Specialist Discusses Infertility Among Men, Women

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This week's Mocha Moms continue their discussion on family planning with fertility specialist Dr. Rhonda Hearns-Stokes. Stokes takes listener questions about reproductive health, including male infertility. Also in the discussion are moms Jolene Ivey and Cheli English-Figaro.

MICHEL MARTIN, host:

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 continue our talk about infertility. A couple of weeks ago, we started a discussion about what infertility is, who it affects, and what we can do about it. You've had a lot of questions so we decided to bring back our fertility specialist Dr. Rhonda Hearns-Stokes. She's with the Genetics & IVF Institute based in Fairfax, Virginia. And she's here along with our regular Mocha Moms Jolene Ivey and Cheli English-Figaro.

Welcome ladies, moms.

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

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

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

MARTIN: So, Dr. Hearns-Stokes, I wanted to ask you this last time but didn't get around to. How did you get involved in this field? It's my understanding that only a handful of people are trained in the fertility field every year. How did - why did you want to be in this field and how did you get involved in it?

Dr. HEARNS-STOKES: I became involved in this field based on my personal experience. I was diagnosed with endometriosis, sometimes debilitating disease that affects reproductive age women and causes infertility. I was a sophomore in college. I'd actually been diagnosed with an infection, which ended up not being an infection. I'd undergone surgery and it wasn't until that time that I was hospitalized. Then, the next day, the physician came to me and told me that I had endometriosis and that I would probably have difficulty conceiving children and that as I became older, my fertility would decline even more.

And his recommendation was that I start to have my kids at that time. It was then that I decided I really wanted to help infertile women because I didn't want women to have to go through what I went to with feeling ashamed and feeling lost and feeling that I've been robbed of something my fertility and just dealing with the difficulty of possibly not being able to have kids.

MARTIN: Well, last time we talked a lot about those situations that affect women, some of the medical conditions that can affect women. I wanted to ask, are there medical conditions that affect men and their fertility?

Dr. HEARNS-STOKES: There are many, many medical issues that can affect men and their infertility. As a matter of fact, up to 50 percent of infertile couples have a male factor related to their infertility.

MARTIN: If you were about to start conceiving, trying to start to conceive, is there something you should be doing proactively to get yourself checked out?

Dr. HEARNS-STOKES: You should. Once a couple starts to have problems conceiving, if they have been unable to conceive for over a year. If you're over 35, then the definition of infertility drops down to six months.

MARTIN: I wanted to - have questions from listeners, well, I want to ask Jolene and Cheli if they had any questions.

Ms. IVEY: Well, first of all, I'm just kind of alarmed, Dr. Hearns-Stokes, that a doctor would tell a young woman who's a sophomore in college to start having children. I mean, would he have told that to a young white woman? It just seems - I hate to bring it to a racial issue but come on. If somebody told, you know, a kid of mine - I don't have girls - but if a doctor told a daughter of mine and she's in college and, you know, obviously, has plans for life to start having kids now because you might have trouble conceiving in 10 years or something, I would really be angry. And how did your parents react to that?

Dr. HEARNS-STOKES: My parents were very supportive. They understood that this was not an option for me and it's actually because of my parents that we continue to seek second and third and fourth opinions about what my problems were because we felt as though, the physicians were not listening. And…

MARTIN: Wait a minute, let's just break it down, Dr. Hearns-Stokes. Let's just get really real about it. What you really think is that the doctor assumed you were sexually active when you weren't.

Dr. HEARNS-STOKES: Exactly.

MARTIN: He didn't take your word for it as you were.

Dr. HEARNS-STOKES: The doctor did not take my word for it. I knew that there was no way I could have a sexually transmitted disease because I was not doing anything that would have caused me to have the sexually transmitted disease and it was very difficult for me because I had to say it to my parents, I don't have an infection.

MARTIN: Hmm. Isn't it that cultural sensitivity plays a role in that?

Dr. HEARNS-STOKES: I think back then, cultural sensitivity may have played a role with respect to the diagnosis of infertility because at one point, it was considered a disease of working women. And so I think earlier in the '80s and '70s, it was considered a diagnosis that you were not as likely to have in the African-American population. But now I think we realize that it affects all races.

MARTIN: I have some questions from listeners. We put out the call for questions if they have and we had a lot of questions. We heard from Johanna(ph) and Antoine(ph), they're listeners from Milwaukee, and they're trying to conceive and they want to know if there's any behavior that could inhibit their chances to reproduce like smoking or even dietary habits?

Dr. HEARNS-STOKES: Yes. Tobacco can decrease sperm function. Excessive alcohol use can impair sperm function as well. Recreational drugs such as marijuana and cocaine and also medications that may be prescribed for illnesses. There are also dietary issues, for example, females who are overweight, they may have more problems with ovulation than those patients who are at a normal body mass index.

MARTIN: How overweight?

Dr. HEARNS-STOKES: If you fall in that obesity range of body mass index, then you - will have decrease chances of ovulating.

