Understanding infertility

For those who want and are ready to start a family, struggles with infertility can be extremely challenging to face. This year, National Infertility Awareness Week is from April 19th-April 25th. The TopLine MD Alliance sat down with affiliated Reproductive Endocrinologist and Infertility Specialist, Dr. Armando Hernandez-Rey to discuss the importance of knowing the facts and changing the conversation surrounding infertility.

What is the purpose of Infertility Awareness Week and what is the main message you’d like to get across to the public?

Dr. Armando Hernandez-Rey: Infertility Awareness Week is very important, just like any of the other awareness weeks that are out there. Traditionally, and historically, infertility has been a taboo topic and as we all know, the paradigm has shifted. We’re all familiar with this. Most couples, most people, are waiting and prolonging their desires to start a family. And unfortunately, biology does not cooperate at times. The median age of a first child in the 1950s was 23 years old. In 2020, the median age of a first child, believe it or not, is 32.8 years old. That’s 10 years. The difference between a 23-year-old and a 32-year-old is worlds apart, from a fertility standpoint.

This is bringing to light the importance of making sure that you get periodic checkups. That you are in tune with your body, that you are aware that time is essential, that you take priority in your fertility and not get lulled into a false sense of security only because your friends, your coworkers, and your family members who are of a similar age are getting pregnant with relative ease. You should take fertility or your fertility very seriously.

The whole purpose of Infertility Awareness Week is to bring to light the importance. Traditionally, infertility was taken for granted. Yet the relevance of that has not caught on to not only the population as a whole, the lay person, but even to the medical community, unless you’re an infertility specialist, you don’t see that [infertility] on a day-to-day basis.

In fact, even in the OBGYN population, they see patients who at 43 years old are getting pregnant. In my world, I have a 23-year-old who’s in menopause. And the impact of telling somebody at 23 years old that they’re going to need an egg donor it is… will really have a very shattering effect on that person’s psyche. And for that reason, while that’s an extreme example, it really encompasses the importance of making people aware that if they desire to have a family, they should really be prioritizing this the same way that when you become 40, you get a mammogram, or when you become 50, you get a colonoscopy.

So, going off of that, what should men and women do if they believe that they might be infertile?

Dr. Armando Hernandez-Rey: The general recommendations are focused basically on maternal age. And if a woman is less than 35 and has been trying to conceive for over a year, then that’s when she should get the green light to seek the care of an infertility specialist. And then certainly after the age of 35, after six months of trying.

Well, I think that that should be tweaked a little bit, and it should focus more on the function of the stress, the anxiety, that that couple is feeling about not achieving a pregnancy. For example, recurrent pregnancy loss, by definition is defined as somebody who’s lost three pregnancies. But tell somebody who’s lost two pregnancies that they have to wait a third before trying to figure out why they’re having these pregnancy losses and they might get a little angry at you. So, I think they should follow those criteria.

What are the options for those that may end up actually being infertile?

Dr. Armando Hernandez-Rey: Well, certainly seeking evaluation. Not everybody that is having difficulty trying to conceive needs in-vitro. Maybe it’s trying to figure out whether they’re ovulating or lifestyle modifications. Maybe it’s a surgical correction, that once they have a fibroid removed, they go on to conceive and have no difficulty with three and four pregnancies. But certainly, an evaluation should be paramount to identifying what is the cause of why couples are not getting pregnant.

By the way, the whole reason these recommendations were put in place is because the human species is really not that efficient. The most efficient we can be is 20% or one out of five. Two teenagers in the backseat of a car when they really, really don’t want to seek a pregnancy, they only have a one in five chance.

So, that only goes down from there. As we get older, we become less efficient. A woman at 20, every single egg of every single month of that year is a perfect egg. At 30, that number is 10 out of the 12 months. At 35, six out of the 12 months. That’s why they get labeled “advanced maternal age”. At 40, maybe one or two, doesn’t mean that 40-year-olds don’t get pregnant all the time, but certainly less so than when they were 20. That’s the reason why age is important and why to prioritize your fertility as you get older.

It is so important that you maintain regular health checkups for your overall health. To start the conversation and determine what’s right for you, speak with your TopLine MD affiliated provider today.