A Baby at Last! A Couple's Complete Guide to Getting Pregnant

June 16, 2010 -- Fertility experts Dr. Zev Rosenwaks and Dr. Marc Goldstein of NewYork-Presbyterian Hospital/Weill Cornell Medical Center offer advice to men and women confronting infertility in their new book "A Baby at Last! The Couple's Complete Guide to Getting Pregnant--from cutting-edge treatments to common sense wisdom."

Rosenwaks is the director of the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical. Goldstein is the director ofthe Center for Male Reproductive Medicine and Microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Read an excerpt of the book below, and then head to the "GMA" Library to find more good reads.

You Are Not Alone: When to Seek Help

Claire, a thirty-seven-year-old designer, had tried unsuccessfully to have a babyfor a year and a half before she went to see her gynecologist. Her doctor foundshe had an incompetent cervix, which he corrected surgically. Six months later, herhusband, Jeff, a thirty-eight-year-old salesman, went to a urologist, who found Jeffhad a very low sperm count and a cyst on one testicle. Claire did some researchon the Internet into hospitals and doctors. An oncologist friend suggested theygo to Weill Cornell, where a radiologist told them that Jeff's cyst was benign, butDr. Goldstein found that Jeff had varicoceles (varicose veins in the scrotum) affectingboth testicles. Microsurgery repaired the varicoceles, but Jeff's sperm countremained very low, so they decided to try an in vitro fertilization (IVF) procedurewith Dr. Rosenwaks.

For the first IVF attempt, three of Claire's eggs were fertilized with Jeff'ssperm and transferred into her uterus, but none progressed to a pregnancy. A fewmonths later, Jeff had better-quality sperm surgically removed from his testicles,and those sperm were used to fertilize ten of Claire's eggs. Dr. Rosenwaks transferredfour healthy embryos.

"I had prepared myself for the possibility that it wouldn't work," says Claire.

"Jeff and I talked a lot during the two-week wait about what we would do ifwe got bad news. We also met with a counselor at Weill Cornell, who made theprocess easier to deal with." When they received word that Claire was pregnant, "Icouldn't believe it," says Jeff. "I'll never forget that call." Their daughter, Connie,is now eighteen months old.

Fertility is, on the face of things, a very simple process. It's a matter ofgetting the sperm and egg together. But the variables are plentiful, and asmany couples find, it's easy for something to go wrong. You need a good quality egg and properly functioning sperm. You need enough sperm to bedeposited where it's supposed to be. The sperm has to be strong enough toswim up the female reproductive tract through the fallopian tube to reachthe egg to fertilize it. The fallopian tube has to be normal to be able topick up the fertilized egg and deliver it to the uterus so it can develop fully.The woman's brain also needs to function properly, so that the pituitarygland produces adequate amounts of hormones necessary to foster follicleand egg development in the ovary. In turn the ovary, under the influenceof the pituitary gland, must produce the critical hormones—estrogen andprogesterone—necessary to promote uterine lining development and supportfor the implantation of the fertilized egg.

This whole series of events need to happen at the right time. There isan eight-to-twelve-hour window within each cycle in which the egg canbecome fertilized. Usually this happens between days 13 and 15 of a typicaltwenty-eight-day menstrual cycle. Healthy sperm can survive for severaldays inside the female reproductive tract, so timing sex around the middleof the cycle increases your chances of conception. Even in the best of circumstances,the chances that a woman will get pregnant are about one infour each month.

You Are Not Alone

There are many reasons a couple may find it hard to get pregnant, and thesereasons can stem from a problem with either or both partners. In about 40percent of infertile couples, the man has a problem. In another 40 percent,the woman has a problem. And in 20 percent both partners have a problem.That's why a couples-based solution is imperative.

Often both partners may have just-below-normal fertility, or subfertility,which may lead them to struggle with having a baby together. Treat-ments to improve each of their fertility levels will maximize their chancesof conceiving.

Many infertile couples striving to conceive feel isolated and helpless,but actually you are not alone. Infertility affects about 7 million Americans,which represents about one in six couples during their childbearing years.There are daunting odds, but here's the good news: while the number ofinfertile couples is on the rise, medical understanding of infertility is moreadvanced than ever. You have more treatment options today than before.Just a few decades ago, there were no drugs to induce ovulation, no microsurgicaltechniques to unclog fallopian tubes or blocked ducts in man,IVF was just a dream, and single-sperm injections were unheard-of. Andour understanding of the nonsurgical methods of increasing fertility—diet,exercise, and other lifestyle adjustments that greatly increase the odds ofconceiving—is now similarly advanced.

When to Seek Help

You may feel lots of anxiety and stress about making a baby, particularly ifyou have been trying for a while. So it is important to know when it is appropriateto seek advice regarding your infertility. Fertility declines rapidlyafter age thirty-five, so women in this age group should consider workingwith a fertility specialist sooner rather than later. Even if you became pregnanton your own when you were younger, you may still have difficultyconceiving when you become older.We begin to be concerned about infertility when a couple has notconceived after twelve months of unprotected intercourse if the woman isunder age thirty-five, and six months of unprotected intercourse if she is agethirty-five or older. However, our policy is to recommend an evaluation ifthe female partner is older than age thirty and has not conceived within sixmonths, especially if the couple has been having sexual intercourse two orthree times per week.

If you are over age thirty, or if you or your partner has reason to believethere is a risk factor in your background (such as a history of genitalinfections, irregular periods, or cancer treatment), this certainly justifies anearly fertility evaluation. We also suggest that a woman who has a history oftwo or more miscarriages and no live births seek out a fertility specialist. Ifyou and your partner are over age thirty or there are clues from your pastthat either one of you might have a fertility problem, and you still don'tget pregnant after optimizing your chances by timing intercourse aroundovulation, then we believe you need not wait as long as six months beforeseeking medical help.