Ask the Expert: Navigating Fertility

A couple’s path to parenthood

By Melissa Snider

“I remember thinking, It’s no big deal, we’re ready whenever,” recalls Jackson resident Deb Keenan.

Deb and her husband Peter always wanted to be parents. But when one of Keenan’s friends shared the news of her second pregnancy, Deb struggled to feel happy for her. Instead she was frustrated at not yet being pregnant herself. “You feel like your body has betrayed you,” she explains.

“Switching your mindset from ‘I don’t want to be pregnant’ to ‘I do’ is very abrupt and not natural to our species,” says Dr. Giovannina Anthony, M.D., an OB/GYN at Women’s Health and Family Care in Jackson. According to Anthony, 85 percent of women who are 35 or younger and who have no obvious reason to be infertile will conceive within 12 months, and an even higher percentage—95 percent—will conceive within two years.

Maternal age is the most common infertility factor Anthony sees in couples she treats. Thirty percent of couples have a male factor for infertility. Another 30 percent never discover a specific reason for their infertility. Some couples conceive a first child without issue but then can’t get pregnant or carry a second baby to term, a problem known as “secondary infertility.”

Infertility of any kind takes a physical, mental, emotional, and financial toll on couples. “A lot of couples have more than one issue,” says Anthony. “Fertility and the path to parenthood is unique to every couple—you have to consider all the pieces of the puzzle.”

The Puzzling Path to Parenthood

Doctors determine a couple’s risk of infertility by coupling the patient’s age with the time spent trying to conceive. A woman 35 or younger should visit her doctor after one year of unprotected sex without pregnancy. If she’s older than 35, the “trying” period shrinks to 6 months. An infertility workup involves a semen analysis of the male partner, ovulation verification of the female partner, evaluating hormone levels related to egg production, and checking for tubal disease. About 30 percent of patients under 35 will have no abnormalities and may receive an oral medication to recruit extra follicles (i.e. eggs), improving the chance of conception.

Jackson medical offices service patients with ovulation induction and intrauterine insemination (or IUI, aka “The Turkey Baster”). But if a couple needs or wants to pursue in vitro fertilization (IVF), their closest option for treatment is Idaho Falls. Many couples choose to visit specialized clinics in Salt Lake City, Bozeman and Denver who partner with local offices to provide some of their treatments in town.

If all of this sounds a little impersonal … it can be.

“There’s a typical path followed in Western medicine which involves a checklist,” says Whitney Fessler, owner of Grand Teton Acupuncture. “So many women turn into numbers.” That said, Fessler feels that practitioners in the Jackson community provide “a nice combination” of options. Fessler works closely with local doctors and is certified through the American Board of Oriental Reproductive Medicine. She digs in a little bit more and treats fertility issues with both holistic techniques and acupuncture. Fessler starts by evaluating the stress level of each partner, reviewing the couple’s blood work, and checking for obvious problems with hormone levels. Acupuncture may help regulate women’s menstrual cycles, increase blood flow to the ovaries, and, according to Fessler, increases IVF success rates 50 percent when used as a combined treatment.

Though many health practitioners focus on women’s fertility, everyone knows making a baby takes two. Nutrition therapy practitioner Tanya Mark of Tanya Mark Mind Body Nutrition stresses that both partners need to consider their diet. “The quality of the sperm and the egg can be hugely related to how you’re nourishing yourself,” she explains. Fessler also acknowledges, “Women have to go through so much—shots, pills, ultrasounds, poking, and prodding—they can feel a little resentful; and men can feel helpless if they’re not identified as an issue.”

An Invisible Roller Coaster

“The extremes are part of the challenge,” says Keenan. “You have a really crazy relationship with your cycle; getting your period feels like the worst … but also like a fresh possibility.”

Mark estimates that 25 pecent of her clients visit her for fertility issues. She encourages couples to look beyond nutrition and into lifestyle. “Take a look at your daily routine,” she says. “For most of us, it’s not relaxed and is over-the-top.” Citing Dr. Claudia Welch, author of Balance Your Hormones, Balance Your Life, Mark reminds us that our bodies will always prioritize our reserves of cortisol (the hormone released in response to real or perceived dangers). This takes precedence over the hormones needed for fertility and digestion. When we overproduce cortisol, it’s at the expense of progesterone, which normally helps keep estrogen in check. This can create a hormone imbalance and contribute to infertility. “It’s more than just your diet,” she says. “It’s how you’re nourishing your whole self, as a couple.”

