Ask Us Anything About… Infertility

People who have trouble conceiving a child are far from alone. It's estimated that up to 15 percent of couples report difficulty getting or staying pregnant.

Dr. Stephanie Estes, a board certified fertility specialist at Penn State Health Milton S. Hershey Medical Center, discusses the causes of infertility and the treatment options that are available.

December 12, 2017 Penn State Health News
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Transcript

Description – The video begins inside an andrology lab at, Penn State Health Milton S. Hershey Medical Center. Inside the lab are research vents, microscopes and other items you would use in a fertility lab. Two people are standing next to each other looking at the camera. From left to right is, Scott Gilbert and Dr. Stephanie Estes.

Scott Gilbert – From Penn State Health Milton S. Hershey Medical Center, this is Ask Us Anything About Infertility. I’m Scott Gilbert. You know people who have troubles conceiving a child are far from alone. It’s estimated that at least 1 in every 10 couples, perhaps as much as 15% of couples, has problems with infertility. We’re going to talk about the causes of infertility today and also the treatments, ways that people like Dr. Stephanie Estes can help couples achieve pregnancy. Dr. Estes is a Board certified fertility specialist here at the medical center. Appreciate you taking the time today.

Dr. Stephanie Estes  – Thank you.

Scott Gilbert – Let’s talk a little bit — actually first about where we are. We’re at 35 Hope Drive on the Hershey campus but it looks like we’re in a lab. Where are we?

Dr. Stephanie Estes  – We are actually in the andrology lab. The andrology lab is where we prepare our sperm specimens for fertility treatment and even directly behind is the rest of the IVF lab. So we have a whole fertility center here as one unit where we can care for our infertility patients.

Scott Gilbert – Okay and right outside here is the clinic. So when a couple comes to see you in clinic for the first time, where does the discussion start? When they come in and say, you know, we’ve been having trouble having a baby. Where do you begin that conversation to try to help them out?

Dr. Stephanie Estes  – Yeah we really pride ourselves in trying to address each individual patient and the needs that they have. And so it’s very important to start at the beginning and to look at the history and the problems that have occurred or even if there’s not any problems to start going through factors that might affect infertility. And then we look at a variety of testing options and after that, we go into the treatment. And the majority of our patients do become pregnant which is the most rewarding part of all.

Scott Gilbert – That’s fantastic. You’re watching Ask Us Anything About infertility from Penn State Health Milton S. Hershey Medical Center. I’m Scott Gilbert alongside Dr. Stephanie Estes and we welcome your questions. Just put them in the comment field below this Facebook post and we’ll make sure we get your answer. Whether you’re watching this video live or even on playback after the fact, leave your comment and we’ll leave an answer to it in the form of a comment here as well. So I’ve seen conception and pregnancy referred to as a complicated process that depends on a number of factors. Put another way, it seems like a lot of stars have to align, don’t they?

Dr. Stephanie Estes  – It does. And we look at a lot of those factors in the testing for the patients that we see. So first of all, we want to have some assessment of the eggs and we do lab work for that. Secondly, we looking at the fallopian tubes and we have evaluations including ultrasound that look at the opening or closing of the fallopian tubes which can affect fertility. And then lastly, we need to evaluate the sperm. So all of those components are looked at in the testing. And all of them — so we need to look at both the partner and the patient to make sure that everything gets together correctly to work. And it is challenging.

Scott Gilbert – So it’s about production of the egg, production of the sperm, and making sure that those two can eventually [inaudible] —

Dr. Stephanie Estes  – Exactly, very important.

Scott Gilbert – All right. And again we welcome your questions here and also make sure you share this post. If this is something that you feel is valuable content as we hope you do, feel free to share it on your Facebook feed. When is it time for a couple to come into clinic and see a physician such as yourself to get tested for infertility? You know perhaps, they say well we’ve been trying for a month or two and it hasn’t happened. That’s early in the game, right?

Dr. Stephanie Estes  – Right and it is really important to look at this because it’s frustrating. You feel like things aren’t happening. People are disappointed. You have other people around you who are pregnant and you maybe go to a baby shower or some other event and you think well when should I really be seen? So it’s important that if you’ve been attempting conception for 12 months and you’re under the age of 35, then we should definitely see you for evaluation. Also if you’re over the age of 35 and you’ve been attempting for 6 months, then we definitely want to see you for evaluation. And besides that, there’s other factors. So if you have irregular menstrual cycles or if there’s been chemotherapy or other treatments in the past, then, of course, come sooner to see us so that we can help evaluate you and get that treatment on the road so that you feel better about the whole process.

