The National Infertility Association will recognize National Infertility Week later this month, from April 23-29, with the goal of empowering those who are struggling and changing the narrative when it comes to an issue that affects millions of Americans. Through various events and fundraisers, the organization aims to educate the general public and assist those facing barriers to starting a family.

Locally, Central Florida is fortunate to have many professionals in the field who are dedicated to the cause year-round. Orlando Family Magazine spoke to two of them—Dr. Milton McNichol of Fertility Center of Orlando and Dr. George Patounakis of Reproductive Medicine Associates Florida—to learn more about medical advancements and treatment options available.

Are there any recent advancements you are encouraged by and have you been able to implement these changes into your practice?

Dr. McNichol: “One of the things that’s been most interesting to me that I’ve tried to implement in our practice is understanding the importance of two factors that have been overlooked. One of them is the importance of good nutrition and antioxidants in the role of optimizing fertility. The second is the importance of the immune system and the role that it plays in overall success.

“There are other exciting options, including platelet rich plasma (PRP) infusion into the ovary, with the hope of rewinding the biological clock—turning back time, essentially. As of yet it’s unproven, but there is new and exciting data coming forth. PRP is an attempt to rejuvenate the ovaries and take someone who has limited capacity for reproduction and hopefully increasing that capacity.”

Dr. Patounakis: “In the past, people had to overcome the shortcomings in embryo culture by transferring more than one embryo at a time and doing it earlier, because you don’t know which one is going to be the best necessarily. By doing that, you can create a situation of twins or even triplets that is an unsafe situation for the pregnancy. But as research and technology have improved, we’ve found ways to narrow down which embryo is going to be the one that can result in a live birth. We only transfer one embryo at a time and that dramatically decreases the chance of twins and pretty much eliminates the chance of triplets. That is a huge part of making the treatment safer.”

Have IVF (in vitro fertilization) birth rates improved and do you believe they will continue to rise in the near future?

Dr. McNichol: “Yes. As we get more skilled with what we’re doing, I do believe there will be a gradual increase in the birth rates. When I trained back in the ’90s, success rates were in the low 20s. Now they’re in the mid-40s. Each year we’ll see small, incremental changes, but we don’t see the dramatic increases anymore, in large part because we’re now pushing up against the limits of laboratory reproduction in terms of egg quality and uterine receptivity.”

When is it a good time to seek treatment for infertility issues?

Dr. Patounakis: “One big determinant is age. Women under 35, if they’ve been trying for 12 months to become pregnant and it hasn’t happened, then it’s time to seek a specialist. If they’re over 35 and they’ve been trying for six months to become pregnant and it hasn’t happened, then they should also see a specialist. If there are any known issues of fertility such as irregular periods that don’t come every month, or if there’s a known issue on the male side of the equation, then they should be seeking the care of a specialist even sooner.”

Why is it important for both women and men to seek treatment?

Dr. Patounakis: “Often, the woman comes in and does all the testing but you can’t get her partner in here to do his part. Much of the time there is a male component, so without testing the man we don’t have a complete picture, and if we don’t have a complete picture then we can’t really help people as well.”

Is egg freezing a good idea and what are some reasons why a woman might be interested in the procedure?

Dr. McNichol: “I do think it’s a good idea and I’ll tell you one of the benefits. We talked about rewinding the clock with PRP; egg freezing is a way of stopping the clock. Fertility, unfortunately, is inexorably linked to the age of the female partner. As a woman gets older, her fertility goes down and it’s because of egg quality. By freezing her eggs, we’re able to stop the process. If she freezes eggs at age 28, then if she came back 10 years later at age 38, she would have 28-year-old eggs. The biggest problem to taking advantage of that is patient awareness. Unfortunately, the women who are most conscious of the need to freeze eggs are older women and they’re the women who benefit the least from it. Young women will benefit the most but they’re not in the frame of mind of doing it. … One of the current indications for egg freezing is in preparation for cancer treatment. Those women are usually keenly aware of that option. But we need to raise awareness for women doing it electively just to preserve their reproductive options.”