Erin Barreto, a pharmacist, reflects on years of infertility, resilience, healing and the joy of welcoming two children through IVF.

"It was a long, uncertain road filled with setbacks around every corner. When you had those moments of hope, you had to hang on to them."

Erin Barreto, Pharm.D., Ph.D., a Mayo Clinic pharmacist and now mom of two, spent nearly seven years navigating the complex path of infertility with the Reproductive Endocrinology and Infertility team at Mayo Clinic in Rochester. The team, comprised of approximately 80 staff members, was recently ranked in the top 10 in Newsweek's "America's Best Fertility Clinics" for the third year in a row. In the last five years, the division has helped welcome more than 1,000 babies into the world.

Erin chose Mayo Clinic because she trusted the data, believed in the success rates and knew that having access to top professionals delivering state-of-the-art care with compassion and empathy could offer hope when it was in short supply.

Though the journey included moments of loss, waiting and resilience, she and her husband, Jason (Jay) Barreto, Pharm.D., held onto the possibility of growing their family. 

Along the way, they had a chance to connect with Ali Ainsworth, M.D., the clinical director of in vitro fertilization in Reproductive Endocrinology and Infertility. 

"Dr. A saw us through it all — miracles and miscarriages," Erin said. "She knew how to advise us because she took the time to get to know us."

"I’m humbled to hear that," says Dr. Ainsworth. "Being part of Erin and Jay's story is a privilege I don't take lightly. Our work is so meaningful — hard and heartbreaking and meaningful." 

A journey marked by care and connections

Erin's journey through infertility opened her eyes not only to the medical demands of in vitro fertilization (IVF) but also to the emotional toll it takes. She found grounding in small rituals like wearing a special pair of wool socks to every egg retrieval, a procedure in the IVF process where mature eggs are collected from the ovaries using a thin needle guided by ultrasound.

Funded by a past Joy Project, the socks carried hopeful messages: IVF got hope. Lucky transfer socks.

Erin remembers putting the socks on before each egg retrieval, channeling all the good energy she could muster.

Support came from people, too — Mayo staff who cared for her not just as a patient, but as a person. 

Maria Lujero, a nurse in Reproductive Endocrinology and Infertility, held Erin's hand during her very first retrieval when she was scared and overwhelmed. 

"She was a relieving force. I will never forget it," Erin says. 

Chelsea Marquardt was a new nurse when Erin started her journey and helped her with medication counseling. This is an important part of the IVF process because the treatment involves complex, time-sensitive medications that patients often administer themselves.

"Chelsea has been a constant support the whole time. While I am a pharmacist, I wanted in that moment to be a patient, to trust that someone would help walk me through things." says Erin. 

Their connection, rooted in that early guidance and nurtured over time, reflects the kind of enduring support that shaped Erin's experience.

Mayo's shift toward a more holistic approach to care also made a difference for Erin, reinforcing her confidence in Mayo Clinic and her care team. 

Erin joined the Mind Body Fertility program led by Nicole Callahan, a nurse practitioner, where participants gathered to talk about the emotional side of fertility treatment. 

"I was further along in my journey when I joined the program, so it felt healing to give back and support others who were just beginning theirs," Erin says." It was rewarding to be a source of hope."

"We know that fertility treatment is more than just a medical process — it touches every part of a person's life," says Dr. Ainsworth. "Programs like Mind Body Fertility reflect our commitment to whole-person care. It's validating to know that patients like Erin have found benefit and support."

Lessons in resilience

There were hard lessons, too. Learning how to self-advocate came later to Erin than she wished. One especially painful experience involved hearing sensitive news in a clinical way, before she was ready and before Jay could be with her. 

In many care settings, results are often shared routinely — sometimes through the patient portal or in straightforward conversations. But over time, Erin realized she needed something more personal. 

"Seeing the Mayo number on my phone on days we were expecting test results was especially triggering. I would think to myself, 'They only call when it's something bad that they don't want to send through the portal.'"

"We talked to the care team and made a new plan. Jay would receive the call and gently share whatever news with me at a time that was right. That way, it wasn't one more thing for me to carry. I wasn't forever having to receive and transmit the news that was so often disappointing. I wish I had realized I needed that sooner."

