Our patients have many questions about infertility and fertility treatments. In addition to the information provided on our website, we hope this list of frequently asked questions helps expand your understanding of infertility. Please consult with our doctors for information that is specific to your personal situation.
Infertility is a disease of the reproductive system (male or female) that impairs the body’s ability to conceive a baby. Conception depends on many factors, such as the production of healthy sperm and healthy eggs. Blocked fallopian tubes may prevent sperm from reaching the egg. The sperm may be unable to fertilize the egg. A fertilized egg (embryo) may be of insufficient quality. A woman’s hormones may not be adequate to sustain a pregnancy. These, and many other reasons, may be the root cause of infertility. Our doctors will help determine why you are infertile, and help you overcome these obstacles to pregnancy.
How is Infertility Treated?
Approximately 85% of fertility patients are treated with therapies such as conventional drug treatments or surgical repair of reproductive organs.
At what time during the month am I most fertile?
In general, “Day 1” is the start your menstrual period. Around “Day 14,” you release an egg (ovulation) and experience a luteinizing hormone (LH) surge. you are most fertile around this time frame, and it is recommended that you have intercourse so that sperm will be waiting in the Fallopian tube when the egg arrives. The egg is viable for 24 hours. Some women, however, may ovulate earlier, later or not at all. Ovulation patterns can vary month to month, and getting your period does not necessarily mean you are ovulating.
How can I tell if I'm ovulating?
In general, if you have regular and predicable cycle, then you are ovulating. If you are unsure, your doctor may instruct you to take your basal body temperature every morning to determine when you ovulate. Your doctor will ask you to record the results on a chart for three (or more) months. You can also buy an ovulation predictor kit.
How often should we have intercourse?
Having intercourse every other day during ovulation is recommended. Each woman ovulates at a different time, but in general, days 10, 12, 14, and 16 are optimal. We do NOT recommend that you use lubricants or douche before or after intercourse while trying to become pregnant, as this may decrease your chances of conception. You can use an ovulation predictor kit to help time intercourse with ovulation.
Does taking birth control affect fertility?
In general, birth control pills do not affect fertility. Within one to two cycles after stopping birth control pills, you should be ovulating. Exceptions are women who do not have a regular cycle and regular ovulation.
What's the difference between urine pregnancy tests and blood tests?
Urine tests depend on your hydration level and are less dependable than blood tests. An early pregnancy could be missed with a urine pregnancy test, but may be detected by your blood levels.
Does egg quality decrease with age?
At this point in medical science, the most reliable test for egg quality is a woman’s age. Age increases the likelihood of chromosomal abnormalities. The quality of your ovarian reserve can affect the probability that an embryo will implant. Although we do not currently have a test for egg quality, we can test the egg supply with ovarian reserve testing.
What is an ovulation predictor kit?
There are many brands that indicate if ovulation is occurring, for instance, the Clear Blue Easy kit. We recommend you begin testing around day 12.
When should we see a fertility doctor?
If you are older than 35 and have been trying for 6 months, or if you have been trying to conceive for a year or more and are under 35, you should visit a fertility specialist. See your OB/GYN immediately if you are over the age of 30 and have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or if your partner has a low sperm count.
How is infertility diagnosed?
When a couple is unable to conceive, or a woman is unable carry a child to term, it is time to consult a specialist. Both partners will undergo physical exams to determine their health and uncover any physical disorders that may be causing infertility. Both partners are interviewed to establish if their intercourse practices are helpful for conception.
What are the types of fertility testing?
Woman can expect blood tests to check reproductive hormone levels, such as estradiol (E2), progesterone, follicle stimulating hormone (FSH), anti mullerian hormone (AMH),luteinizing hormone (LH), thyroid hormone, prolactin, and possibly male hormone levels. In addition, Hysterosalpingogram (HSG), an x-ray, or a Saline Infusion Ultrasound (also called a Sonohysterogram or SHG) may help determine if the fallopian tubes are open and the appearance of the uterus and ovaries are normal. Males undergo a complete semen analysis.
How long does the treatment last?
For Intra-uterine insemination (IUI), expect the process to last for about two weeks, during which time your ovaries will be stimulated to produce follicles. Ovulation will occur, followed by insemination. For in vitro fertilization (IVF), treatment can last four to six weeks prior to egg retrieval. The embryos are then transferred three to five days later.
We will see you until you are 8-9 weeks gestation. At your last ultrasound appointment, will will encourage you to make an appointment with your OB. Most OB’s will want you to see you in their office between 8-13 weeks so that they undertake first trimester testing. You can sign a form allowing us to release your blood results to your OB.
What resources are recommended for learning more about fertility?
What are the most common male infertility factors?
1.) Azoospermia (no sperm cells are produced), 2.) oligospermia (few sperm cells are produced), 3.) sperm cells may be malformed or die before they can reach the egg, and 4.) less commonly, male infertility may be caused by genetic diseases such as cystic fibrosis or chromosomal abnormalities.
What are the most common female infertility factors?
1.) Ovulation disorders, 2.) blocked fallopian tubes, 3.) other problems caused by pelvic inflammatory disease or endometriosis may cause female infertility, 4.) women who have birth defects, 5.) women who have congenital abnormalities in the structure of the uterus, and 6.) uterine fibroids that may cause miscarriage. More specific tests may be required, such as an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy.
What is In Vitro Fertilization?
