Gynecology at the David Geffen School of Medicine. He holds the positions of Reproductive Endocrinologist at Cedars-Sinai Medical Center and Attending Physician in its Department of Obstetrics and Gynecology. Dr. Danzer has co-authored several books and is a respected researcher with a focus on strategies to enhance patients’ chances of a successful pregnancy.
Q: What are the first steps someone should take if they’re unable to conceive and do those steps differ based on a woman’s age?
Hal C. Danzer, MD (HD): Dealing with infertility is intimidating for many people. Less than 50 percent of couples who are referred to an infertility specialist end up making an appointment. They’re afraid their problem can’t be treated or that the cost will be too high. But the first step towards achieving a successful pregnancy is to have an evaluation by an experienced fertility specialist. The sooner you start this process, the better.
If you’re under 35 and have been trying to get pregnant for a year, you should ask your OB/GYN for a referral to a fertility specialist. For women who are older than 35, if you have not become pregnant within six months, you should see a fertility specialist to check for potential gynecological problems such as endometriosis, ovarian cysts or fibroids or pelvic infection. If you’re 40 or older, you should see a fertility specialist before trying to become pregnant and undergo tests that will help you and your physician identify when you’re ovulating and determine whether your partner’s sperm count is normal. A blood test known as the Anti-Mullerian Hormone test (AMH) can provide an estimate of how many egg you have left. Because women over 40 only release a genetically balanced egg one in every four cycles, it’s important to have a plan in place to achieve optimal timing for successful fertilization.
Q: What are the most current, effective treatment options for infertility?
HD: For patients undergoing in vitro fertilization (IVF), genetic screening of embryos is an extremely important tool. It allows us to select the most viable embryo and to screen for genetic disorders such as cystic fibrosis, Tay Sachs disease, spinal, muscular atrophy, and fragile X syndrome. The best practice is to transfer a single embryo rather than multiple embryos, which was the common practice in the past. When you transfer a single, genetically tested embryo, the pregnancy rate is 50-60 percent and the miscarriage rate is 30 to 40 percent lower.
The technology for freezing embryos has also advanced significantly in the last two years and this allows us to let the woman’s uterine lining recover from the process of egg retrieval for a month before we transfer an embryo. This approach results in 15 to 20 percent higher pregnancy rates due to better implantation. Studies have found that the pregnancy rates achieved with thawed embryos are consistently close to those of fresh embryo transfer. In addition, one study conducted in Finland found that babies born from frozen embryos were less likely to be premature, had a higher birth weight, and had a lower likelihood of being small for their gestational age.
Q: Are there proactive steps women can take before trying to become pregnant to improve their chances of conception and a healthy pregnancy?
HD: Stress reduction helps pregnancy rates. Both acupuncture and meditation are good tools to manage and minimize stress. Good nutrition, exercise and having a healthy body mass index are also important.
Q: What factors should someone consider when choosing a fertility specialist?
HD: The Centers for Disease Control and Prevention (CDC) publish success rates for all fertility programs in the U.S. As a consumer, you need to do your homework and find a center with a high rate of producing successful pregnancies. That will provide you with basic, objective information that will help you make your decision. Once you’ve identified programs with higher success rates, you’ll want to interview at the centers and get a feeling for how they care for their patients. Compare the treatment plans for all the centers you’re considering. In addition to high success rates, you need to feel comfortable with the doctors and staff.
Learn how a health advisor can help you get the objective information you need and connect you with an experienced fertility specialist.