This small change made a meaningful difference for both Erin and Jay. "Being met with compassion in those vulnerable moments changed how we carried the experience," she said.

Her advice to others considering IVF is heartfelt. 

"Be hopeful," she says. "Be excited. Find people who understand what you're going through. Build a support system, even if it's small."

The joy that waited

After three transfers — the final step in the IVF process, where one or more fertilized embryos are carefully placed into the uterus in hopes of achieving a pregnancy — Erin and Jay finally welcomed their first child, a daughter born during the pandemic. Later, after more heartbreak, their second child arrived. They named them Charlotte and Thomas.

Charlotte, now four, embraces her new role as big sister with delight.

"She calls him her 'baby guy,'" Erin smiles. "She'll say to him, 'Hi, it's Big Sis!' and it's the most magical thing." 

Thomas, just four months old, is beginning to smile, and hints of his personality are already starting to shine through. Erin is soaking in every moment.

"Having my children is the greatest blessing," she says. "In this phase of life, it's about sitting on the floor, doing puzzles and hearing my kids laugh. That's the best part. That's what we were waiting for."

The post ‘What we were waiting for’: Couple shares journey from infertility to joy appeared first on Mayo Clinic News Network.

So what are the effects of testicular cancer and its treatment on fertility?

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (0:59) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"When we first evaluate men with a new suspected testicular cancer, we do talk about fertility," says Dr. Bradley Leibovich, a urologic oncologist at Mayo Clinic.

Dr. Leibovich says it's one of the top questions he hears from men with testicular cancer: Can I still have kids?

"Men with testicular cancer have fertility concerns because the testicular cancer itself can impact fertility and our treatments can impact fertility. So the first thing we do with men that are interested in preserving fertility is talk about sperm banking," says Dr. Leibovich.

One side effect of surgery, chemotherapy, radiation and other cancer treatments can be infertility, which is why it's important for men who still want to have children after their cancer is cured to save their sperm before they start treatment.

"Fertility issues we normally address up front by assuring that men sperm bank, so it's rare that's a long-term concern for men," he says.

Another concern is lower levels of testosterone, a hormone produced primarily in the testicles.

"Most men have normal testosterone levels with just one testicle. For men that do wind up with a lower level of testosterone, it's really easy to replace," says Dr. Leibovich.

Under the guidance of a healthcare professional, testosterone replacement therapy, in the form of injections, pills, patches or gels, can restore normal testosterone levels in men.

The post Mayo Clinic Minute: Can testicular cancer affect fertility? appeared first on Mayo Clinic News Network.

Infertility is defined as trying to get pregnant (with frequent intercourse) for at least a year with no success. Female infertility, male infertility or a combination of the two affects millions of couples in the United States. An estimated 10 to 18 percent of couples have trouble getting pregnant or having a successful delivery.

Infertility results from female factors about one-third of the time and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.

Female infertility causes can be difficult to diagnose. There are many available treatments, which will depend on the cause of infertility. Many infertile couples will go on to conceive a child without treatment. After trying to get pregnant for two years, about 95 percent of couples successfully conceive.

Symptoms

The main symptom of infertility is the inability to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating. There may be no other outward signs or symptoms. 

Each of these factors is essential to become pregnant:

• You need to ovulate.
  To get pregnant, your ovaries must produce and release an egg, a process known as ovulation. Your doctor can help evaluate your menstrual cycles and confirm ovulation.
• Your partner needs sperm.
  For most couples, this isn't a problem unless your partner has a history of illness or surgery. Your doctor can run some simple tests to evaluate the health of your partner's sperm.
• You need to have regular intercourse.
  You need to have regular sexual intercourse during your fertile time. Your doctor can help you better understand when you're most fertile.
• You need to have open fallopian tubes and a normal uterus.
  The egg and sperm meet in the fallopian tubes, and the embryo needs a healthy uterus in which to grow.

Watch: Female fertility animation.

Journalists: Broadcast quality video is in the downloads at the end of the post. Please "Courtesy: Mayo Clinic News Network."

