Assistant Division Director
Walter Reed Medical Center
Tinina Q. Cade Foundation
Five things need to happen to make a pregnancy possible:
A woman’s ovaries need to produce a high quality egg
That egg needs to be able to mature and be released into the woman’s fallopian tube
That fallopian tube needs to be open at both ends
High quality sperm needs to reach the open fallopian tube to fertilize the egg
The resulting embryo needs to be able to travel out to the uterus and implant in the wall of the uterus
If one of these steps doesn’t unfold and a woman, or couple, has trouble conceiving naturally, there are a lot of options available, but here we’ll mention the 3 most common.
Oral Medications: To start, many women will be given an oral drug like clomid or letrozol and be told to continue to have intercourse during the woman’s “fertile window.” These drugs help signal to the woman’s body to grow and release a mature egg. If someone isn’t ovulating, these drugs can help to make that happen, which is why taking these medications is sometimes referred to as “ovulation induction.”
Intrauterine Insemination or IUI: The next, more intensive, approach, is to undergo artificial insemination, which is also known as intrauterine insemination, or IUI. Basically, this entails injecting sperm directly into the uterus. If a woman takes certain fertility drugs, the costs & rates of success can vary dramatically, as you can see here in our course on the subject.
In Vitro Fertilization or IVF: Finally, the most intensive approach is in vitro fertilization or IVF. Here, eggs are surgically removed, fertilized in a laboratory, and resulting embryos are transferred back into the uterus.
As you can see in the chart below, each of these interventions carries increasingly higher odds of success, but also requires more money and a heavier burden.
Unfortunately these treatments don’t work equally as well for all patients and usually the patients who begin treatment at younger ages have a baby more quickly. Below you can see a breakdown of birth rates per cycle for both IUI and IVF, broken down by age.
As women age, the volume and quality of their eggs begins to diminish, and unfortunately, this lowers the odds a woman will produce a high quality egg, which you may recall is requirement #1 for a woman to conceive.
This fact, that success rates go down with age, is crucial for Black patients to understand, because Black women often begin treatment 1 - 2 years later than Caucasian women. The 5 studies below showcase this fact.
A one to two year delay in fertility treatment can be meaningful, as you can see below in the context of treatments like IVF. Here is per-cycle success rate data for all US fertility patients in 2016, divided into approximately 1 - 2 year increments. To illustrate the point, notice the 11 point gap between ages 38 - 40 and 41 - 42. Those 11 points represent a 55% drop in per-cycle success rates.
As you can see in the dataset below (featuring women under the age of 38), if a woman can’t conceive naturally after 6 - 12 months of trying during her fertile window, the odds she’ll be able to succeed in any successive month is incredibly low. For that reason, most doctors recommend seeing a fertility specialist after 12 months if a woman is age 34 or younger and after 6 months is she is 35 or older.