People who get pregnant easily might not understand why anyone would possibly need a formal strategy when it comes to fertility. Doesn’t getting pregnant just happen? For some people, yes. But for the 10-20% of couples who suffer from infertility, having a strategy is a very useful thing. People in this situation often have two types of frustration. They have the obvious frustration of not achieving what they desire — a pregnancy. They may also have the frustration of feeling lost, of not knowing what to do next.
Having an actual strategy is helpful in two ways. It helps people make better decisions about what to do and when to do it. It also helps emotionally by bringing some clarity and guidance to an otherwise confusing situation.
I’m a board-certified MD, who has been practicing for over twenty years. As a reproductive endocrinologist, I have helped, at last count, in the conception of 2317 babies. When it comes to solving problems, I like to analyze things in terms of probability.
Some problems in this world are clearly binary. Take the case of a burnt-out light bulb. If you do nothing, the problem never solves itself. Conversely, if you do something and replace it with a fresh bulb, this solves the problem nearly 100% of the time. Even in medicine, there are some almost-binary situations. A patient has a bladder infection. After taking antibiotics, the problem goes away. Here, however, the process has a bit more uncertainty than the light bulb example. Sometimes, a bladder infection goes away on its own without the patient taking any action. Sometimes, even after taking first-line basic antibiotics, the infection persists.
More so than in any other field of medicine that I can think of, fertility treatment is non-binary and lends itself best to a paradigm of probability analysis.
The fundamental question for a fertility patient each month is this: Should I continue trying patiently in the same way or should I do something new instead? If you are trying to get pregnant naturally, you may eventually succeed without changing your strategy. On the other hand, trying something new can often change the monthly probability. A higher monthly probability can affect whether you ever get pregnant in your lifetime or if you run out of time. Even for a patient who ultimately gets pregnant naturally, being proactive can affect the promptness in which the pregnancy occurs. This has value in many ways, including affecting if they retain the option to have a second or third child.
EACH MONTH, A PERSON HAS A CERTAIN PROBABILITY OF GETTING PREGNANT. For someone who has zero sex that month, it is 0%. For someone doing everything humanly possible that month, utilizing the most advanced medical technology, it can often approach 80%, but it still can’t be 100% certain.
Here are some general rules:
The magic number that represents ones probability in a given month is not known precisely, but can be inferred.
It can change dynamically from month to month, year to year.
It is influenced by the characteristics of the players involved (the sperm provider and the egg provider) and it is influenced by what actions they take that month.
Let’s begin by classifying the ways people get pregnant into three categories.
First, there is the natural way, which is the way everybody knows, namely by sexual intercourse. This is the way that most couples get pregnant, couples who have no fertility issues. Some infertility patients can also get pregnant naturally, either with some help from medications or other lifestyle interventions.
Second, there are low-tech medical procedures. This refers to IUI (intrauterine insemination), a procedure where the sperm is enhanced in the lab and then physically guided into the uterus using a catheter, so that it goes a lot farther and faster to the final destination.
Third, there are high-tech medical procedures. The most famous of these is In-Vitro-Fertilization, a procedure in which the eggs are surgically taken out of the body and allowed to fertilize in the laboratory. Subsequently, the developed embryo is placed directly into the uterus.
A common rational approach is to try the first method until sufficient attempts have failed. Then the second strategy is adopted until a sufficient number of attempts have all failed. Then, it’s time to move on to the third stage. Along the way, there are different variations of these three ways that can be done, but it still boils down to fundamentally one of these three ways.
In future posts, where there is discussion of specific cases, it will be helpful to come back and remember the fundamental framework discussed above.
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