Helping in a time of need
Infertility can be an emotional, expensive and stressful process.
The definition of infertility is 12 months of unprotected sex without resulting in pregnancy, or if a women can get pregnant but not carry the baby.
While there are various reasons for infertility, the number of couples struggling with the problem is on the increase. Age is one of the main factors for that increase.
According to the Centers for Disease Control and Prevention, more women are waiting until their 30s and 40s to have children. About 20 percent of women in the United States now have their first child after age 35.
"Age is a growing cause of fertility problems. About one-third of couples in which the woman is older than 35 years have fertility problems," the CDC says.
Just two of the local doctors seeing those infertility problems are Jim Christensen with Essentia Health St. Mary's and Jaimie Deraney of Sanford Health.
"Infertility is increasing commonly due to patients postponing childbearing, putting patients at an older age. As women age, fertility tends to decline," Deraney said.
Christensen said that according to statistics, there are more than 1 million couples a year in the United States that have sought medical help when dealing with infertility.
"Of course there are a lot of people in the United States," he said, "but it's still a lot."
Between 7-15 percent of couples will experience infertility, and after a second year of trying to conceive, half of those couples remaining will still have problems conceiving, he said.
"There is a lot of different data and percentages," Christensen said.
When struggling with infertility, the doctors in Detroit Lakes are able to assist with oral ovulation, stimulation medications and injections to promote ovulation, which the patient actually gives herself.
Once a woman comes to the clinic and hasn't gotten pregnant, Deraney said he usually breaks it down into three categories: male factor (issues with quantity and quality of sperm), pelvic factor (inadequate uterus or appropriate eudiometric cavity with open fallopian tubes) or ovulation factor ("Obviously if a woman isn't ovulating every month and releasing an egg, then you don't have a chance of obtaining pregnancy.")
"I evaluate each case individually and determine which testing has a higher priority," Deraney said, "because a lot of this testing is very expensive, and if there are some tests we feel we can avoid and save the patient some money, then that's how I like to proceed."
For example, if the male partner has fathered other children, the problem is less likely to be him so there's no sense in running tests on the male right away.
"The basic workup or evaluating for infertility, we can provide here," Christensen said. "Depending on what is uncovered or discovered, as far as causes, most of the workup can be done here in Detroit Lakes, male or female."
Whether it's a hormonal or physical factor, once the doctor has identified the problem, they can then address the cause and see if medication or surgery will help solve it.
About 10 percent of the time, doctors are unable to identity a cause for infertility, he said.
"If they go through the whole workup and everything is normal, labs and evaluation and studies, you can still attempt medication and treatment," Christensen said. "Sometimes that will work and sometimes it won't. It certainly doesn't mean you can't help assist with infertility assistance."
Deraney explained that for the pelvic test, doctors will do what's called a HSG, hystero-salpingogram, where they inject dye into the uterus and use fluoroscopy to evaluating the uterus cavity and the patency (openness) of the fallopian tubes.
For the ovulation factor, the doctor has the patient use ovulation predictor kits to determine if and when they are ovulating.
Deraney said that medications such as Clomid and Femara are used to help produce a mature follicle, and Ovidrel is used for ovulation once the follicles are ready.
And while only the beginning options of infertility treatments can be done in Detroit Lakes, there are more in-depth options available at the Fargo clinics.
That doesn't mean there aren't local possibilities for the future though.
"I have been in contact with St. Mary's lab to try and start semen preparation for intrauterine inseminations, IUIs," Deraney said.
The conversations have just been preliminary though.
"It's tough to get a new thing started," he said. "They have to have certain requirements, lab requirements, in order to do it. They have to have the people certified or trained specifically to do that, so that's the trouble we're having with that right now."
Christensen said it is a possibility to have more services in Detroit Lakes in time.
"It's kind of up to the OB/GYN providers here in Detroit Lakes. There is certainly an opportunity to do so. As far as I know, in our clinic, there's nothing planned though.
Since more technical treatments aren't available in Detroit Lakes at this point, doctors treat their patients anywhere from three months to a year before recommending they more on to the Fargo clinics for enhanced services. The decision can be both doctor and patient driven.
Deraney said he treats patients for up to 6 months, and if pregnancy has not resulted by then, he refers patients to the Sanford Reproductive Medicine Institute in Fargo.
"When you go to the doctor, you want a fix right away. But, when it comes to this, it's not always right away."
Then again, sometimes it is.
One patient of his, Deraney said, is a prime example. He put her on Clomid, and one month later she was pregnant with twins.
Christensen said he'll treat couples for up to a year.
If they're young and in their early 20s, we have a little more patience," he said. "If they're in their later 30s or 40s, certainly their window of opportunity is a little shorter, so we're a little aggressive to transfer them to the reproductive endocrinologist services sooner. It's as much up to the couple as anything."
Insurance companies don't cover infertility and therefore some families aren't able to have as many treatments as may be needed to conceive.
"Unfortunately, insurance companies don't consider this a medical disease and therefore, it's not typically covered. It's mostly out-of-pocket," Deraney said.
"Once a patient goes from seeing me, a general OB/GYN, to reproductive medicine, the costs increase significantly. But you don't have to go from what we're doing to in vitro fertilization. There are intermediate steps, like follicle stimulating injections."
While there is a major expense to the process, there is a major emotional expense as well.
"You have to be very compassionate and reassuring," Christensen said of working with patients going through the rollercoaster of emotions that accompany infertility.
"Patients sometimes feel the gloom and doom, that they're never going to be successful. It's a rollercoaster ride every month. It's tremendous stress each month as it goes by," he added.
Deraney said, however, that there is never a time to tell a couple they'll never have a baby.
"I never say that," he said. "Invariably, you're proven wrong. I've had patients come to me and saw, 'well, this person said I'll never have babies and I'm pregnant.'"
Even people who have gone through infertility treatments in Fargo with no results can experience a spontaneous pregnancy.
"You have to be sensitive to the emotions of the patient," Deraney said.
"You just try and provide as much support as possible and reassure them as much as you can that it's one month at a time and try and take it a day at a time, a month at a time," Christensen said.
"In time, by far and away, the majority of couples are able to conceive and have successful pregnancies. You just try and keep them on an even keel. There aren't many things more important to couples than having children."