Medicine Offers a Chance for Couples Struggling with Conception
Jordan Chaffman enjoys singing and it’s a love passed on to her year-and-a-half-old son, Joel. “If I have the radio on, he’s humming along with me,” she says. “He loves The Wheels on the Bus. It’s] his favorite song that we sing all the time. He also loves the Zac Brown Band..” Joel also loves books. He will sit and read books for minutes at a time, which is not normal for a toddler. He has a great vocabulary. He is talking up a storm. He’s just a lot of fun.. … He is such a blessing and an answered prayer.”.”
Chaffman and her husband Tim were married nearly six years ago and the Ijamsville couple began trying for a baby a year later. She got pregnant but miscarried at nine weeks. With a long history of irregular menstrual cycles, her obstetrician sent her to Shady Grove Fertility Center in Frederick. “I’ve always wanted to be a mom,” she says. “That’s not ever something I doubted or thought about. I never thought my journey would be this way. I didn’t think I would have a hard time getting pregnant. I never thought I would miscarry. This journey has just been a little different but it’s our journey and we have accepted that that’s what it’s going to be and we have to have a different way of doing things.”
Infertility affects about 15 to 16 percent of the population, which means about one in six couples will have difficulty trying to conceive. “If I drew a pie chart of the causes of infertility, we’d find about roughly 40 percent of the time there is a male factor—either a problem with sperm count or the sperm movement or something like that,” says Dr. Jason Bromer of Shady Grove Fertility Center. “Another 20 percent would be problems with the eggs [in] the ovulation process. Another 20 percent would be problems [like scar tissue] with the fallopian tubes. So it’s about 40 percent male factor and about 40 percent female factor.
“Then about 20 percent of the time, all the testing comes back normal,” Bromer says. “We call it unexplained infertility. It’s really frustrating because patients are coming in because they want an answer but we are very careful to explain that that doesn’t mean there is not a problem. The fact that you have been trying for so long indicates there is a problem. We’ve done our basic set of tests and it has not uncovered the problem. We have some treatments that work quite well even in the case of unexplained infertility.”
Frequently people don’t know they have conditions that can lead to conception difficulty. So how soon should you see an infertility doctor? If the woman is under the age of 35 and has tried unsuccessfully to conceive for a year or longer, it’s time to be evaluated. If the woman is between the ages of 35 to 40, a couple should seek help after six months of no conception. If over the age of 40, the couple should be checked out when they decide to start trying.
When a couple first comes to Shady Grove Fertility Center, which has multiple offices throughout the region, they meet with a physician to review medical history and discuss a diagnostic plan to try to figure out why there’s a problem. “Testing usually looks at a couple of key areas,” Bromer says. “We do some blood tests and ultrasounds for the woman to assess how her eggs are functioning and her hormonal status. We do a semen analysis for the man to review the sperm parameters.” They also do an X-ray test to determine if the uterus cavity and fallopian tubes are open. “Once the testing is done, we sit back down again for what we call a follow-up consultation with the physician, go over the results and put a treatment plan together,” Bromer says. “A lot of patients think when they hear ‘fertility doctor’ they think in-vitro fertilization (IVF) is their only option and that’s actually not typically where we start.”
Lower-tech treatments are the first options. If a woman is not ovulating, they help her to start or, if she is ovulating, they try to make her ovulate with more than one egg. Tests discovered Chaffman had polycystic ovary syndrome (PCOS), which affects a woman’s hormone level. “To finally find out there was something wrong with me and it was fixable and treatable was really helpful,” she says. Doctors put Chaffman on a drug used for diabetic patients. “My insulin levels aren’t regulated, so I don’t produce enough insulin,” she says. “I get a regular cycle but I don’t release an egg when that happens so I had all these eggs stored and stored and stored.” With her insulin regulated, the couple conceived Joel naturally. “There was a very slim chance that could happen [without the drug],” she says.
Physicians will also try intrauterine insemination (IUI) where a high concentration of sperm is inserted into the uterus. If these methods fail, they move on to treatments like IVF where a patient’s eggs are removed, combined outside the body with sperm and reinserted back inside the woman. Donor eggs or sperm can be used.
