Living Well

Hope for Infertility

By Robin Gallaher Branch | Photography courtesy of Dr. Paul Brezina and LiveWell

Spring often signifies new life, but for some couples having a baby is not easy. Advances in reproductive health have given new hope to couples trying to conceive.

Infertility is a widespread problem that often causes marital heartache and despair. “It affects 10 percent of the population,” says Dr. Paul Brezina, Director of Reproductive Genetics and Partner at Fertility Associates of Memphis.
However, there’s hope for those couples who long for a child, yet experience month after month, their seeming inability to conceive. ART (Assisted Reproductive Technology) has advanced greatly in the last two-plus decades. “The majority of the couples we see are helped and have children,” Brezina says.
Typical patients coming to Fertility Associates are often a tired and discouraged married couple. As the husband and wife sit in the waiting room, they can’t help but see numerous baby pictures on the wall. “I’ve had couples say to me, ‘We want our baby on that wall’,” Brezina says.
That statement indicates their determination to go through the process, a process that can be long as well as emotionally and financially difficult. For many patients, insurance is adequate to identify and correct the underlying medical conditions of infertility. However, some plans do not cover in vitro fertilization (IVF), which is fertilization outside the body and is usually costly.
Brezina listens intently throughout the first appointment. The man and woman take turns describing their marriage, efforts to conceive, and disappointments so far.
“I meet very strong and courageous people,” Brezina says.
Perhaps they’ve had multiple miscarriages. Perhaps they hear the increasingly loud ticks of the so-called “baby clock” of prime fertility years. Perhaps hopeful grandparents exert not-at-all-subtle pressure. Perhaps one half of the couple blames the other.
When that happens, Brezina quickly says, “There’s no fault. It’s 50-50.” He emphasizes hope and a team approach; he offers to be part of the team.
Brezina sometimes shares his own story. He and his wife struggled with fertility issues as well. They now have 10-year-old twins, a boy and a girl.
Their struggle is one reason Brezina switched from a career track in hospital administration to becoming board certified in Reproductive Endocrinology and Infertility and in General Obstetrics and Gynecology.
After taking the medical history of the man and the woman, Brezina suggests tests, which will determine a treatment plan.
Brezina defines terms and procedures for the couple. For example, with IVF, the egg and the sperm are outside the bodies. Fertilization takes place in the laboratory.

Sperm is retrieved from the man. A woman receives hormones that stimulate egg production. Eggs are retrieved under anesthesia using a needle.
In a laboratory, each egg is fertilized by sperm. Brezina favors a single embryo transferred at a time to the uterus and not multiple embryos for multiple births.
This method bypasses the fallopian tubes. “We get interaction between the egg and the sperm that isn’t possible in normal intercourse,” Brezina says. IVF sidesteps problems like poorly developed fallopian tubes, endometriosis, low sperm count, and/or poorly developed sperm, he says.
The goal is pregnancy. The success rates have more than doubled over several decades, giving hope to many couples, Brezina says.
At about 10 weeks of gestation, the couple transitions from the fertility clinic to an OBGYN who will walk the couple through the pregnancy and deliver the baby.
Brezina said a safe pregnancy follows these general guidelines: a healthy lifestyle, no smoking, and maintaining a healthy weight.
The couple can choose to have the embryos frozen separately. The parents can return several years later if they decide to increase their family. It’s also possible to freeze the eggs and sperm separately and unfertilized.
“Roughly 1.5 percent of all live births in this country are thanks to conception through IVF,” he says.
Brezina outlined several other advances in the field of reproductive health:

Embryo Cryopreservation (the ability to freeze, cryopreserve, embryos). “It is now common for couples to have an IVF cycle which generates three-to-four embryos. These are cryopreserved and used one or two at a time for multiple pregnancies spaced out over the years,” Brezina says.

Egg Preservation. Advances in freezing time enable a woman to preserve her eggs. “Reproductive potential decreases with advancing maternal age,” Brezina says. “Fertility preservation is a strategy to mitigate the impact of maternal age on the ability to have a genetic child.”

Genetic Testing of Embryos. A condition called aneuploidy increases with advancing maternal age. It accounts for the majority of first trimester miscarriages. Down Syndrome is a form of aneuploidy. “Current technology allows for genetic testing of an embryo, before embryo transfer is performed, to determine if aneuploidy is likely,” Brezina says. “Genetic testing of embryos allows parents who harbor serious genetic diseases to identify these traits in IVF embryos and reduce the chances of having a child affected by a debilitating genetic disease.”

Vasectomy Issues. If a man had a vasectomy decades ago, reversal may prove unsuccessful and not result in a pregnancy. However, sperm retrieval is possible via a needle, Brezina says.

Brezina’s life and his practice are happy and satisfying. One reason, he says, is because “two or three people drop by daily to show me their babies.” The happy parents often bring a framed picture of their baby for the office wall.

Read More in DeSoto Magazine online.