Healthy Manhattan: The Ins and Outs of IVF

Written by Dr. Cynthia Paulis on . Posted in Healthy Manhattan, Posts.

Let’s face it, babies are in the news. In fact, they are everywhere. Just walk down the streets of Manhattan and you will see the strollers that are as large as trailers coming at you with two, sometimes three children on wheels. But what happens when you are the one who can’t get pregnant? What lengths will you go to and how much will you spend to have a family? Why is it some people can get pregnant on the first try, and others spend years trying to get pregnant? Is infertility on the rise?

Infertility affects million of couples in the U.S., with female infertility factors about one third of the time, male infertility factors about one-third the time and the rest a combination of unknown factors for both sexes.

Dr. Victor R. Klein, director of patient safety and risk reduction, specializing in high risk pregnancies at Long Island Jewish–Health System, in Manhasset, said, "When I started practice 20 years ago, 10 percent of the women had infertility issues, and I feel it is the same number [still]. The difference is people have the technology available and they are availing themselves of the technology, so those who couldn’t become pregnant years ago are now becoming pregnant."

The second thing he noted was that many women who had delayed child bearing due to careers are getting pregnant in their late thirties and forties. "The vast majority do well," he said. "I had a woman who was 54 come to me and wanted children because she was retired and was financially stable. She gave birth to twins."

He also noted that people are more open now with communication. "Twentyfive years ago people didn’t talk about infertility and now people are talking about it. Similar to people who had breast cancer 30 years ago and used to hide it from people, like it was a problem, that it was their fault or they should be embarrassed about it. Of course you shouldn’t be. It’s a disease where you can’t get pregnant and you go for help."

Dr. Klein said many insurance companies have changed, and now cover infertility treatments. The first in vitro fertilization was performed in 1979, but infertility clinics really didn’t start to rise until the 1990s. Now many people have infertility insurance, but there are usually caps. Most people are covered for evaluation and three cycles of in vitro before the insurance ends. Dr. Klein said about 90 percent of the time, women who try to get pregnant on their own are successful within a year, and women undergoing IVF have the same success rate.

There are many reasons why women are infertile. Sometimes the issue is an ovulation problem, which accounts for 25 percent of the cases where there is a flaw in the regulation of reproductive hormones. Another issue can be damage to the fallopian tubes, which would prevent sperm from getting to the egg. This can be caused by diseases such as chlamydia or gonorrhea. A previous ectopic pregnancy or previous surgery in the abdomen or pelvis can cause problems. Another contributing cause of infertility is endometriosis, when tissue that normally grows in the uterus implants and grows in other locations. Other problems can be fibroids or tumors, common in women in their thirties, which can impair fertility by blocking the fallopian tubes or disrupting implantation.

Some things put you at higher risk of infertility, such as age. Women over the age of 30 can have fewer and poorer quality eggs. Smoking increases the risk of miscarriage, along with damaging fallopian tubes. Heavy drinking is associated with increased risk of endometriosis and ovulation disorders. Being significantly over- or underweight can inhibit normal ovulation. A history of sexually transmitted diseases will cause damage to fallopian tubes.

Alisa, a pediatric physical therapist who did not want her last name published, spent five years and $50,000 in multiple attempts to get pregnant. First she used oral meds to get pregnant, and then tried artificial insemination, which resulted in two miscarriages. She then had diagnostic surgery, which revealed a problem with the uterus. After corrective surgery, an additional two IVFs failed. Frustrated, Alisa started looking into adoption and found a helpful website,, where she met other women facing similar problems and realized she was not alone.

"I asked myself the question, which was more important, having a baby or being a mom," she said. "Being a mom was paramount."

She started the adoption process and suddenly Alisa found herself pregnant without any help at all.

"The stars just aligned," she said. She now has a 5-year-old daughter. "Being a mom is the most incredible journey, watching her grow and develop. She makes me a better person."