Scott Gilbert – And I noticed you mentioned different windows of time for — based on age. Why is age a factor in fertility? What’s happening inside the body at different ages that might affect things?

Dr. Stephanie Estes  – Age is really important. We all feel young and unfortunately, the eggs don’t respond that way. So especially for women, it is important to take that into account and age is one of the biggest factors that can affect your success. So you have to evaluate that and please, you know, come to see us because we can help move some of those factors along to a successful pregnancy if we see you early enough in the process.

Scott Gilbert – And so that’s one of the most common factors. What are some of the other common causes or factors of infertility that you see?

Dr. Stephanie Estes  – The other common causes are first of all, male factors. So we can have problems with hormones or with sperm production or transport. And so we look at that in the semen analysis. The second most common option — most problem is ovulation dysfunction. So if you have difficulty ovulating especially in the setting of polycystic ovarian syndrome and other such problems, then we can help you with ovulation and achieve a pregnancy. And we do a lot of research here too on PCOS. So that’s another subspecialty that we deal with frequently.

Scott Gilbert – And we’ll make sure we add some links below the Facebook post for this because there is a lot of interesting work happening at Penn State Health with regard to research into PCOS. You’re watching Asking Us Anything About infertility from Penn State Health. I’m Scott Gilbert. This is Dr. Stephanie Estes. She’s a Board certified fertility specialist and welcomes your questions. Just add them to the comment field below this Facebook post. As I mentioned before, whether you’re watching this video live or if you’re watching on playback. We talked about some of the most common factors and I’m just curious, are there ever cases where the actual reason for infertility or the reason for things not happening just can’t be found?

Dr. Stephanie Estes  – There is. When we evaluate all the things that we just mentioned the eggs and the fallopian tube and the sperm, and if we can’t find other factors, that’s called unexplained infertility. And so even in those cases, we have treatment options that allow couples to become pregnant and whether, you know, have surgical processes for enhancement of fertility or actual medical treatment. Then we can use both of those to move forward to achieve the goals that we want to.

Scott Gilbert – Okay. And speaking of the treatment options. Let’s talk about a few of those because I know there are several and you mentioned you have a high success rate. So that’s very cool. What are some of the first things that you try or I guess, perhaps, it varies depending on the cause of the problem.

Dr. Stephanie Estes  – It really does vary and that’s another reason why seeing a physician is helpful because sometimes you see treatments and they may not be exactly appropriate for you but if we get in there and really delve into all this testing, then we can make recommendations that give you the best chance of success. So, for example, if you’re not able to ovulate we use certain oral medications or injectable medications to help ovulation. If we have an unexplained picture, we can use injections plus inseminations or oral agents plus inseminations or even all the way up to in vitro fertilization process.

Scott Gilbert – Okay and we’ll get into more of those processes a little bit more because you know, we’ve heard of some of those things but people may not know what they are. First of all, I want to take a question from Patti. She’s asking can a healthy pregnancy result after having an ablation?

Dr. Stephanie Estes  – That’s a really difficult situation. So usually after an endometrial ablation it is very difficult to become pregnant. And so the recommendation from our national [inaudible] society is that we don’t achieve pregnancy after ablation.

Scott Gilbert – And ablation involves the elimination of fibroids, is that right?

Dr. Stephanie Estes  – It’s actually the kind of burning of the lining of the uterus on the inside of the uterus. And so that’s one situation where it’s difficult to achieve a pregnancy. On the other hand, ablation of endometriosis by laparoscopy which is a totally separate situation can lead to successful pregnancy.

Scott Gilbert – Let’s talk in a little bit more depth about some of those ways that you try to treat couples and help them achieve success with pregnancy. One of them being in vitro fertilization. How often is that used and what does that involve?

Dr. Stephanie Estes  – And that’s actually a great reason why we’re here today in the andrology lab. We really collect the specimen of the sperm. Kind of washed and prepared. In the meantime we’re giving women injectable medications to take and we simulate their ovaries to make eggs. We retrieve the eggs from the ovaries with an outpatient procedure. And then combine the eggs and the sperm right here behind us in the lab and then put those embryos into the uterus. And that’s the process of IVF.

Scott Gilbert – Fantastic. And how about surgery? What happens — because you’re also director of robotic surgery here at the medical center, we should point out. So when does surgery become involved or become an option in the process?

Dr. Stephanie Estes  – Surgery’s an option for patients who want to have tubal reversals who can’t get pregnant after a tubal ligation. We also treat fibroids. We treat endometriosis, ovarian cysts, and we evaluate other tubal factors at the time of surgery. So [inaudible] tubal factors and surgery are important to certain populations. And we do that all here at Penn State Hershey.

