It's the elephant in the room, the subject of infertility. It's personal, it's risky, and it's an emotionally fraught journey, and many folks are unaware of the painful feelings it can produce.

Millions of couples are affected by this issue annually, but fortunately, there are resources that can help. As they always say, the first step is the hardest, and that is realizing there is a treatable problem.

My husband and I had no trouble conceiving our first son. We made the decision to try after five years of marriage and 40 weeks later, there he was. After a few years of enjoying our singleton, we casually decided to add to our little family. And that's where the trouble began. Nothing happened. I thought it would be as easy as it was the first time, but what began as a haphazard attempt at reproduction changed over time to become an all-out assault on fertility.

This secondary infertility became our nemesis, our battleground, and over time, tested our mettle as a couple and as a family. Infertility can prove to be a harsh and unforgiving taskmaster, one which can provoke a wide array of emotions, encompassing hope, fear, uncertainty, anxiety, anger, sadness and depression. And that's before the hormone shots and medications start.

Statistics clearly show that fertility treatments are highly effective for a wide range of people seeking help in conceiving a child. In my case, age was becoming a significant factor, and we needed to address the problem quickly. According to Dr. Ernest Zeringue, founder of California IVF: Davis Fertility Center, Inc. and a fertility specialist, “Age is by far the biggest cause of infertility. We can overcome blocked fallopian tubes, uterine fibroids, poor sperm problems, but we can’t change genetically abnormal embryos.”

We tried to conceive in the morning, at night, upside down, during ovulation, in the full moon, in the car. We bought into the many theories that abound about getting pregnant. Boxers were bought. Hot tubs were banned. We stayed away from all smokers, family or not. We took basal temperature after basal temperature. We bought pregnancy tests that reinforced our failure to conceive.

After months of this, we sought help. Granted, we already had one child, so what I was experiencing was secondary infertility – the inability to conceive after a successful pregnancy and birth. Still, we were completely unprepared for the in vitro/fertility/hormone shots/turkey baster/seeming freak show that is the baby-making roller coaster.

One of the most natural human drives is the primal urge to have children. It's basically programmed into us, this need to reproduce. For most people, the path to pregnancy is a smooth and definable journey. But for some, roadblocks appear that may seem insurmountable. Infertility is a dual-edged sword, cutting both emotional and physical swaths through the lives of those afflicted with it.

THE DIAGNOSIS

According to Dr. Janice Andreyko of Northern California Fertility Medical Clinic in Roseville, infertility is defined as “the failure of a couple to conceive after one year of regular, unprotected intercourse when the women is 35 years of age or younger and after six months for couples when the woman is over the age of 35.” Infertility does not discriminate – young or old, male or female, rich or poor, healthy or not. Factors that influence the diagnosis of infertility are many.

The sooner you reach out, the better. As women mature, their eggs decline in number and quality. Although there are a significant number of different variables that affect fertility, age is the most common culprit. Other issues include male infertility (which, says Zeringue, is more common than you might think), ovulatory disorders, uterine problems, genetic abnormalities and our infuriating diagnosis, unexplained infertility.

Initially, doctors will take a complete medical history and do physical exams on both partners. The tests for male infertility are relatively straightforward. According to NCFMC, common causes of infertility in males include “environmental, lifestyle, endocrine (hormonal) and physical factors that may influence the production, quality or transfer of sperm.” Following a semen analysis, your physician can detect any anomalies in concentration, motility or morphology. With male-related infertility, treatments can usually rectify the problem, and in vitro fertilization can take you the rest of the way.

Tests for women are both more comprehensive and extensive. With women, it's usually all about the eggs. While men continue producing viable new sperm as they age, women are born with a certain number of eggs, which decrease over time. After about the age of 35, fertility begins to dramatically drop. “As she ages, so do the eggs that are in her ovaries, and the older the eggs, the higher the chances for chromosomal abnormalities in them,” says Andreyko.

Diagnostic tests to check female fertility include, but are not limited to, blood and urine tests, a basal body temperature test, and an ultrasound to determine if there are cysts or fibroids in the reproductive system.

THE TREATMENT

Once diagnosed with infertility, a couple will need to decide which of several paths to take. Of course, speaking with your OB/GYN is the first step, one which will likely lead you to a reproductive endocrinologist. As Zeringue says, “Patients should not expect their doctors to be fertility experts, just as a fertility doctor is not an expert at delivering babies.” Choosing a fertility clinic that is the right fit is essential, since this is a process that is a huge financial and emotional commitment.

It might seem that the best bet is to jump right in and go with assisted reproductive technology (ART). According to the Centers for Disease Control and Prevention, ART “includes all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from a woman's ovaries, combining them with sperm in the laboratory, and returning them to the woman's body or donating them to another woman.” This does not include procedures such as intrauterine insemination (IUI) or medications to stimulate egg production (often the first ramparts to be breached). Given the many options available, it's prudent to weigh and measure. There are less invasive choices to initially explore.

