By John Lundy Duluth News Tribune, Minn.
WWR Article Summary (tl;dr) Sue Stahl, a nurse practitioner who specializes in fertility at the "Reproductive Health and Fertility Center" in Duluth says anywhere from 10-15 percent of the population has difficulty conceiving.
Duluth News Tribune, Minn.
Seven-year-old Joy Hacker is aptly named.
The dark-eyed girl with the big smile was "kind of a miracle baby," said her mother, Michelle Hacker.
When they married in 2004, Bret and Michelle Hacker of Ely planned from the start to have a family, Michelle said during a phone interview last week. But for six years, they were frustrated.
"We did struggle with infertility," Michelle said.
They're not alone. Anywhere from 10-15 percent of the population has difficulty conceiving, said Sue Stahl, a nurse practitioner who specializes in fertility at the Reproductive Health and Fertility Center at the Essentia Health-Duluth Clinic First Street Building.
More than 7 million women ages 15-44 have used infertility services at least once, according to the U.S. Centers for Disease Control and Prevention.
But it's far from just a female problem. According to the American Society for Reproductive Medicine, about one-third of infertility is attributed to the female partner, one-third to the male partner and one-third are either attributed to both or unexplained.
Dr. Randle Corfman, a reproductive endocrinologist who founded the Midwest Center for Reproductive Health in Maple Grove, Minn., in 1992, said the problems he sees involve men even more often than those statistics suggest.
"I would say half of the patients we see, the man has abnormal sperm parameters," Corfman said in a telephone interview last week. "So that's why we insist on seeing them as a couple."
Infertility is not a disease; it's a condition, Corfman said. It has a specific definition: one year of unprotected intercourse without conceiving (or six months if the woman is 35 or older).
The worst time Couples who want to have children but are unable have just been through a tough season, Corfman said.
"It's the worst time of the year for couples facing this because -- Thanksgiving and Christmas, a time for children," he said. "You're around families, and your other family members are having children without any trouble, and people that don't want children are having kids. ... You want to have a child, and your parents want you to have children."
But for most, infertility is treatable.
Corfman estimates that 85-90 percent of the couples who see him and the professionals he's associated with -- including Stahl -- will have a child.
For perhaps 80 percent of them, the solution will be "low-tech," he said. In some cases, that may include lifestyle changes. There's a greater risk of infertility if a woman is a smoker and if she's obese, so the recommended treatment may include giving up smoking and losing weight.
For many, oral medicine is effective, said Corfman, whose rounds include a visit to the Essentia Health-Duluth Clinic several times a year. Until about six years ago, the drug of choice was Clomid, but it came with significant side effects, producing hot flashes, irritability and mood swings.
Clomid largely has been replaced by letrozole (brand name Femara), which originally was developed to treat breast cancer. It is effective for many and has few side effects, Stahl said.
The main "side effect" with any fertility medication is the possibility of multiple births, she said.
In vitro fertilization When other efforts fail -- in about one out of five cases -- Corfman offers in vitro fertilization as an option.
That can't be performed at Essentia Health in Duluth, but the accompanying treatment can be.
"They'll come down to Maple Grove one day to have their eggs harvested, and then come back five days after to put the embryos back into them," he said.
If one embryo is planted, there's a 50 percent chance of successful delivery, Corfman said. If it's two embryos, the odds increase to 68 percent, with a good chance that twins will be delivered. Most people choose to increase their odds with two embryos, he said. He won't implant more than two because of the increased chance of multiple births.
It's pricey -- between $18,000 and $20,000, Corfman said, and usually not covered by insurance.
It's also not for everybody. The Roman Catholic Church, for instance, opposes in vitro fertilization.
"I don't take that into consideration," Corfman said. "I just make sure they know what all their options are, and then at the end of the discussion, they'll be able to go home and make decisions about what's going to work best for them."
A natural approach Bret and Michelle Hacker, who are Catholic, wanted nothing to do with in vitro fertilization, Michelle said, and chose to take another approach from the beginning.
"We wanted the conception to happen within the union of our marriage," she said.
They chose to consult with the Northland Family Program, which has office space at Essentia and which follows the Creighton Model of Fertility Care, developed by Dr. Thomas Hilgers in Omaha, Neb.
With the Creighton Model, the woman checks her cervical mucus -- i.e., vaginal discharge -- daily and charts her observations to determine the peak days to conceive. (It's also used as a birth control method.)
Michelle started the method when she got engaged, and even by the time she and Bret married, it revealed concerns, she said. "I had a hard time noticing when I was ovulating," Michelle said. "We started to notice these dry cycles."
During their first years of marriage, people at the Northland Family Program encouraged the Hackers to travel to the Pope Paul VI Institute in Omaha, which Hilgers founded, for further consultation. "We postponed a lot of that," she said.
Michelle's pregnancy with Joy surprised everyone. "Doctors to this day don't know how we got pregnant," she said. But their problems continued. Michelle battled anxiety. Three years later, the couple hadn't had a second pregnancy.
Dr. Kimberly Bigelow, a family practice doctor in Hibbing who consults with the Northland Family Program, "basically looked at us and said, 'You need to go to Omaha for your own health,'" Michelle recalled.
Physicians in Omaha diagnosed multiple problems. Michelle had endometriosis, a condition in which tissue lining in the uterus is mimicked by tissue appearing elsewhere. She had hormone issues, including very low progesterone, a hormone that plays a major role in maintaining pregnancy. She had thyroid problems, adrenal gland problems and premenstrual syndrome.
"They were surprised I was able to have our first baby and carry her to term," Michelle said.
That was in March 2014. In June, the Hackers returned to Omaha for laparoscopic surgery to remove the endometriosis and for treatment of her other conditions.
A different view Corfman is a fan of natural methods to enhance fertility, to a point. "But after 12 months of doing that, if it hasn't worked then, you need to move on," he said.
He also argues that charting should only be done for the short term, perhaps two or three months at the most.
"In my opinion, it adds a tremendous amount of stress on the woman," he said. "It reinforces with her at the beginning of every day that she's childless. That's not fair. And it really wears on people."
For people whose faith makes them unaccepting of in vitro fertilization, an option may be to accept donated embryos, with the reasoning that "it'd be better to do that than let them be destroyed," he said.
Corfman, who compares the use of donated embryos to adoption, said there's about a two-year wait for donated embryos.
"It's actually very cost-effective because these embryos are already there, and they're not being sold," he said.
"They're donated. Couples of faith that are not OK with in vitro fertilization, many of them, their hearts will be open to using donor embryos."