Best of Tot Snob: Fertility Specialist Dr. Andy Huang

Dr. Andy Huang, M.D.

UPDATE: I first brought you this interview with Dr. Huang after Angelina Jolie was reported as having gone through IVF to conceive twins, Vivienne and Knox. Even though he did not treat her, his practice, Reproductive Partners was quoted in a US Weekly article. Since I knew him, I thought it would be interesting to ask him frequently asked questions and to clear up misunderstood facts about infertility. Since then, Dr. Huang is has become even more interesting to me because he has treated my sister who is now pregnant, after only one treatment of IUI! It is only fitting that this interview be brought back for Best of Tot Snob. =)

First of all, why did you get into infertility?

It’s the best job in the world. Partnering with couples to help create families. (That’s why we are “Reproductive Partners”) What could be better?

What is the #1 reason for infertility?

There is really no #1 reason for infertility. 40% of the time, it’s related to the male, 40% of the time it’s related to the female, 20% you can’t determine (unexplained).

Male factor has to do with the quality of sperm. Female factor can be associated with numerous reasons. This can include problems with anatomy, ovulation, or the quality of the eggs. Quality of eggs is most related to the natural process of aging. Women’s peak fertility occurs around age 22. Until age 32, fertility remains relatively stable. Even to age 38, changes are relatively subtle. After age 38 however, fertility begins to drop more noticeably. Unexplained infertility means there is not a specific reason found for the infertility.

There seems to be a lot more infertility issues these days? Why is that? Will eating more organic and using less microwave ovens and cell phones help?

More women and couples are deferring having their families until a later age. There is nothing wrong with enjoying personal time, but we often don’t realize that time is passing quickly. The lifetime chance of having a child at age 40 (70%) is significantly lower than that at age 30 (95%).

Increasingly, lifestyle issues have been shown to influence a couple’s fertility. This applies to both men and women. A healthy lifestyle minimizing and eliminating stress, nicotine, caffeine, and alcohol has been shown to improve a couples chances of conceiving. Less is known about microwave ovens, cell phones, and position. There is also a genetic component of a woman’s reproductive age. If your mom and grandmother transitioned to menopause early, you can anticipate a similar early transition to menopause and a shortened reproductive window.

Do you get a lot of women, like Angelina Jolie, without a history of infertility issues go in for IVF just to speed things up and make sure they get pregnant?

In our practice’s 20+ year history, we have seen everything. In general, IVF is used for the treatment of infertility for couples dealing with infertility and other reproductive/medical issues. In reality, every case is different, and we individualize treatment based on each couple’s needs. We really try to create a partnership with couples to achieve their goals. And no, we do not purposely try to achieve twins.

What are the risks of infertility treatment? You hear a lot about the hormones used in treatment to cause cancer, what are the facts relating to that?

The risks of infertility treatment are mainly associated with the risks of multiple pregnancies. Twin pregnancy is an acceptable result with a little added risk to the pregnancy. But triplets and more bear greater risks associated with prematurity, birth defects, and the mom’s health during pregnancy. There is no association thought to exist between the hormones used for infertility treatment and cancer. There is a small association between being infertile and cancer. Sometimes if the ovaries make too many eggs, some women can get Ovarian Hyperstimulation Stimulation Syndrome (OHSS) and become very sick. It is important to balance getting sufficient eggs and not causing undo risk to women.

What is OHSS?

OHSS occurs when the ovary swells as a result of the hormones used for infertility treatment. Symptoms include nausea and vomiting, severe bloating, and fluid accumulating in the abdomen. It is not cancer. OHSS goes away with time. Usually symptoms better in a few days with rest, but if pregnancy ensues, can persist for longer.

So do you discuss the possibility of terminating one or more of the embryos when there are multiples? Or is this too awful to contemplate?

We do recommend considering selective reduction with triplets or more. It is not an easy discussion to have with parents, but very important for parents to understand that they do have options.

Are there differences between IVF babies and naturally conceived babies?

No.

Can you 100% determine the sex of the baby through some sort of sperm sorting process? Or at least better than 50/50?

Microsort which our office offers can detect sperm for males to 73% accuracy and sperm for females to 88% accuracy. The only method that is virtually 100% is Preimplantatiion Genetic Diagnosis (PGD) which can be used in conjunction with IVF.

OK, you’re throwing out all these medical terms. What is PGD?

PGD is where you take one cell from an 8 cell embryo to detect specific genes. This can only be performed with IVF. You can use PGD to screen for heritable disorders like cystic fibrosis, chromosomal disorders like Down’s Syndrome, and gender selection. After screening the embryos, we simply place a few of the desired embryos back into the woman’s uterus.

Women who have problems conceiving deal with a lot of grief and anger. How do you deal with the emotional aspect of your patients?

Studies show that the stress of infertility is comparable to the stress of being diagnosed with cancer. We sometimes suggest stress reduction programs, personal and couple’s counseling or acupuncture for stress reduction. Studies have shown that such programs can help to improve chances of conceiving.

We hear more about female infertility but how do you correct male infertility? What is the ratio between male and female infertility? Who has more issues?

In general for patients less than 40 years old, the cause of infertility is about 40% male factor, 40% female factor, 20% unexplained. With age, female fertility declines more rapidly than male fertility. After age 40, the ratio shifts more to the female. Male infertility can be treated by correcting medical issues, lifestyle changes, artificial insemination, or in the most severe cases, IVF with Intracytoplasmic Sperm Injection (ICSI).

Please explain how ICSI works.

ICSI is where you take a single sperm and inject it into the egg to achieve fertilization. In general men’s sperm quality decreases with age, but not sufficiently enough to detect a difference in their fertility, so sperm from a 70 year old man can still be used to achieve pregnancies.

What is the success rate of infertility treatments?

This is age and program dependent. At our program, in 2006 women under 35 years of age had a 54% chance of livebirth per cycle of IVF. Those 35 – 37 years of age had a 50% chance of delivering a child. Between 38 – 40 years of age, the chance decreased to 32%.