“Fertility and the path to parenthood is unique to every couple—you have to consider all the pieces of the puzzle.”
– Dr. Giovannina Anthony, M.D.

In addition to stress reduction, Mark strongly recommends couples focus on food quality. The Environmental Working Group provides lists of the “Clean Fifteen,” conventional produce that is relatively free from harmful chemicals, the “Dirty Dozen,” produce treated with large amounts of chemicals and pesticides, and guidelines for quality proteins. Mark explains that it’s helpful if couples book an appointment with her approximately three months prior to trying to conceive so they can work together on the health of the couple. “Nutrition is a big piece,” she explains.

Fessler also mentions that partners can benefit from acupuncture treatments that regulate the body before trying to concieve. “[Using] herbs and acupuncture is sometimes enough,” she explains.

Riding a mostly invisible roller coaster while life goes on around you often causes couples to feel alone. “You can, very easily, start to isolate yourself,” says Keenan, who encourages couples to share their journey with close friends.

The Keenans ultimately opted for IVF and were devastated when their first two viable embryos stopped dividing the very morning they were scheduled for implantation. They grieved deeply over the loss of their potential pregnancy. “Everything—your marriage, your finances—becomes exhausted,” she says.

The Ultimate Question

Dr. Anthony’s primary question to any couples (especially those experiencing difficulty getting pregnant) is, “Do you want to be parents?” If their answer is “yes,” she reminds them of the many ways to achieve that goal. Through medical intervention, an embryo donor, or adoption, couples can go on to experience parenthood.

“Your fertility journey ends up being a magnifying glass—it intensifies your life,” says Keenan. After 3 1/2 years and two rounds of IVF, the couple celebrated the birth of their daughter on Mother’s Day 2014. Reproductive medicine made parenthood possible for them.

She offers one final piece of advice to couples who are just starting to research infertility treatment: “Don’t be afraid of what you don’t know. Be empowered by what you can know. And then ask yourself, ‘What is my courageous choice?’”


Adoption at a Glance

“Every single adoption is a relationship,” says Jackson resident Nicki McDermott.

She and her husband Brendan have two daughters they adopted through the Wyoming and Colorado Children’s Society (coloradocs.org). This organization, an evolution of the oldest nonprofit adoption agency in the state of Wyoming, provides pregnancy support services, domestic infant, waiting child, and inter-country adoption services in Wyoming.

On the road to adoption, the McDermotts first completed an extensive list of questions on “parenting philosophies.” Then they provided fingerprints, federal background checks, and financial information to prove they could support a child. Finally, an employee of the agency completed a home visit. Once approved, the McDermotts’ profile was shared with potential adoptive mothers.

The adoption agency spends a lot of time with birth parents. “From the very beginning, they’re trying to help the birth mother make the choice that’s right for her, and also do the right thing for the baby,” says Nicki. The birth mother decides whether she prefers an open, semi-open, or closed adoption, and is given twenty-four hours after the baby is born to officially relinquish her parental rights. Within six months after bringing a child home, the agency conducts another home visit before finalizing the adoption.

“If you’ve experienced infertility issues, you’ve already given in to the fact that so much is out of your control,” says McDermott. “You can’t control how long the [adoption] process takes and you can’t control whether a birth parent chooses you. So bring your very best self to the process and try to be patient. Every experience is really unique.”

Adoption Glossary

domestic adoption: The placement of U.S.-born babies for adoption
by their birth parents, who legally consent to both the adoption and the family of their choice.

waiting child adoption: The placement of children in need (often survivors of abuse and neglect) with capable forever families. These children are often “waiting” in foster homes and are considered more difficult to place based on their age or a range special needs, which can include keeping them together with siblings.

open adoption: The birth parent requests ongoing communication
and visitation with the adoptive family and child.

semi-open adoption: The birth parent desires to meet the
adoptive family and receive letters and photographs; identifying information is limited.

closed adoption: The birth parent doesn’t wish to meet or select
the adoptive family.