MARTIN: Hmm. Jolene?

Ms. IVEY: Well, One thing I'd like to point out on behalf of the thin women of the world of whom I am one, I had trouble conceiving at first with my first child and I think that could have been part of it. Somebody took me aside and said, why don't you just put on a few pounds, that might help?

MARTIN: That's interesting. Why would that be?

Dr. HEARNS-STOKES: And you are absolutely right. That would be because in order to ovulate normally, you have to have a certain percentage of body fat.

MARTIN: If you're just joining us, it's our regular weekly visit with the Mocha Moms and we're joined by guest mom, fertility specialist Dr. Rhonda Hearns-Stokes.

We have a question from Anne(ph) in Michigan. She writes: she wants to know about fibroids. She says, I'm 34 with multiple fibroids. I do not plan to have a hysterectomy. I'm not sure if I want kids but now I feel like it's now or never.

What's the plan here? I mean, what should she do? She - hysterectomy isn't the only choice, right?

Dr. HEARNS-STOKES: Hysterectomy is not the only choice for women with fibroids depending on the size of the fibroids and the location of the fibroids. Fibroids are actually overgrowth of smooth muscle in the uterine wall. They can cause problems such as excessive bleeding, sometimes pain depending on where they're located. In general, they don't typically cause infertility unless they are blocking the fallopian tubes or if they're blocking the cervical canal or if they are in the uterine cavity, okay, inside the womb or if they are distorting the cavity, distorting the womb pushing into the womb. My recommendation would be to be evaluated to determine exactly where they are located and what the size dimensions are and that would give you a better idea of what the best option for you is. But hysterectomy is not the only option for fibroids especially if you want to conceive.

MARTIN: Dr. Hearns-Stokes, I wanted to ask if there is anything about this field that is different from what you're expected.

Dr. HEARNS-STOKES: That it's harder. More emotionally taxing.

MARTIN: That's interesting. That's an interesting question.

Dr. HEARNS-STOKES: It can be very emotionally taxing. You have to be a good listener. You have to be an empathetic physician which is why I really went into the field. I think I can relate to patients but it is truly a very - at times, it's very difficult to give the patients what they want because like a lot of you may realize, when you cannot become pregnant, you feel like you've been robbed of something. Even in those patients who have delayed conception for whatever reason they have, they haven't met Mr. Right, they were dealing with their family, their career or whatever it was, it's something that we put off knowing that when we're ready, it's going to be there. So when we come back and you have a physician saying to you, I'm sorry, this is a problem, you may not be able to conceive without some sort of treatment. And even with that, there is no 100 percent guarantee. It really hits you really hard.

MARTIN: Cheli, you have a question?

Ms. ENGLISH-FIGARO: Do you find that men are in denial about their problems more because they're macho to be able to impregnate a woman?

Dr. HEARNS-STOKES: I don't know that it's denial because lots of times, you evaluate the male with a female analysis, and lots of times when it is abnormal, we do recommend repeating it at least once because every one is entitled to a bad day. So I don't think it's so much denial as it is feeling that they are not able to produce, and…

MARTIN: But isn't it the case that most times, couples come to you, the women assume that it's her?

Dr. HEARNS-STOKES: Well, lots of times, the woman does assume it's her and lots of times, there are couples who don't want to start the evaluation of the male process until the female has been evaluated. But I always tell them that it's usually going to be, you know, about 50 percent, 50/50, so it's best to go ahead and evaluate both patients simultaneously rather than evaluate one part of the couple and have things come back normal and then have to go back and evaluate the other.

MARTIN: Do you think that that something that people should emphasize in their routine kind of thoughts about health as young people that in their kind of 14 physical examinations that fertility should be discussed. Well, I just wonder if you think that doctors should start talking about young women and men with an eye toward their future fertility. So gee, you know, if you're thinking about having a family at some point, these are some things you should be thinking about.

Dr. HEARNS-STOKES: I think that this is something that should be discussed at the annual GYN visit. However, I can say I'm an infertility specialist but in order to do that, you have to become an OB-GYN first, and you go through that red OB-GYN residency and that's not how they taught us. We were not trained to discuss this during the annual GYN exam. And until we put that into the training program, we may, unfortunately, but not intentionally disservice some of our patients.

MARTIN: Dr. Rhonda Hearns-Stokes is a fertility specialist with the Genetics & IVF Institute. It's headquartered in Fairfax, Virginia. She joined us in our studio in Washington along with our regular Mocha Moms Jolene Ivey and Cheli English-Figaro. You can find links to the Mocha Moms and Dr. Rhonda Hearns-Stokes at our Web site, npr.org/tellmemore.

Ladies, moms, thanks so much for joining us today.

Ms. IVEY: Thank you.

Dr. HEARNS-STOKES: Thank you, Michel.

Ms. ENGLISH-FIGARO: Thank you.

(Soundbite of music)

MARTIN: And that's our program for today. I'm Michel Martin and this is TELL ME MORE from NPR News. Let's talk more tomorrow.

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