For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are:

• One of the two ovaries releases a mature egg.
• The egg is picked up by the fallopian tube.
• Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
• The fertilized egg travels down the fallopian tube to the uterus.
• The fertilized egg implants and grows in the uterus.

In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of the factors below.

Ovulation disorders

Ovulation disorders, meaning you ovulate infrequently or not at all, account for infertility in about 1 in 4 infertile couples. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovary, can cause ovulation disorders.

• Polycystic ovary syndrome (PCOS).
  PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's the most common cause of female infertility.
• Hypothalamic dysfunction.
  Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
• Premature ovarian failure.
  Also called primary ovarian insufficiency, this disorder is usually caused by an autoimmune response or by premature loss of eggs from your ovary (possibly from genetics or chemotherapy). The ovary no longer produces eggs, and it lowers estrogen production in women under the age of 40.
• Too much prolactin.
  The pituitary gland may cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility. Usually related to a pituitary gland problem, this can also be caused by medications you're taking for another disease.

Damage to fallopian tubes (tubal infertility)

Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

• Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections.
• Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops in a fallopian tube instead of the uterus.
• Pelvic tuberculosis, a major cause of tubal infertility worldwide, although uncommon in the United States.

Endometriosis

Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may block fallopian tubes and keep an egg and sperm from uniting.

Endometriosis can also affect the lining of the uterus, disrupting implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Uterine or cervical causes 

Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage:

• Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
• Endometriosis scarring or inflammation within the uterus can disrupt implantation.
• Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.
• Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.
• Sometimes the cervix can't produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.

Unexplained infertility

Sometimes, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it's frustrating to get no specific answer, this problem may correct itself with time. But, you shouldn't delay treatment for infertility.

Risk factors

Certain factors may put you at higher risk of infertility, including:

• Age.
  The quality and quantity of a woman's eggs begin to decline with increasing age. In the mid-30s, the rate of follicle loss speeds, resulting in fewer and poorer quality eggs. This makes conception more difficult, and increases the risk of miscarriage.
• Smoking.
  Besides damaging your cervix and fallopian tubes, smoking increases your risk of miscarriage and ectopic pregnancy. It's also thought to age your ovaries and deplete your eggs prematurely. Stop smoking before beginning fertility treatment.
• Weight.
  Being overweight or significantly underweight may affect normal ovulation. Getting to a healthy body mass index (BMI) may increase the frequency of ovulation and likelihood of pregnancy.
• Sexual history.
  Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected intercourse with multiple partners increases your risk of a sexually transmitted infection that may cause fertility problems later.
• Alcohol.
  Stick to moderate alcohol consumption of no more than one alcoholic drink per day.

Prevention

If you're a woman thinking about getting pregnant soon or in the future, you may improve your chances of having normal fertility if you:

• Maintain a normal weight.
  Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, exercise moderately. Strenuous, intense exercise of more than five hours a week has been associated with decreased ovulation.
• Quit smoking.
  Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
• Avoid alcohol.
  Heavy alcohol use may lead to decreased fertility. And any alcohol use can affect the health of a developing fetus. If you're planning to become pregnant, avoid alcohol, and don't drink alcohol while you're pregnant.
• Reduce stress.
  Some studies have shown that couples experiencing psychological stress had poorer results with infertility treatment. If you can, find a way to reduce stress in your life before trying to become pregnant.
• Limit caffeine.
  Research suggests that limiting caffeine intake to less than 200 milligrams a day shouldn't affect your ability to get pregnant. That's about one to two cups of 6 to 8 ounces of coffee per day.

When to see a health care provider sometimes depends on your age:

• Up to age 35, most health care providers recommend trying to get pregnant for at least a year before testing or treatment.
• If you're between 35 and 40, discuss your concerns with your health care provider after six months of trying.
• If you're older than 40, your health care provider may want to begin testing or treatment right away.

Your health care provider may also want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, prior cancer treatment, or endometriosis.

This article is written by Mayo Clinic Staff and can be found with other health and medical information on mayoclinic.org.

