HERSHEY, Pa. — When Jess Hammaker and her husband, Justin Baer, of Mechanicsburg, got married in 2020, they knew they wanted children — but not at that moment, they said. The couple, both in their early 30s, had their wedding delayed by the COVID-19 pandemic, and Hammaker was completing her nursing degree. But by 2022, they had been trying to conceive for a year and the pregnancy tests stubbornly returned a single line month after month. It was time to investigate.
“My husband and I had a lot of lab work done at Penn State Health, and everything came back normal,” Hammaker said. “Dr. [Stephanie] Estes gave us two options — either try intrauterine insemination (IUI) or jump straight to in vitro fertilization (IVF).”
The couple chose the recommended three rounds of IUI with no success before moving on to IVF. After two rounds of ovulation stimulation and an egg retrieval, they had six viable embryos. One transfer failed, but the next was successful, and their son Miles was born.
Fertility issues are common
Stephanie Estes and Samantha Butts, reproductive endocrinologists at Penn State Health, said that fertility issues are common, though not widely acknowledged. The American Society for Reproductive Medicine estimates that infertility affects 10% to 15% of heterosexual couples.
Reproductive endocrinology addresses disorders of the menstrual cycle and reproductive function in both men and women. Butts said that while her practice primarily sees heterosexual couples struggling with fertility, they also treat other patients, including people interested in becoming single parents using donated sperm or eggs, same-sex couples and people who need help with fertility preservation.
Although IVF is the most intensive fertility treatment, Estes said there are many steps people can take before that to spur ovulation. These include several oral medications and injectable treatments, along with healthy lifestyle choices like a healthy diet, regular exercise and quitting smoking.
For some patients, more advanced interventions may be needed, Estes said.
“We try to optimize success and get the balance of risks and benefits with each type of intervention, but we also have to look at the diagnosis,” Estes said. “If someone has low or no sperm, IVF is the only option. If they have normal sperm, tubes and eggs, we generally start with three rounds of ovulation induction with IUI.”
If IUI doesn’t prove successful, Estes said, as in Hammaker’s case, IVF offers the best chance for a successful pregnancy.
Depending on the patient’s situation, providers will act sooner in some cases, Butts said.
“If you have polycystic ovarian syndrome (PCOS) and you only ovulate three times a year, I’m not going to ask you to try for a year,” Butts said. “We have to look at your diagnosis and take steps from there.”