These scenarios are representative examples of the kinds of situations faced by many infertile couples.

Helena and Doug

Helena is 38 years old and has a 12-year-old daughter by her first husband. She re-married two years ago and has not used contraception since. She has had two pregnancies, but both have ended in miscarriage. She and her husband, Doug, are both healthy and would very much like a child, but they are hesitant about “invasive treatments” because of expense and fear of long-term risks.

Helena’s workup showed a problem with her thyroid gland. Once she started treatment, she was advised to try to conceive, but admitted to some ambivalence related to fear of another miscarriage. Supportive counseling was initiated and the patient successfully conceived. During the first two months of her pregnancy, she was monitored closely.

Annette and John

Annette is 42 years old and has been trying to conceive since she got married, five years ago. She has had a complete workup, which was normal. Various medications were given to stimulate ovulation and she tried several cycles with intrauterine insemination. When these treatments failed, IVF was tried for two cycles. Recently Annette was told that her FSH level was high and she was advised to try donor oocyte IVF. Neither Annette or John was interested in donor oocytes. At consultation, they were advised that their chances of conception were low without donor eggs. They decided that what would be best for them was to look for opportunities to adopt a child.

Janice and Mike

Janice is 32 years old and has been trying to conceive for a year and a half. She has never been pregnant and has used birth control pills until 18 months ago when she and her husband, Mike, decided to conceive. She has irregular menstrual cycles and has never had any significant health problems. Her husband is in his early thirties and is in good health. The couple has tried to time sexual relations for the most fertile time period each month, but they have had trouble determining when this is because the temperature charts and urinary kits are always confusing. They have grown increasingly frustrated and wonder about the next steps.

Janice was seen for consultation and exam. Hormonal work up was initiated and she was found to have polycystic ovary syndrome. Tests of her fallopian tubes and husband’s sperm were normal. She was given clomiphene to induce ovulation. Janice became pregnant within 5 months of her initial visit.

Bridget and Glen

Bridget is 29 years old and stopped using contraception three months ago. Because Glen is a cancer survivor, she requsted a consultation to find out whether treatment would be necessary to help her conceive. Glen’s sperm count was very low (less than one million). Bridget and Glen were advised that the option most likely to succeed would be insemination with donor sperm or IVF. Preliminary workup for IVF was completed, but they needed to delay treatment because of cost. Six months later, they were able to obtain partial coverage through a change in their insurance coverage. This enabled them to undergo a cycle of IVF.

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