If Lora and Ryan Jacobson didn't want to spend holidays with you or see pictures of your children, don't take it personally. It's likely you didn't understand what they were going through.

The Jacobsons had tried for a year to get pregnant on their own. When that didn't work, they turned to infertility treatments. The lack of success going that route led to Lora pulling away from many friends and family.

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"Those relationships and those bridges will never be built the same way. They didn't mean to pull away, and I didn't mean to pull away, but I didn't want to be around those people talking about their kids," Lora said. "I realize a lot of burned bridges were my fault, but it was my only way of coping."

Couple Not Alone

Dr. Carol Kowalczyk of the Michigan Center For Fertility and Women's Health in Warren, Mich., said that fertility treatments for patients are becoming more common.

"Two things are happening: Couples are getting older and waiting to have kids when they are more established professionally, and with getting older, there is more exposure to medical (and) environmental factors that have an impact, as well as lifestyle habits," Kowalczyk said. "Depending on the age, infertility affects 1-in-4 to 1-in-6 couples."

Deb Brown, a registered nurse with Obstetrics, Gynecology and Infertility in Minneapolis, said that medical advances have also led to more people looking for help, and that the innovations have also kept up with demand.

Doctors Being Proactive

Kowalczyk doesn't treat patients until after their regular physician has referred them to her, and she sends the patients back to their physicians after they get pregnant. She said that more primary care physicians are acknowledging infertility, which is a positive change.

"They are educating their patients and doing more appropriate intervention earlier," she said. "They are guiding patients to specialists earlier after what they're able to do doesn't work."

Kowalczyk said the standard definition of infertility is the inability to conceive after one year of trying. For patients older than 35, the standard is 6 months. After 40, she said, they should be seen "yesterday."

First Steps

Brown said that at her practice, physicians usually start with Clomid. According to WebMD, Clomid is an oral drug that stimulates an increase in the amount of hormones that support the growth and release of a mature egg.

One of the side effects of Clomid, which Lora said affects her to this day, is problems with night vision.

"Along the way, the doctors would say to me, 'It's not a matter of if, but when,'" she would get pregnant, Lora said. "I just figured it would be fine, but I would baffle them because I would get the worst reaction to drugs."

Next Steps

Both Brown and Kowalczyk recommended injection medications, but the ones Lora was giving herself didn't help and put her at risk.

Both practitioners also said a laparoscopic surgical procedure could be conducted to rule out problems such as endometriosis, which is when the tissue that lines the uterus, grows outside the organ and attaches to other organs in the abdominal cavity. The scar tissue can block the fallopian tubes or interfere with ovulation.

Doctors also may want to check into the health of the prospective father.

"If you look at the literature, (men) account for 30 to 40 percent (of infertility cases)," Kowalczyk said. "We definitely need a sperm analysis, which doesn't catch people off guard any more because the obstetrician is notifying the patients."

Cost A Factor

Lora said that any treatments beyond injections, such as in-vitro fertilization or sperm implantation, were too expensive for them.

"For the most part, insurances usually cover 80 percent, but the cost is definitely prohibitive when patients move on to IVF," Brown said. "I have only seen two or three insurance carriers cover this service, and it can cost upwards of $15,000 each time."

Kowalczyk said that she's seeing more insurance companies cover a portion of the infertility process, especially the more expensive options.

"What I recommend to patients is to look through your plan, and when you have choices and options, look at what covers fertility the best," she said. "The patient needs to educate themselves with the options every year (at open enrollment) when they're going through the process."

Emotional Toll

All the advances in technology and treatment don't add up to a 100 percent success rate, however.

After nine months of infertility treatments, Lora said that her body and her emotions couldn't take any more, so the treatments were stopped.

Kowalczyk said that she sees a range of emotions when people come to see her.

"We see a range. Some (see) a fertility specialist and are recharged, others dismayed," said Kowalczyk, who added her office has counselors on staff to handle the emotional well-being of the patients. "Most centers have counselors on their team so that they can be supportive of patients in this trying time. Most patients don't feel comfortable talking about infertility at a cocktail party.

"The counselors can provide stress management techniques to use with each other," she said. She added that all good specialists keep an eye on where patients are emotionally.

Final Step

The Jacobsons were present for the birth of their adopted son Jonah on June 4, 2006.

"Things are wonderful with Jonah," Lora said. "Looking back at all those things, I think a part of me will never heal, but I would do it all over again for Jonah. He's our perfect baby, and he didn't have to come from us to be that. All I know is that (infertility is) a silent killer of women. I felt like I was hurting all the time and people would have no idea. I know that there are women all over feeling the same way."