Fertility Specialist to Women: Know Your Options

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

Coming up, how to win the credit card reward game, if you should play at all.

But first, they say it takes a village to raise a child, but maybe you just need a few Mocha Moms. We visit with members of this mother support group each week for their common sense and savvy parenting advice.

Today, we want to talk about infertility. And before you break out in a sweat and say this has nothing to do with me, you might want to consider that in this country about 20 percent of women now wait until after age 35 to begin trying to conceive. And age does affect a woman's chances of conceiving successfully. So we think knowledge is power, and we decided to talk to a fertility specialist about what you need to know if you want to try for a family at mid-life.

I am joined by our regular Mocha Moms — Jolene Ivey, Cheli English-Figaro and Divina McFarland, and our special guest mom, Dr. Rhonda Hearns-Stokes. She's a fertility specialist with the Genetics & IVF Institute headquartered in Fairfax, Virginia.

Welcome, ladies, moms.

Ms. JOLENE IVEY (Co-Founder, Mocha Moms): Hi.

Ms. DIVINA McFARLAND (Member, Mocha Moms): Hi.

Ms. CHELI ENGLISH-FIGARO (President Emerita, Mocha Moms): Hi.

Dr. RHONDA HEARNS-STOKES (Fertility Specialist, Genetics & IVF Institute): Hi.

MARTIN: Dr. Hearns-Stokes, start us off, infertility means what?

Dr. HEARNS-STOKES: Infertility is the inability to conceive, inability to become pregnant, and there are actually two definitions. If you are less than 35, the definition is the inability to conceive or become pregnant for more than a year. However, if you're greater than 35 that definition, the time drops down to six months.

MARTIN: Why is age so critical for women?

Dr. HEARNS-STOKES: Unlike men, we're born with all of the eggs we'll ever have in a lifetime. The most eggs we have were in utero. And then once we're born, we have thousands of eggs, but then we continue to have those eggs, they continue to die off.

And so as we age, it's unusual because when we're in our 20s, that's our most fertile period, and then as we continue to age, you see more eggs drop off. But the other thing that people forget is that just like us, as we age, things get older; those eggs get older. So it's like they're just sitting on a shelf and we have to dust them off a little bit to use them because those eggs undergo cell division, and, lots of times, the division becomes abnormal. And that's why the older women will also sometimes have problems with miscarriages.

MARTIN: I'm going to bring the other moms in, in just a minute, but I do want to ask this question that I think, you know, women of color often labor under a stereotype of hyper-sexuality, you know, hyper-fertility that, you know, Fertile Myrtle, you just, you know, all you got to do is, you know, sit down after dinner and get pregnant. So I'm wondering since that is a stereotype that I think a lot of women of color want to resist, is fertility or infertility an issue equally across ethnic groups?

Dr. HEARNS-STOKES: It is an equal problem across ethnic groups and I'm glad you brought that up because I do know the stereotype as well. You know, our grandparents and even our parents, sometimes, they were able to have lots of kids. But what we have to remember is they started earlier than we did, and that's where the, I think the difference is. But it is a stereotype. But it's a stereotype in all women, even women of other ethnicities, they come in and the first thing I hear them say is, well, my mother, she had me when she was 42. But these are not the norm, these are the exceptions and a lot of people don't realize that, yes, it's never zero, your chances are never zero, but they're very, very slim to none when you reach that 40, 42 age.

MARTIN: But the reason I bring that up is that I think it is not uncommon for people to absorb stereotypes even when they aren't aware that they're doing so and I would imagine that's - if you somehow internalize the stereotype, it might be even more devastating than it is for other women who are used to seeing celebrities on the news who've gotten pregnant at a later age and think, why not me? This shouldn't be me. This shouldn't be happening to me.

So Jolene, I wanted to ask the moms if any of them have ever struggled with this issue. And I'm tempted to say I know I'm not talking with you and your five kids, but have you?

Ms. IVEY: My issue was that I just kept having boys, and we were very interested at that time in having a daughter. And so we actually went to the doctor's fertility institute in Virginia and had a consultation, and we did find out their process of how you can actually attempt to have a particular sex. But it turned out I was already pregnant with another boy.

MARTIN: Well, what about the idea of fertility planning for family balancing as it were? Is that actually a common practice?

Dr. HEARNS-STOKES: I don't know if it's necessarily common, but there is a good percentage of patients who or consumers out there, you know, who are interested in balancing their family if they have all children of one particular sex.

MARTIN: Any other question? Cheli.

Ms. ENGLISH-FIGARO: I had my first child in my 20s. I had my second child in my 30s. I had my third child in my 40s. But in between those children, I had some miscarriages. And I was interested in knowing about secondary infertility because I know that's an interesting problem because people who don't have any children, there's a lot of sympathy a lot of times. But if you have one child and then you're having problems having a second child, people don't seem to have the same kind of sympathy and I'm wondering if you treat that any differently, the secondary infertility?

MARTIN: Secondary infertility being, if you already have one child and you have…

Dr. HEARNS-STOKES: Somehow unable to…

MARTIN: Have another child.