Related articles:

• Hypothyroidism and infertility: Any connection?
• Fallopian tubes: Is pregnancy possible with only one?
• Ovulation
• Causes of endometriosis
• Female fertility tips
• Tilted uterus: Can it lead to infertility?
• HSG test
• Ovulation signs

The post Women’s Wellness: Tests and treatments for infertility appeared first on Mayo Clinic News Network.

My husband and I have been trying unsuccessfully to get pregnant. I've seen many ads for fertility herbs and supplements. Do they work?

Infertility can be a difficult problem to treat, and modern interventions — while sometimes effective — can be expensive. So it's not surprising that some people look to herbs and supplements as a possible alternative treatment.

However, there's no evidence in the medical literature that supports herbs or supplements as a treatment for infertility. The research on so-called fertility herbs and supplements is inconclusive and based on a few small studies. Some of the fertility herbs and supplements studied include:

• L-carnitine.
  For male infertility, studies didn't show increased sperm production and motility in men who took a combination of acetyl-L-carnitine and L-carnitine.
• Vitamin E.
  One study found an association between taking vitamin E and improved sperm motility in men who had low sperm counts or poor sperm motility. Other studies found no improvement in male fertility when vitamin E is combined with vitamin C or selenium.
• Coenzyme Q10.
  A few studies have suggested that coenzyme Q10 may improve sperm counts or motility, but this was not shown to improve the chances of getting pregnant. Another study suggests that coenzyme Q10 may improve egg quality in mice, but study results haven't been confirmed in humans. More research is needed to determine whether such findings lead to improved fertility.
• Folic acid.
  Although some research suggests that folic acid taken with zinc may improve sperm counts, more research is needed to determine if this will have an impact on conception.
• Vitamin C.
  Some preliminary research indicates that vitamin C might help with certain types of female infertility. More research is needed to clarify whether vitamin C can improve fertility in men and women.

While herbal supplements are often marketed as "natural," this doesn't mean these products are safe. Consider these important issues about herbal supplements:

• They have limited Food and Drug Administration regulation.
  Herbs and supplements supplements are subjected to limited regulation by the Food and Drug Administration. The regulations are less strict than are those for prescription and over-the-counter drugs.
• They have a potential for drug interaction.
  Conventional hormone and drug treatments for infertility are complex. It's not known how herbs or supplements might interact with them.
• They can have potentially serious side effects.
  This is true especially when taken in larger doses. If you have side effects from a supplement you take, stop taking it and contact your health care provider.

Talk to your health care provider about herbs or dietary supplements you take or plan to take. Until researchers more clearly define the risks and benefits of fertility herbs and supplements, conventional treatment for infertility appears to be the best option.

The post Home Remedies: Can herbs and supplements enhance fertility? appeared first on Mayo Clinic News Network.

Infertility results from female factors about one-third of the time and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.

Female infertility causes can be difficult to diagnose. There are many available treatments, which will depend on the cause of infertility. Many infertile couples will go on to conceive a child without treatment. After trying to get pregnant for two years, about 95 percent of couples successfully conceive.

The post Women’s Wellness: Causes, tests and treatments for infertility appeared first on Mayo Clinic News Network.

Infertility is defined as trying to get pregnant (with frequent intercourse) for at least a year with no success. Female infertility, male infertility or a combination of the two affects millions of couples in the United States. An estimated 10 to 18 percent of couples have trouble getting pregnant or having a successful delivery.

Infertility results from female factors about one-third of the time and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.

Female infertility causes can be difficult to diagnose. There are many available treatments, which will depend on the cause of infertility. Many infertile couples will go on to conceive a child without treatment. After trying to get pregnant for two years, about 95 percent of couples successfully conceive.

The post Women’s Wellness: Infertility causes, tests and treatments appeared first on Mayo Clinic News Network.

ANSWER: Your irregular periods could be part of the reason you haven’t gotten pregnant, but that’s not necessarily the case. However, at the very least, it means you may have had fewer times when you could get pregnant. That makes it harder to time intercourse. For women in your situation, investigating a possible connection between irregular periods and infertility is a reasonable place to start. It would be a good idea for you and your husband to consult with a health care provider with expertise in evaluating infertility.

