- [Jayme] This Med Talk, presented by HCA Midwest Health. I'm Jayme Monacelli with Dr. Celeste Brabec, infertility specialist. And we are talking about infertility. A new study shows that women are waiting longer and longer to have a family. And while we all might know that that will decrease your odds of getting pregnant, what measures can men and women take to be proactive about their fertility? So Dr. Brabec, is it true that women are indeed putting off having a family and if so, why?

-[Dr. Brabec] Yes, it is. From the early 1900s to the mid 1900s to today, actually, the age at first pregnancy has consistently risen. From around 20 or 21 to now late 20s and almost approaching 30. This has come from safe and effective contraception, education, career, and travel.

- [Jayme] It used to be that after 40 wasn't an ideal time to get pregnant. And I speak as someone who's 40 years old. Is that still the case?

-[Dr. Brabec] Absolutely. But interestingly, by the late 20s, fertility rates already start to decline. So this rise at the age of first pregnancy is, of course, something we need to be aware of. The great news is teen pregnancy is down. Interestingly, birth rate in the United States for women under 35 has been dropping. For women 35 and older and women 40 and older, pregnancy rate and birth has been rising. And while these more mature women are more motivated, they're more educated, they're financially more stable. Age has a major adverse impact on pregnancy success.

- [Jayme] So, when does a woman or man know if they actually have a fertility problem? 

-[Dr. Brabec] Okay, sure. So first of all, very interesting, about one in eight couples experience infertility. So very, very common. And interestingly, in a fully fertile couple, the chance of conceiving in one month under age 35 is only 15 percent. By age 35, it drops to 9 percent. And by 40, under one percent. That's in a fully fertile population.

We typically define infertility as trying for one year, when the female partner's under the age of 35. Six months if the female partner is 35. And immediately at age 40 or immediately if there are known medical conditions, such as irregular menstrual periods, fibroids or condition called endometriosis.

- [Jayme] Tell us more about endometriosis really quickly, because it's a term that we hear coming up quite a bit.

-[Dr. Brabec] It is, and endometriosis is a confusing term. But it's when tissue that normally lies inside the uterus and sheds every month with the menstrual period, can become implanted in an irregular place in the abdominal cavity that is termed endometriosis.

- [Jayme] Are there things that women can do to reverse their odds of having trouble later getting pregnant?

-[Dr. Brabec] Absolutely, and first of all of course, like in general health, maintaining good health is key. So that would be diet and nutrition, exercise: not too much and not too little. Maintaining a normal weight, good sleep patterns, no tobacco, minimizing alcohol, but most of all, and most importantly, is getting information early. Educate yourself, make informed decisions, so that you can meet your own personal life goals.

- [Jayme] How does weight affects women and men?

-[Dr. Brabec] There's almost a linear relationship between increase in weight and body mass index, and infertility, as well as decreased success rates with almost all the fertility treatments.

- [Jayme] So I assume the higher your weight, the more trouble you are going to have? 

-[Dr. Brabec] Both extreme differences in weight, whether it be too high or too low, have an adverse impact on pregnancy in live birth rates.

- [Jayme] Let's talk about couples. What are some of the options for couples if they're having trouble getting pregnant? 

-[Dr. Brabec] Really, there is a wide range of couples ranging from low tech, inexpensive relatively easy, to more high tech, depending on what is appropriate for any individual couple. And, of course, like many things in life, low-tech tend to be less expensive, but also tend to have a slightly lower pregnancy rate. And high tech, that are more expensive, have a very high pregnancy rate.

- [Jayme] Take me through some of the timelines. At what point in the process of "trying" do you do what things?

-[Dr. Brabec] Certainly. So first of all, a diagnosed, diagnostic evaluation for infertility is easy. There are four things: egg, sperm, tube, uterus. We can test all those in under a month time. So those answers are can be obtained quite quickly.

Baseline basic, low-tech treatments might involve oral medications, maybe some ultrasound monitoring, maybe an outpatient procedure called (inaudible) insemination.

Those are things that can be completed within one months. Typically require approximately two very short office visits in a month. 

Higher tech things have a much higher chance of pregnancy and interestingly, some of the high-tech options have very high birth rates, sometimes approaching 75 percent in one try, while at the same time the high-tech options with the high pregnancy rate afford the very lowest, the very minimal, multiple pregnancy with a very highest chance of a healthy singleton.

- [Jayme] I've heard medications that can help just some of the simpler things at the very beginning. What are some of those options early on?

-[Dr. Brabec] Certainly. There are several ovulation induction medications, oral medications (inaudible). When more high-tech procedures are performed, typically injection medications that contain a hormone are often utilized.

- [Jayme] What about the couples, who are getting married later in life as a lot of couples are, and they're delaying starting a family, in pursuit of their careers and to be more financially stable. And this so-called egg banking fertility service. Tell me more about that.

-[Dr. Brabec] So the availability of successful egg freezing is relatively new compared to freezing of sperm. We've been able to effectively freeze sperm for many, many years. Certainly donor egg freezing is very, very common, and we have a lot of long-term data with large numbers from that.

So freezing eggs for elective fertility preservation is certainly an excellent option, but long-term data is scarce.

The earlier you freeze your eggs, the better. And, interestingly, it takes around 15 eggs perhaps to achieve a reasonable chance of one live birth. For those people who miss that window of freezing their eggs, there are alternative options. And those involve things such as third-party reproduction. We can even successfully achieve pregnancy in women who are menopausal. There's use of third-party gestation of carrier also known as host uterus. And we can even treat successfully a couple who have surgical absense of the uterus or a medical (inaudible) to carrying the pregnancy.

- [Jayme] Do you suggest to women or would you suggest to women who are maybe younger, let's say maybe in their 20s, to have -- they're not a relationship, and they think they want to have kids someday but they're going focus on their career for a while -- would you suggest them going and having their eggs frozen? 

-[Dr. Brabec] I think really, it's important to get information and to know yourself and what your goals are. Many women if they're in their teens or early 20s -- certainly the earlier you are when you freeze your eggs the better. However the earlier you are, the greater the chance that you may meet someone and conceive on your own and not need to go through the process itself.

So, I would probably suggest for most people that there's individual differences, according to patients' wants and needs, of probably somewhere around 30 would be a great time. We know that freezing eggs certainly has decreased efficacy at 35 and 38. So certainly, we sometimes have women come to see us at 40 or above, wanting to freeze their eggs, and certainly they're not getting the maximum opportunity at that point in time, but it's not impossible. But that's the idea.

- [Jayme] Thanks to Dr.Brabec, infertility specialist, for joining us. This has been Med Talk presented by HCA Midwest Health. I'm Jayme Monacelli.