For fertility nurse Teresa Majers, NP, RN, empathy is natural when providing treatment, but what patients at Carle Clinic Reproductive Medicine in Urbana, Ill., may not know is that this compassion was born out of her own struggle with infertility.

Majers was diagnosed with endometriosis at 22. She married eight years later, but was unable to conceive after a year of trying. She used fertility drugs for a year, then finally stepped onto the roller-coaster ride of in vitro fertilization.

The first four IVF attempts failed, but on the fifth try, she conceived Patrick. Three attempts later, she conceived Nicholas. In the end, she and her husband had shelled out about $30,000 to have their two sons.

This experience is one reason why Majers understands patients who make radical decisions to deplete their 401(k)s and mortgage their homes in their effort to become pregnant using assisted reproductive technology. She is one of many nurses who staff the growing number of infertility clinics throughout the United States.

Between 1989 and 1999, the number of babies born per year using assisted reproductive technology mushroomed from 4,800 to 31,000, and the number of clinics offering these services more than doubled, according to the Society for Assisted Reproductive Technology.

And nurses are claiming a range of posts throughout the infertility field. Some, such as Majers, work in clinics that offer treatments such as IVF, while others facilitate matches between egg donors and their recipients. Still other nurses work primarily in counseling programs to help couples navigate the emotional land mines that infertility can create.

Majers credits an ob/gyn doctor with introducing her to the infertility field. After graduating from nursing school, she started working in an ob/gyn unit, where this physician took an interest in her and suggested she study to become a nurse practitioner. After earning her NP, the physician recommended that she explore the infertility specialty.

"I fell in love with it," Majers said. "It's like a big puzzle. Often, couples feel so out of control, and it's important to show them they can be proactive and have a sense of control."

When patients arrive, Majers works with a doctor to determine the cause of infertility, which usually is one of three things: a hormonal problem in the woman that interferes with functions such as ovulation, an anatomical issue, such as a defect in the uterus or fallopian tubes, or a sperm problem in the man.

The most frequent cause of infertility, Majers said, is a hormonal abnormality in the woman, and the treatment plan she typically suggests is to start with oral drugs that stimulate ovulation. This costs between $1,000 to $1,500 per cycle and results in pregnancy about 20 percent of the time at her clinic, she said.

If this method fails, she'll often suggest a more expensive drug, such as Gonadotropin, a hormone that helps women ovulate. This drug has to be injected and costs about $3,000 per round. The chance of pregnancy using this method is about 25 percent to 30 percent, she said.

If a couple fails to conceive after several rounds of these less-invasive treatments, Majers said the next option usually is IVF. The advantage of this method is that it has the highest chance of resulting in pregnancy-40 percent. But it requires injected drugs, frequent trips to the doctor and a procedure to retrieve the egg.

If the doctor is able to retrieve more than one egg during the initial procedure, the physician can attempt to fertilize all the eggs and store extra embryos that aren't transferred to the woman's uterus. This allows a couple to make additional attempts to conceive without requiring another egg retrieval procedure.

Emotional investment

Although the majority of the patients in her clinic eventually become pregnant, Majers said the most difficult phone calls to make are the ones in which she has to report failure in fertilization.

"It's very emotional," she said. "We cry with our patients. It's a sad moment, but it's important to come up with another plan."

M-Lyn Butterfield, MS, RN, specializes in one of these alternative options for couples. At the Family Fertility Center in Walnut Creek, Calif., she works in a program that provides couples with egg donors and, if needed, a surrogate mother.

She recruits egg donors and screens each one to find ideal candidates. Donors have to be 21 to 30 years old, have a good health history, take a personality test, pass a psychological test and undergo a face-to-face interview. Less than 10 percent of applicants are accepted. The pregnancy success rate in her program, Butterfield said, is about 60 percent, with 37 percent conceiving twins.

"I just think there's nothing more gratifying than helping someone build their family," Butterfield said. "You see how this alters people's lives in an earth-shaking way."

The majority of the women who come to her clinic to receive eggs are 40 or older, and their own eggs usually no longer are viable.

Like Majers, Butterfield has personal experience with infertility. She tried IVF four times, and each time the embryo wouldn't implant. At 43, she adopted a child and, two years later, decided to try again using a donor egg and sperm. By this time, technology had improved and made it possible for the embryo to attach.

While most fertility nurses work with patients in clinic settings, Amity Carriere's niche in the field helps patients in a more indirect way. Carriere, RN, works as a field training manager for Ivpcare, a Texas-based company that provides pharmaceutical drugs for infertility clinics. Carriere said infertility clinics often struggle to find pharmacies that carry the drugs needed by their patients. She had firsthand experience with this when she worked at Emory Clinic in Atlanta.

"I was so busy on a day-to-day basis making sure patients were having egg retrievals at the right time that it was hard to juggle that with helping patients find their medications at a pharmacy," she said.

Carriere teaches the sales representatives about the infertility field and develops training programs for nurses. One of these programs, for example, teaches how to instruct patients to inject themselves with infertility drugs.

Deidra Rausch, Ph.D., MSN, a licensed marriage and family therapist, also has pioneered a nontraditional path in the infertility field. She worked as a private nurse in reproductive endocrinology, but as the practice grew, she had less time to talk with patients.

She decided to pursue further education and open a counseling practice. About one-third of her patients cope with infertility.

After years of counseling couples, she's discovered that men and women usually have different coping mechanisms with regard to infertility. "Men often feel that their first concern is their wife's welfare," Rausch said. "They can put their own emotions on the back burner. And their wives often need someone to listen, and not someone to fix them."

For women, the inclination is to feel guilty if they are the source of the fertility problem. Even in this modern era in which many women pursue careers, Rausch said women's identities still are connected to having children, and infertility can be a painful blow to their confidence.

Rausch counsels couples to carve out time to talk about their feelings with one another. She suggests that they establish routine times to talk.

"Couples can set aside 10 minutes for each person to talk every night," she said. "If this time is defined, then they know they won't talk about it too much or too little."

She also tells couples who aren't able to conceive to be intentional in the way they grieve. For some, a formal ritual can be helpful, such as holding a funeral for the child that will never be or planting a tree.

"Too often, relatives and friends want to help them and say, 'Well, just adopt,' " Rausch said. "But there has to be a break between loss and what they try next."

She admits that one of the most difficult parts of her job is working with couples who would be wonderful parents, but simply are unable to conceive. But at the same time, offering hope to these clients is one of the most deeply satisfying parts of her job.

"I love helping couples see that, whether or not a child is conceived, you can be successful," Rausch said. "Success means staying married, adding new tools to cope with tough things in life and gaining a sense of appreciation for what is. It's very rewarding to see them walk through this journey."

Contact Heather Stringer at heathers@nurseweek.com.