Dr. HEARNS-STOKES: And actually I do treat that very differently. I'm very empathetic in that way because I, like you, I had one child and then after that child, I did want more kids and unfortunately I had three miscarriages. But because I'm in the field, I've realized a lot of that had to do with my age. So as you get older, you tend to lose pregnancies more often. And so I am very empathetic because this is something that has touched me personally as well.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. We're talking about fertility and what you might need to know if you're trying to start a family.

Ms. McFARLAND: I have a question…

MARTIN: Divina?

Ms. McFARLAND: Yes. I have a question. My question is do you find that African-Americans are less likely to seek your services, to seek your help because of some of the stereotypes that you talked about? Do you find that people who come into your office, is it equal? Is it more one race than another?

Dr. HEARNS-STOKES: I actually do see more Caucasian patients. I don't see as many African-American patients as I would expect to see. I don't. And some of that may fall into the stereotype. A lot of it sometimes just women in general, we put off fertility for various reasons.

The other thing is that we may think that we have a long time to wait. And lots of times you take that for granted. And I think even on myself as a, when I was younger, I took it for granted that if you want to have kids, you'll always be able to have kids.

But it wasn't until I was diagnosed with endometriosis, a disease that causes infertility, that I really felt like something may have been taken away from me. And then it hits you a little harder.

(Unintelligible) so I think, as we see the - like you mentioned, Ms. Martin, the celebrities who are becoming pregnant now at such a late age, we start to feel that, oh, we do have time to do whatever it takes. But what we're not realizing is that a lot of these women are not using their own eggs at this late age.

There is a process called donor egg. And, but there is a patient confidentiality between the patient and physician, so no one's going to say this particular celebrity or this particular friend of yours used donor egg.

MARTIN: Do you think shame is still a reason that some people don't seek help or you think people are pretty well passed up?

Dr. HEARNS-STOKES: I think a lot of people are passed up, but there are still some groups, cultural groups where shame may still play a role.

MARTIN: And so what would you say to them?

Dr. HEARNS-STOKES: I would say to them that you have to make the best decisions for you, determine how important it is for you to be a mother or father and then let that be your guide.

MARTIN: Speaking of fathers, how often is there an issue with men? Is age still an issue for men? How often is it that there's a problem in the men who find infertility?

Dr. HEARNS-STOKES: Actually, what a lot of people don't realize is that there's an equal incidence of male and female fertility. Forty percent of the time, it's the female. Forty percent of the time, it's the male.

MARTIN: Oh.

Dr. HEARNS-STOKES: Okay, the other 20 percent of the time, there are other things there. And actually a lot of that is a combination, male and female. So just because one partner is tested and you find an abnormality or you think you found the problem, lots of times you still need to test the other part of the couple as well because there's going to be a dual problem there.

MARTIN: What are some of the - this is such a complicated area that we can't get in to all the details - but what are some other things you can offer a patient who comes to you and if otherwise healthy, but is having difficulty conceiving? What are some of the things that you can do?

Dr. HEARNS-STOKES: Well, the first step would be…

MARTIN: Besides pray.

Dr. HEARNS-STOKES: The first step would be to complete an evaluation and exams of history to determine whether there is something in your lifestyle that maybe preventing you from becoming pregnant. For example, obesity, you know, just being a little overweight, not necessarily obese, but that has a lot to do with your ability to conceive and deliver a healthy child.

And that, so there are lifestyle modifications that one can partake in. It is, are you smoking because a lot of people don't realize that the cigarettes, tobacco, it decreases our egg quantity.

So it depletes our ovarian reserve. Okay, so our ovaries aren't working as well. We don't have as many eggs left. Those women actually go in to menopause earlier. There are certain medications and drugs that can affect both women and men with regard to fertility.

Sexual history, those things are important, any history of sexually transmitted diseases because those things can affect your fallopian tubes. If the fallopian tubes are blocked, the egg and the sperm won't be able to meet because that's where the egg is fertilized by the sperm in the middle of the fallopian tube.

MARTIN: Just briefly, what is your ovarian reserve? This is your egg supply.

Dr. HEARNS-STOKES: That's your egg supply, exactly. And that's what age is as we age.

MARTIN: Is there something you could tell us to kind of walk away with? If you, when should people seek help if you're in a situation where you want to have children and you're just - things aren't working for you? At what - I don't know, I guess just give us some sort of parting thoughts that at what point people should start reaching out for help.

Dr. HEARNS-STOKES: If you have not been able to have children after unprotected intercourse for more than a year and you're less than 35, you should seek a fertility specialist. If you're greater than 35 and you've not been able to conceive, you should seek a fertility specialist within six months because the longer you wait, the more your chances decrease of ever having that child that you wanted.

MARTIN: A lot to think about. Dr. Rhonda Hearns-Stokes is a fertility specialist with the Genetics & IVF Institute that's based in Fairfax, Virginia. She joined us from our studio in Washington.

We are joined by a regular Mocha Moms, Jolene Ivey, Cheli English-Figaro and Divina McFarland also here in our studio in Washington. You can find links to the Mocha Moms and Dr. Rhonda Hearns-Stokes at our Web site npr.org/tellmemore.

Ladies, thanks so much for joining us today.

Ms. IVEY: Thank you.

Ms. ENGLISH-FIGARO: Thank you.

Ms. McFARLAND: Thank you.

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