Doctors always told Jackie Jacobs that her irregular periods were "no big deal." She believed them—until, at age 25, she wanted to get pregnant.

After a year of trying, Jacobs sought help from her obstetrician, who prescribed hormone pills. She felt like she had bad ]]>PMS]]> every day, not to mention hot flashes, bloating and extreme mood swings when she took the pills.

After a few unsuccessful, painful months, Jacobs switched obstetricians and both she and her husband underwent fertility testing. ]]>Male infertility]]> was ruled out, and her second doctor found multiple ]]>cysts]]> on her ovaries. She was referred to a fertility specialist—a reproductive endocrinologist (RE)—and began cycles of fertility shots, daily monitoring, and artificial insemination.

Rough on the Marriage

"It breaks your heart," says Jacobs, an emergency room nurse from Cincinnati. "You don't think you'll ever have kids, then you go through these treatments that totally mess your hormones up. You gain weight, you feel bad, and then you still don't get pregnant."

The devastation Jacobs felt each time she started her period, along with the hormone-induced mood changes, took a toll on her marriage. "I can't say we were actually going to get divorced," says her husband Eric. "But we weren't getting along very well."

"If we had stopped trying, our marriage would have been in really big trouble," adds Jacobs. "I would have always felt inadequate."

Risky Business

Conception, which finally happened after a successful artificial insemination, was not the magic cure Jacobs hoped for. She developed ]]>diabetes]]> and had to take four insulin shots a day; her ]]>blood pressure]]> rose dangerously high. She was hospitalized and put on bed rest for the last 12 weeks of her pregnancy, which ended early with a ]]>Cesarean section]]> .

Two years later, the nightmare had faded enough so that Jacobs underwent fertility shots and artificial insemination once again. When the techniques didn't work after three months, her RE recommended ]]>in vitro fertilization]]> (IVF). Though Jacobs didn't rule out this expensive option, she wanted a second opinion. What she discovered next might well have saved her life.

The Cause of Jackie's Infertility

The next RE she consulted saw the ring of cysts around her ovaries and diagnosed her with ]]>polycystic ovary syndrome]]> (PCOS), a condition that can pose serious health hazards, including increased rates of ]]>type 2 diabetes]]> , ]]>heart attacks]]> , and ]]>strokes]]> over the long term. Some doctors believe PCOS may also be one of the single largest causes of female infertility. At the recommendation of her RE, Jacobs tried fertility shots again, coupled with a technique to thicken the lining of her uterus to increase her chances of conceiving. Jacobs became pregnant after the first try, then ]]>miscarried]]> .

Help for Women With PCOS

Tired of the efforts and the pain, Jacobs and her husband decided to stop seeing fertility doctors, to stop worrying, and to start living. Then Jacobs saw a news story about a local researcher working with PCOS patients. Charles Glueck, MD, director of The Cholesterol Center at Jewish Hospital, was treating PCOS patients with Metformin, a diabetes drug he said would make them healthier, regulate their ovulation cycles, and improve their fertility.

Jacobs met with Dr. Glueck and started taking Metformin. The first month she took the drug, she ovulated and became pregnant. Against the initial advice of her obstetrician and RE, she continued to take Metformin. Though the drug's use during pregnancy is considered very controversial, Jacobs believes it helped keep her stable and healthy while she carried her daughter Audrey to term.

The Waiting Game

Like millions of couples each year, the Jacobses learned how emotionally and financially draining infertility can be. Between 10% and 15% of couples are infertile, according to Steven Nakajima, MD, an RE at the University of Louisville. They spend billions of dollars trying to conceive and often suffer heartbreaking setbacks. He says that couples shouldn't necessarily wait a full year before consulting a specialist.

Those who should seek early fertility help include women who:

  • Are 35 or older with no children
  • Smoke (regardless of age)
  • Have had previous reproductive surgery
  • Have irregular menstrual cycles

"What's important is to start early," Dr. Nakajima says.

Jackie Jacobs, who was told countless times that taking a relaxing vacation would help her get pregnant, agrees. "When you have a medical condition causing infertility, you can go on a relaxing vacation every weekend for the rest of your life, but you're still not going to get pregnant," she says.

Who Is Infertile?

Many doctors recommend that men be tested for fertility either before or at the same time as their female partners, in part because male testing is not as invasive as female testing, and in part because male-factor infertility is as common as female-factor.

About 30% of the women who can't conceive without the help of assisted reproductive technology (ART) don't ovulate, according to Dr. Nakajima. Others have blocked fallopian tubes or tubal damage from ]]>endometriosis]]> . A few have causes that cannot be identified.

Medicine and Technology

Thanks to technological and medical advances, most infertile couples today can eventually conceive. Men whose sperm won't naturally penetrate an egg can have it injected into the egg through a technique called Intra cytoplasmic sperm injection (ICSI). Women whose eggs can't develop into embryos can carry fertilized donor eggs to term. Men who produce very little sperm can have sperm extracted from testicular tissue and injected directly into a partner's egg. Although much attention has been paid to IVF techniques and test-tube babies, some fertility specialists find noninvasive medical breakthroughs just as exciting as their high-tech counterparts.

"We're getting away from patchwork approaches to look at the underlying abnormality," explains Mark Perloe, MD, who pioneered treating PCOS patients with diabetes drugs to increase their fertility and improve their quality of life. Dr. Perloe maintains that only a thorough evaluation of both partners can determine the most appropriate and least risky line of treatment.

Pregnancy at Any Cost

For patients struggling with the emotional highs and lows of infertility treatments, understanding is also essential.

"It's important for the people who are providing infertility care to realize that they're helping couples build families, not destroying the family that's already there," says Dr. Perloe. His center offers counseling and online support for all couples to help them focus on their child—not their pregnancy—as the ultimate goal.

Jackie Jacobs knows that after she started down the slippery slope of high-tech treatments, she would have stopped at nothing to have her first child, even if it meant spending tens of thousands of dollars on IVF or traveling around the world in search of special care.

"You get in the mindset that if you stopped, you would be giving up…and psychologically that would be telling yourself that you didn't even deserve kids."

Family First

Though they're still paying bills from their infertility treatments and joke that they've spent their son's college tuition on home pregnancy tests, the Jacobses think the hardships of infertility helped them discover the depth of their commitment to each other.