Scott Gilbert – And I want to talk — back up a little bit and talk a little more about the testing process because we talked about coming into clinics, speaking with a specialist but people may say, well there are these kits out here and how helpful are those in terms of store bought kits that can help them determine, you know, what the issue may be?

Dr. Stephanie Estes  – We do have women do ovulation predictor kits at times and that is a good assessment of whether or not initially you’re ovulating but once you reach that stage where you haven’t gotten pregnant for 12 months if you’re over 35 or in 6 months. Excuse me. Twelve months under the age of 35 or 6 months over the age of 35, then you really should kind of go further and we do lab work then. So that’s a little bit more close assessment. And there are some sperm kits out there but again, they don’t do the same assessment that we do here in the lab. So initially okay to look at some of those things but when you get to a certain point then please move on and see us for a more detailed evaluation.

Scott Gilbert – You’re watching Ask Us Anything About infertility from Penn State Health. We welcome your questions for Dr. Stephanie Estes. Just put them in the comment field whether you’re watching the video live or on playback, and we’ll make sure that we get you an answer. And well you touched on this briefly before talking about kind of the baby shower situation where it may be people going to baby showers thinking why can’t that happen for us? What are some of the psychological implications that patients face when they repeatedly have trouble getting pregnant?

Dr. Stephanie Estes  – It really can lead to a lot of depression and so what we try to do is work together as a team. So we have not only our physicians but our nursing staff and then if there are situations, you know, we have good contact with our patients to support them. And if it gets to a point that more is needed than that, then we have referral to counseling and other things which is really important during this time because it’s a stressful situation. It’s difficult to talk to each, you know, partner, and they have a communication issue. And so you can have independent person work with you very helpful in this time.

Scott Gilbert – How about health insurance? How often are some of the treatments we discussed covered by health insurance? Are a lot of them pretty widely covered?

Dr. Stephanie Estes  – In Pennsylvania, it has been challenging. There is not as much as insurance coverage as we would like but that’s becoming more and more progressive. And then what we have actually here at Penn State Hershey is we work with a group that does payment plans called Arc. So we have that available. We also work every opportunity that we can for cost savings during the treatment regimen itself.

Scott Gilbert – As we bring things to a close, we welcome your questions for Dr. Stephanie Estes here on Ask Us Anything About infertility from Penn State Health. I’m just curious. I mean you mentioned that often things are successful with couples. What is that like for you professionally, even personally to kind of see that kind of success happen in clinic and when you can deliver that good news to a patient?

Dr. Stephanie Estes  – Yeah and that’s why we do what we do. It’s really exciting and to be honest, we are committed to providing a process and working with couples through to the end. And when that happens, it is a most joyful moment because we’ve worked through it with honesty, integrity, and really the excellence that the institution also supports with us. And to be honest, one of the greatest things that we do is to have that pregnancy occur and really be excited with our patients about that.

Scott Gilbert – That’s fantastic. Now I understand one of the questions that you do get in clinic sometimes involves freezing eggs. People saying can I freeze my eggs? What are the reasons people would perhaps want to consider doing so and how do they go about doing that?

Dr. Stephanie Estes  – Yes, we’re happy to see people for consultation for that. It’s important. If you’re going to have the ovaries removed. If there are other severe medical problems that are involved when you might not be able to become pregnant now but we can use those eggs in the future. So egg freezing is something that we want to consider.

Scott Gilbert – Sarah has a question. She’s asking what are the chances of a healthy pregnancy after a blooded ovum and is there anything that could be done to prevent it in the future? Can you talk about what a blooded ovum is though for all of us?

Dr. Stephanie Estes  – A blooded ovum is a form of miscarriage and so definitely we have great success after patients have that. And to become pregnant. So I mean I would encourage you, Sarah, to continue to have hope for the future and we would be happy to discuss with you further but overall, people do become pregnant again after a blooded ovum.

Scott Gilbert – That’s very encouraging. As we bring things to a close, Dr. Estes, anything else that you’d like to add that we didn’t touch on here? Any advice for couples who may want more information.

Dr. Stephanie Estes  – No, I think the main thing is, again, just to reiterate if there are certain circumstances or if you meet those time requirements to have an evaluation, please do so. We’re happy to be here for you.

Scott Gilbert – Dr. Stephanie Estes is a Board certified fertility specialist here at Penn State Health Milton S. Hershey Medical Center. Thank you very much for your time.

Dr. Stephanie Estes  – Yeah.

Scott Gilbert – And we appreciate you watching Ask Us Anything About infertility from Penn State Health.

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