A couple is considered to have fertility issues if they have been trying to get pregnant for at least a year without success — or for at least six months if the woman is 35 or older. Infertility is common in the U.S. About 10 to 15 percent of people of reproductive age have problems with fertility.

Age can be a factor in infertility for both men and women. With women, it comes a bit earlier. Women tend to start experiencing fertility problems in their mid-30s to early 40s. For men, it tends to happen later in life, typically in the 40s and 50s. When the causes of infertility are broken down, about 40 percent come from men and about 40 percent come from women. In about 20 percent of cases, the problem involves a combination of factors that include both.

Difficulty with ovulation — which could be the source of irregular periods — accounts for infertility in about 25 percent of infertile couples. In some cases, hormonal disorders that affect the release of eggs from the ovaries are the underlying problem.

For example, polycystic ovary syndrome is a common condition in which the release of eggs from the small collections of fluid in which they grow, called follicles, is disrupted. Hyperprolactinemia, a condition in which the body makes too much of the hormone prolactin, also can interfere with ovulation. Too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility, as well.

A less common disorder is primary ovarian insufficiency, or POI. It involves the loss of normal ovarian function before age 40. Women who have primary ovarian insufficiency might have irregular or occasional periods for years. Other causes of irregular periods that could affect fertility include excessive exercise, eating disorders, injury or tumors.

Just because you have irregular periods, however, doesn’t necessarily mean you have one of these conditions, nor is the unpredictability of your menstrual cycles automatically the cause of your infertility. Although assessing the possible causes of irregular periods is typically a starting point for investigating infertility, there are various underlying conditions that could hamper your effort to get pregnant.

A thorough evaluation of you and your partner with a health care provider who has knowledge of infertility can help define what's going on and help you decide how to best move forward. Testing usually can identify the problem within several months, or sometimes an underlying cause of infertility cannot be found. The good news is that effective therapies are often available. Studies show that about 70 percent of couples who have dealt with fertility issues go on to conceive after receiving infertility treatment. — Dr. Elizabeth Stewart, Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q and A: Irregular periods, infertility not necessarily linked appeared first on Mayo Clinic News Network.

October is Breast Cancer Awareness Month. On the next Mayo Clinic Radio program, Dr. Karthik Ghosh, director of the Breast Diagnostic Clinic at Mayo Clinic, will highlight the importance of breast cancer screening and early detection. Also on the program, Dr. Elizabeth Stewart, division chair of Reproductive Endocrinology and Infertility at Mayo Clinic, will discuss causes of infertility and treatment options. And Dr. David Erasmus, medical director of Mayo Clinic's Lung Transplant Program, will explain lung restoration, which can make more donor lungs available for transplant.

Here's your Mayo Clinic Radio podcast.

The post Breast Cancer Awareness Month: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

October is Breast Cancer Awareness Month. On the next Mayo Clinic Radio program, Dr. Karthik Ghosh, director of the Breast Diagnostic Clinic at Mayo Clinic, will highlight the importance of breast cancer screening and early detection. Also on the program, Dr. Elizabeth Stewart, division chair of Reproductive Endocrinology and Infertility at Mayo Clinic, will discuss causes of infertility and treatment options. And Dr. David Erasmus, medical director of Mayo Clinic's Lung Transplant Program, will explain lung restoration, which can make more donor lungs available for transplant.

To hear the program, find an affiliate in your area.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Breast Cancer Awareness Month appeared first on Mayo Clinic News Network.

October is Breast Cancer Awareness Month. On the next Mayo Clinic Radio program, Dr. Karthik Ghosh, director of the Breast Diagnostic Clinic at Mayo Clinic, will highlight the importance of breast cancer screening and early detection. Also on the program, Dr. Elizabeth Stewart, division chair of Reproductive Endocrinology and Infertility at Mayo Clinic, will discuss causes of infertility and treatment options. And Dr. David Erasmus, medical director of Mayo Clinic's Lung Transplant Program, will explain lung restoration, which can make more donor lungs available for transplant.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Breast cancer awareness / infertility / lung restoration appeared first on Mayo Clinic News Network.