Fertility drugs, commonly known as ovulation-inducing drugs, can be the initial process for many couples. In our case, we began with Clomid, a drug that definitely wreaked havoc with my hormones (we liked to call it “going Clomicidal”). I found the wildly fluctuating emotional response I had to, well, almost anything, was the first difficult passage. Although we were in this together, it cost an emotional price for my husband as well, since poorly responding to a woman with a heightened hormonal system can lead to solitary nights and cold dinners. If dinner at all.

The many different medications used during fertility treatments affect a patient's hormones and emotions, so it's wise to discuss all the possible side effects and ramifications with the specialist. That way, certain emotional landmines can be avoided. The proliferation of potential complications can lead to unexpected pitfalls if not armed with as much knowledge as possible. Most, if not all, of the fertility clinics and specialists in the area offer counseling with treatment, a service that is wise to utilize.

After two rounds of fertility medication and a failed attempt at IUI, we decided to put all our eggs in one basket. Literally. After a lengthy consultation with our specialists, we boarded the in vitro fertilization (IVF) train.

The most familiar method of ART is IVF – the transfer of fertilized eggs into a woman's uterus. According to the CDC, “Over one percent of all infants born in the United States every year are conceived using ART.” This complicated process begins with ovulation induction using medications followed by injections (don't worry – they'll teach you how and it's really not that bad. Seriously). When the eggs are mature, they are collected and combined with the sperm and stored in a highly technical medical fashion until the stars align – or your doctor concludes the eggs are fertilized and are ready for implantation. The embryo transfer is the next step, and then, with more medical supervision and more shots, the result is, with hope, pregnancy.

EMOTIONAL AND FINANCIAL STRAINS

When my husband and I embarked on our voyage, hope was the omnipresent emotion. We were told about all the risks and probabilities up front, but one thing to remember when you are seeking to create a human being is to not neglect the human soul. Hope can overwhelm reason, and it's vital and practical to remember that hope does not necessarily translate into the desired result. The first go-round for us was a no-go. And it was a devastating call.

Although our knees buckled under the sorrowful news that we were, after all the shots and worries and pains, not pregnant, somehow with the incredible support of friends and family, we rebounded. And, as we sat in front of the perfect house to purchase, with contract in hand, we decided to forgo the home and once more try to navigate the stormy waters of fertility. As my husband said, “We can get a house at any time, but this is the last chance to make a baby. A lifetime choice.” And I agreed. So we did it again, using what would have been the down payment for our home.

The financial strain is another burden that inevitably comes with the territory. “This is a financial as well as a time commitment, which of course adds to the emotional burden the couple is already experiencing in dealing with infertility,” notes Andreyko. IVF can be a huge expense, the weight of which can affect any couple's relationship. It's important to check your insurance, and discuss with your doctor all the options that the facility offers.

“Fortunately, with continued advances in clinical and laboratory technologies, pregnancy rates are far better than they were even a few years ago, and they continue to improve,” says Andreyko. Alternative treatments can also be worth exploring – there is always hope for the hopeless. Acupuncture, egg donation, sperm donation, surrogacy and adoption offer viable solutions for infertility as well.

The economic reality is that treatment will cost a great deal, but the emotional reality is that you may wind up with what you seek so desperately – a baby. Or in our case, two. For us, the odds won out, and we were blessed with two energetic and healthy twin boys. And, go figure – eventually, we even got the house.

FERTILITY RESOURCES

California IVF Davis: Fertility Center , Inc.
1550 Drew Avenue, Suite 100, Davis
530-771-0177, californiaivf.com

Camellia Women’s Health

8735 Sierra College Boulevard, Suite 210, Granite Bay
916-486-0411, camelliawomenshealth.com

Folsom OB/GYN Medical Group
Jeffrey R. Cragun, M.D.
1735 Creekside Drive, Folsom
916-983-3500, folsomobgyn.com

Kaiser Permanente Center for Reproductive Health
1600 Eureka Road, Roseville
916-614-5005, kpivf.com/Roseville

Marshall Medical OB/GYN
1095 Marshall Way, Placerville
530-344-5470, marshallmedical.org

Northern California Fertility Medical Center
1130 Conroy Lane, Suite 100, Roseville
916-773-2229, ncfmc.com

Sutter Roseville Medical Center

One Medical Plaza Drive, Roseville
916-781-1000, sutterroseville.org

Sher Institutes for Reproductive Medicine-Sacramento
2288 Auburn Boulevard, Suite 204, Sacramento
916-568-2125, haveababy.com

UC Davis Fertility Center
2521 Stockton Boulevard, Suite 4200, Sacramento
916-734-6106, ucdmc.ucdavis.edu/fertility