An Interview with Dr. Hugh D. Melnick Author, The Pregnancy Prescription
What is the most common cause of the failure to conceive, in apparently normal couples?
The most common cause is genetic abnormalities which occurs in the embryo when the egg and the sperm meet. At the time of fertilization, the combination of the chromosomes form each, more often than not, goes awry. As a result, the genetic blueprint for the development of a perfectly formed baby is flawed. consequently, a fertilized egg will become an embryo and grow for a short period of time, but will not become a viable pregnancy. Most often, a woman will get her menstrual period normall and not be aware that conception had occurred!
Don't most people believe that the major problem is that the egg and the sperm just don't meet?
This belief is only true in cases in which a woman's Fallopian tubes are blocked or when the male's sperm count is either of very low count or has poor 'swimming ability'. However, in most cases, each month that a woman produces an egg and has sex at the proper time and pregnancy does not occur, there is a chromosomal (genetic) problem with the embryo that is responsible for the failure of conception.
In your book, is this what you refer to as Nature's critical role in the process of conception?
That is exactly correct. "Mother nature's" role in the survival of every species on this planet is to insure that each and every offspring born is healthy enough to survive to the point that is able to produce its own offspring. In scientific terms, thisphenomenon is known as natural selection. Through genetic control mechanisms in every embryonic life form, only those offspring that are chromosomally perfect are born.
Are you saying that since nature ultimately controls conception, couples have very little control over their ability to conceive?
That is absolutely correct! If, from a fertility point of view, they are "normal", the only thing that a couple can control in the reproductive process is to have sex once during a 72 hour window of fertility that occurs each month.
Do you believe that good health, a healthy diet, vitamins and reduced levels of stress will aid in conception?
Unfortunately not, since conception is based entirely upon genetic perfection of the embryo. Contrary to logic and popular belief, many unhealthy women are very fertile! A "healthy" diet and vitamin supplements seem to me to be unnecessary, since, in areas of the world plagued by famine, conception still occurs regularly, although the health of these babies can be compromised by poor prenatal nutrition. With regard to stress, women conceive under the most stressful circumstances; in war zones, prisons and after rape. The truth is that conception is ultimately governed by nature and couples, as well as fertility specialist, have little control over the process of conception!!!
What about those "infertile" people who conceive after years of trying on a vacation or after adopting a baby? Why were they able to conceive, against all odds?
Approximately 3% of infertile couples who adopt will conceive after they adopt a baby. Such conceptions are sufficiently rare enough that no causative relationship between the two events can be established. As for couples who miraculously conceive after years of trying, their conception resulted from a rare genetically perfect egg that had been fertilized and gave rise to a chromosomally perfect embryo. In such couples, who have long-standing unexplained infertility, the presence of good quality eggs in their ovaries is extremely rate and therefore, the monthly probability of conception is in the range of 1% to 3%. Since their monthly probability of conception is clearly not 0%, couples just never know when that perfect egg will be produced.
In your book, you describe the "Success-Oriented" approach to conception. How does this approach differ from the Diagnostic-Oriented approach that has been used traditionally?
The truth is that, aside from the most obvious causes of infertility, the problems causing the failure to conceive, in most cases, are undetectable, since they occur on the cellular or molecular levels. Therefore, in the Success-Oriented approach, we rule out the three most obvious causes of infertility - lack of ovulation, blocked fallopian tubes, and sperm problems. This is done with three simple, painless tests and can be accomplished during one menstrual cycle. Should the woman not be producing eggs, fertility medications are used to make her ovulate regularly, until conception occurs. If there is a mild male factor, a simple procedure called intrauterine insemination is used, in which the male's activated sperm specimen is placed high inside the woman's uterus, very close to the egg. This procedure is much like a pap smear. finally, if the fallopian tubes seem to be the problem, or the sperm count is extremely low, In Vitro Fertilization is used. In intermediate cases of unexplained infertility, intrauterine insemination, combined with fertility drugs to produce several eggs each month (instead of the usual single egg) provides multiple targets for the sperm. What we are doing is helping nature by producing many eggs, in the hope of getting the genetically perfect egg that is required to produce a pregnancy! Should the process be unsuccessful, treatment with IVF is recommended.
Is IVF a painful and difficult procedure?
Now days, the process has been made much more "patient-friendly". The entire procedure is usually performed on an out-patient basis. Injectable fertility medications are now given with a tiny needle, just like insulin, but can be given in such a way that only one daily shot is needed. the egg retrieval procedure is virtually painless, performed with a very safe anesthetic agent and rarely takes more than 10 minutes to complete. The embryo transfer is basically like a pap smear or an intrauterine insemination and does not require anesthesia.
What is the most important advice would you offer infertile couples?
The most common difficulty is advanced maternal age of today's couples. People are marrying much later, in their mid to late thirties, and are well past their time of prime egg genetic quality.
What can be done when a woman's egg quality is too poor to produce a pregnancy or when a woman has a premature menopause?
These situations are much more common than would be believed. Fortunately, most of these women can conceive by using eggs donated by a very young woman. These egg are fertilized using the husband's sperm and the embryos produced are transferred into the older woman's uterus. She, then, would carry and deliver the baby and would be its legal and biological mother (but not the genetic mother). The practice of egg donation is more common than would be believed today. Most women will, rightfully, not disclose that they have used donated eggs. However, whenever an older woman, in their forties, conceives, especially with twins, they probably used donatedeggs. Why I point this out is that many women in their thirties, with egg quality issues, seeing older women conceiving with donated eggs, but believing their conception to have happened naturally, are made to feel unnecessarily inadequate and defective.
What advice can you impart to women desirous of preserving their fertility?
Most women come to me in their late thirties or early forties, asking to preserve their eggs. By then, it is way too late. The American Fertility Society advises against any form of cryopreservation, unfertilized eggs or embryos, after the age of 36. My best advice is to start trying to conceive as soon as possible and do not wait more than six months of unprotected intercourse to do basic fertility testing, which is neither painful or costly.