“[An infertility diagnosis is] tremendously stressful to couples,” Bromer says. Shady Grove Fertility Center offers psychological support to patients either through scheduled appointments or support groups based throughout the region. “We think it is very important that for couples that need [help] that they have access to not just the psychological support but specifically psychological support from people who are specially trained and attuned to helping infertile couples.”
At the very start of the process, couples meet with a financial coordinator to go over insurance information and discuss what the process will look like from a financial standpoint. “Maryland is a little bit unique,” Bromer says. “There are only about, as far as I know, seven states where there is fairly comprehensive insurance benefits to cover fertility treatments. Maryland residents are particularly lucky—not all, but a lot of Maryland residents will have some fertility benefits. Those policies can be very complex and hard to understand so when there are benefits we want our patients to have someone who can explain to them: ‘This is what’s covered. This is what’s not covered. Here’s what your co-pays look like. Here’s what your deductibles look like.’ For the people who don’t have insurance benefits …one of the nice things about being a large fertility practice is that we have some of the most innovative financial programs in the world to help make fertility treatments affordable. We actually have patients coming from all over the world just to utilize our financial programs.”
Bromer can empathize with patients because he and his wife needed fertility treatments. His first child was conceived after several failed IVF attempts. They tried IVF again for a second child but were unsuccessful. After giving up, they got spontaneously pregnant and had another baby.
Some couples do fail and it’s tough for Bromer to see. “I take it really personally when my patients are unsuccessful,” he says. “I can’t help but feeling I have let them down when they are unsuccessful. … There is a helplessness there. … There are very few things in your life that if you work really hard you can make happen and getting pregnant is not one of those things and that is devastating to couples when they are unsuccessful.”
A majority of patients are successful. Maybe not the first try but eventually. Once patients are far enough along to be released to an OB/GYN, Bromer says, “I always tell them bring your baby back so I can meet him or her. It’s the best part of what we do. … I’ve known since I was five years old that I was going to be a physician and I picked this field because it’s such a great field where we can make such a big impact.”
Gettysburg resident Katharine Weaver would get horrendous abdominal pain beginning in her pre-teen years. The pain would increase as she got older, sending her several times to the emergency room and to multiple gynecologist appointments. A doctor would later discover she has endometriosis, a condition where tissue that lines the inside of the uterus grows on the outside. “I partly was relieved because nobody believed me when I said I was in pain and most doctors told my mom I was faking it. I was trying to get out of school: ‘She has a low tolerance of pain. She doesn’t know what bad cramps are,’” she recalls. “So I was really relieved when [the doctor] told me what it was that I have. To have a name and know it wasn’t in my head and my parents believed I wasn’t faking it.”
After marrying her high school sweetheart Brandon in 2009, she began trying for a baby right away. Weaver had been told because of her condition that having a baby would be difficult. She had surgery to remove the endometriosis at 18 and then again a year after her marriage. After the last surgery, her doctor sent her to Shady Grove. They would try IUI four times yet each attempt failed. “It was a letdown,” Weaver says. “It was hard.”
While insurance would pay for two more tries, their doctor said they should try IVF and the first attempt worked. “We told everyone in the family,” she says. “They were all happy for us.” On Mother’s Day and only six weeks along, Weaver found out she miscarried. The couple was devastated and didn’t want to try any more, citing stress and financial cost. Weaver’s father would call her and say ‘Take some time and if and when you are ready, I want you to know that I am paying for it.’
They decided to try one last time and transfer the two remaining embryos they had. Two weeks later, the office called Weaver with the results. “They called and I almost didn’t want to answer the phone because I didn’t want them [to say I was not pregnant].” The whole staff was on the phone to relay that she was pregnant and there was a possibility of twins. “I started crying,” she says. “Everybody was cheering in the background.”
Today, the Weavers are parents to 1-year-old twins Hunter and Alice. “They love to chew on everything,” she says. “They like music. They will kind of wiggle and dance to music and they really love [the family] dogs.”
Weaver is thankful for her doctors’ care and hopes other women will seek out help if they need it. “Endometriosis is real and I hope that women get out there and get to a doctor that can help them and if they want to have children, know there are still options.”