Infertility: Don’t despair

By Dale Rodebaugh Herald staff writer

It’s a common problem, but it’s one of those closet issues that often isn’t mentioned even among family members.

It can be a “roller-coaster ride to hell,” a Durango woman interviewed for this story said bluntly.

The topic is infertility, which affects more than 1 in 6 couples, said Dr. Joseph Gambone, the only board-certified reproductive endocrinologist in the Four Corners. He practices at Durango Reproductive with Dr. James Irish.

They treat infertility, recurrent pregnancy loss and male-erectile dysfunction if it’s associated with infertility.

Infertility specialists don’t accept couples until diligent attempts to conceive have been unsuccessful for a year, Gambone said.

It’s not always easy to get pregnant, he said. Consider the odds: A woman at age 24 – the peak age for impregnation, has only a 22 percent chance per ovulatory cycle that her egg and her partner’s sperm will meet.

Women younger than 24 women are less viable reproductively and, by age 40, the chance of impregnation is 5 percent per cycle, Gambone said.

Infertility treatment starts with oral medication which, if unsuccessful, is followed by a combination of oral and injectable meds, then injectables alone and finally in vitro fertilization – fertilization outside the womb.

Until he determines the cause of infertility, Gambone likes to deal with both husband and wife – either could be the root of the problem.

“Half the time, it’s the male, half the time, it’s the female,” he said. “Guys don’t seem to get it, though. They like to say, ‘What’s wrong with you?’ and send their wife.”

Husband and wife visit together about half the time, he said.

Male infertility frequently involves defective sperm, Gambone said. Female infertility is more complicated – blocked fallopian tubes, infection, no ovulation or endometriosis, a uteran abnormality.

When other treatments fail, in vitro fertilization in which eggs are removed from the ovary, fertilized and then replaced in the uterus is tried.

Since an egg must be fertilized within 12 to 24 hours, Gambone monitors a woman’s condition closely, seven days a week if necessary.

“The ovaries don’t take weekends off,” Gambone said.

Patients travel to a laboratory in larger cities away from Durango for the actual in vitro procedure.

Kathryn Catsman, a personal trainer, had two successful in vitro fertilizations after two failed attempts.

“It’s a roller coaster ride to hell,” Catsman said in an interview. “There are six to eight weeks of prep for an in vitro procedure. You feel crazy from the ups and downs of the hormones.”

Catsman, 35, has polycystic-ovary syndrome which, like autism, manifests itself in various forms. She didn’t know it, however, until diagnosed at Durango Reproductive.

She had married at 27, but decided with husband, Gardy, to wait two years to get pregnant. When natural attempts to conceive failed, the couple started treatments. Finally Catsman’s roller coaster ride ended with in vitro fertilization.

“I felt like I was a science project,” Catsman said. “When the first attempt failed, I was devastated because I thought I was a shoo-in.”

On the second attempt, the couple scored, producing a son, Chip, in July 2009. They waited a year, then tried in vitro in September 2010, only to fail again. The fourth attempt in late 2010 produced a daughter, Quinn, in November 2011.

“I can’t imagine life without my children,” Catsman said. “I was willing to try four times, but not again because it’s physically and emotionally taxing.”

If she has advice, Catsman said, it would be: Conceive young, trust the process and don’t hold back about discussing infertility.

An egg – which is about the size of a dot made by the point of a sharp pencil – must be fertilized within 24 hours maximum, Gambone said.

“We monitor the cycle of the ovarian follicle, the cyst that contains the egg,” he said. “If the egg needs to be fertilized on Saturday or Sunday, then Monday is too late.”

About 60 to 70 percent of couples who have trouble conceiving seek counsel, Gambone said. The remainder end up adopting or resigning themselves to their fate.

In vitro fertilization is expensive, $15,000 to $20,000 per procedure, Gambone said. Procedures that lead up to in vitro are done in Durango and are much less expensive.

Catsman said eggs are removed, but the fertilized eggs are not placed in the uterus for four to five days, during which time the patient’s condition is monitored, she said.

Oral medication has a 6 to 8 percent success rate, Gambone said. The combination treatment is 15 to 17 percent effective; injection alone is 18 to 22 percent effective; and in vitro proves successful 30 to 35 percent of the time.

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