A Reproductive Endocrinologist's POV: Infertility, IVF Treatments & Surrogacy
We sat down with Dr. Laura Meyer, a Reproductive Endocrinologist with Illume Fertility to talk about what infertility is, what causes infertility, what some of the treatments are, and what types of paths to parenthood are available.
The Definition of Infertility
Infertility is defined as trying to conceive for a year or more without success if the woman is under 35 years old, and for six months or more if the woman is over 35 years old. Infertility is a retrospective diagnosis. If you’re unable to conceive it doesn’t mean that you will never get pregnant on your own or that you can never get pregnant on your own, it simply means that a couple has been trying for a certain amount of expected time and it hasn’t happened yet.
Who Does a Reproductive Endocrinologist Treat?
Reproductive Endocrinologists (REs) see patients for a variety of reasons. There are usually four types of people who will come to a reproductive endocrinologist.
One subset of people who may go to an RE are those who have been trying to conceive on their own (as mentioned above) but without success and they want to figure out why, and what we can do to help them get to their goal of having a baby.
A second subset of people who may find themselves speaking with an RE are those who may not have been trying for very long, but they already know that they will need help. This could mean that they have known risk factors for infertility, such as when a woman has irregular cycles and is not ovulating in a predictable way. Or, women may come in because they’ve been able to get pregnant, but are having trouble staying pregnant and have had recurrent pregnancy losses.
The third subset of people know they need our help to have a baby because they are a same-sex couple and they need a sperm donor or an egg donor or a gestational carrier - or some combination. While others know they need assistance in growing their families because they’ve had difficult pregnancies, problems with their uterus or have a medical history that dictates the need for a gestational carrier or an egg donor.
The fourth subset of people who see an RE is for fertility preservation, usually in the form of a woman who wishes to retrieve and freeze her eggs until she’s ready for family planning.
There are many different reasons that people find their way to a Reproductive Endocrinologist. Our job then is to get to the bottom of what brings them in, what’s going on, how we can best treat them.
Causes of Infertility
When a patient reaches out to us, we’ll have them come in to talk through issues and we’ll do a workup tailored to their specific situation.
For example, for people trying to get pregnant on their own who haven’t had success, we might do a semen analysis and check the sperm, make sure fallopian tubes are open, and check their hormones and look at their anatomy - these are the things we’d do first to help identify what is going on.
Similarly for people who are facing recurrent pregnancy loss, there are a number of things we can check that can cause this. Most pregnancy losses are due to abnormal genetics of the pregnancy - typically chromosomal abnormalities - but there are also other reasons so there’s a workup to see what other causes might be.
Figuring out the cause of the infertility and loss will determine what the course of treatment will be.
For some, a less invasive treatment may work. This includes completing a cycle with an oral medication and pairing it with an intrauterine insemination, where we take a sample of sperm and place it directly into the uterus a little closer to where it needs to go to help to optimize the chances of getting pregnant.
Other people may end up needing more invasive treatments such as IVF.
What Is IVF?
IVF stands for in vitro fertilization, meaning the fertilization of the egg by the sperm is happening in vitro, or in the laboratory, instead of in vivo, or in the body. IVF is a process in which a woman will take injectable medications to stimulate the ovaries to cause multiple eggs to mature at the same time (vs the single egg that would mature naturally each month). When the eggs are mature, instead of having them ovulate into her body, she will have an egg retrieval - a minor surgical procedure - to remove those eggs out of the ovaries and fertilize them with sperm in the laboratory to create embryos. Those embryos can be cultured in the lab, typically for a period of about five or six days until they reach the blastocyst stage, at which point they can be transferred or frozen or genetically tested (or some combination of those).
There are a few variations to this, including transferring embryos at the Day 3 stage, or some women will retrieve eggs and then freeze them to preserve their fertility.
What Is Third-Party Reproduction?
Third-party reproduction is a term used for when there is an additional person in the creation of the pregnancy; this could be a sperm or egg donor or a gestational carrier.
Some individuals and couples know from the get-go that they require third-party reproduction. Others will realize the need early on, depending on their circumstances. For IVF in general, the success rates are primarily dependent on the age of the woman at the time that she does it, and the number of eggs that she retrieves. So as a woman gets older, and her egg quality and quantity decrease, she has lower success rates. This may lead to her using an egg donor. (Editor's note: You can learn more about things to consider before using an egg donor in our related blog post.)
For the case of surrogacy, some people know immediately that they will need this method of family building. This includes the LGBTQIA+ population, as well as women who don’t have a uterus or have had gynecological cancers or endometriosis, or women who’ve had difficult pregnancies and deliveries and it’s not safe for them to carry again.
We do have patients who try to get pregnant on their own and don’t see success, or who try IVF and either don’t have success or get pregnant and suffer multiple losses. These patients may find themselves needing a gestational carrier in order to move forward. This is a smaller percentage of patients; it’s more common that people come in knowing they need a surrogate.
Making the decision to move to third-party reproduction is not a straight path. We’ll speak with patients individually and talk through what has happened so far, what the options are for next steps could be, and the likelihood for success with different routes. An RE’s job is to give patients as much information as possible so they can make the decision with which they are most comfortable.
Dr. Laura Meyer is a reproductive endocrinologist at Illume Fertility. Dr. Laura Meyer is double board certified in Reproductive Endocrinology and Infertility and Obstetrics and Gynecology. After graduating from the NYU School of Medicine, she completed both her residency and fellowship at New York Presbyterian Hospital/Weill Cornell Medical Center. Prior to joining Illume Fertility in 2020, she was an Assistant Professor at the NYU School of Medicine, practicing in Westchester and Fairfield counties in Connecticut.