“in vitro” is Latin for “in glass.” Women who have blocked or absent fallopian tubes, or men who have low sperm counts, may be candidates for in vitro fertilization (IVF). This procedure involves the surgical removal of eggs from the ovary. The eggs are mixed with sperm in a Petri dish and examined after approximately to determine if they have become fertilized and are dividing into cells. These fertilized eggs (embryos) are placed in the women’s uterus (bypassing the fallopian tubes) in an attempt to achieve pregnancy.
“Mini In Vitro Fertilization is a more holistic approach to fertility treatment and causes less ovarian hyper-stimulation. It calls for lower doses of medication (or no ovarian stimulating drugs at all) and produces fewer eggs. Not all women are candidates. But for those women who respond poorly to standard methods and have a low number of eggs to work with, this option may be a reasonable alternative with a success rate similar to conventional IVF treatments. In these cases, it can be a cost effective option that simplifies the IVF option.
Since 1981, millions of babies have been conceived worldwide by Assisted Reproductive Technology (ART) procedures such as IVF, GIFT, ZIFT, or a combination various procedures. IVF currently accounts for more than 99% of ART procedures. The Society for Assisted Reproduction Technology reported in 2012 that more than 61,000 babies were conceived with the help of IVF in the United States.
Do Insurance plans cover infertility treatments?
The scope of overage for infertility treatments depends on your insurance plan and where you live. Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia have laws requiring that insurers cover or offer to cover some form of infertility diagnosis and treatment. Check with your insurance plan, talk to a representative, and check with your HR department.
How will you fertilize my eggs?
Most eggs are fertilized by in vitro fertilization after being placed in a culture with thousands of normal functioning sperm. If there are not enough normal sperm for IVF, then “intracytoplasmic sperm injection” or “ICSI” may occur, in which a single live sperm is injected into each egg. On rare occasions when these methods do not work, couples may opt to use donor sperm or eggs to achieve fertilization. A consultation with your fertility specialist will help you determine which approach is best for you.
How many embryos are transferred?
Every situation is different, many factors must be considered, and patient input is critical. Generally, anywhere from one to five embryos are transferred at one time. Women over 42 years of age, or woman who have had recurrent IVF failure, may elect to transfer more embryos.
What if I decide not to use my stored embryos?
You can donate your embryos anonymously (anonymous embryo donation) so that another woman can attempt pregnancy. You can donate your embryos to a woman you know (directed embryo donation). You can donate your embryos for laboratory research. Or you can ask that your embryos be thawed and discarded.
What if I don’t respond to ovarian stimulation?
Available eggs (ovarian reserve), appropriate hormone levels, taking medications properly, lifestyle choices and environmental factors all contribute to your response to ovarian stimulation. Consult with your physician about ways to improve your response to ovarian stimulation.
Should we have genetic testing?
Some couples choose to undergo preimplantation genetic testing (PGT) in which one or more cells is taken from an egg or embryo (fertilized egg) for testing to determine genetic make-up of the rest of the cells in that embryo. Patients with a history of single-gene disorders (such as cystic fibrosis or sickle cell anemia), or a history of sex-linked disorders (such as Duchenne muscular dystrophy and Fragile X syndrome), or who have inherited familial diseases, may opt to have genetic testing. Families in search of a bone marrow donor may be able to use PGT to bring a child into the world that can provide matching stem cells for an affected sibling.
Other patients may also decide to use genetic screening if they have experienced recurrent pregnancy loss, have severe male factor infertility, have advanced reproductive age, or recurrent IVF treatment failures. With genetic screening, the tests (which are considered by many to be experimental) look for abnormalities rather than a specific disease.
Do you only treat married couples?
We provide expert fertility medical treatment for married and unmarried couples, same sex couples and individuals.
How do we decide how many embryos to transfer?
We will discuss this with you when you sign consent form, but generally follow the guidelines of The American Society for Reproductive Medicine. These numbers may vary depending on your individual medical condition:
Under 34 years old = 1-2 embryos
35-37 years of age = 2-3 embryos
38-40 years of age = 3 embryos
What happens when I become pregnant?
You will return to the office for repeat blood work and an ultrasound to ensure an ongoing successful pregnancy. After a fetal heartbeat has been confirmed, patients are referred to an obstetrician for the remainder of the pregnancy.
If I am not pregnant, when can we try again?
Usually we ask that patients have two complete menstrual cycles before beginning another ART cycle.
Will I need a high risk obstetrician because I conceived with an art procedure?
ART does not increase the risk to your baby. A high risk OB is needed if there are complications that put you or your baby at increased risk, or if you are pregnant with multiples.
Is there a higher rate of miscarriage rate for art patients?
The miscarriage rate for art is approximately the same as experienced by the general population. Because pregnancy testing is done two weeks after embryo transfer, we usually know about spontaneous miscarriages in the earliest stages of pregnancy (which would probably go unnoticed in the general population).
As a future father, what can I do to improve the quality of my sperm?
Sperm development takes three months, and everything that happened in your body three months ago can affect sperm quality on the day of egg retrieval. Do not smoke, consume alcohol or take illegal drugs during ART treament. Do not sit in hot tubs, spas, Jacuzzis, or saunas. Do not begin any new form of endurance exercise. If you have a fever of 101 or higher, it may adversely affect sperm quality. If you become ill during the ART cycle, please notify us immediately and take Tylenol to keep your temperature below 101 degrees. Tell us if you have ever had genital herpes, or suspect you have been exposed to genital herpes. Also tell us if you have pre-lesion symptoms, develop a lesion, or have healing lesions before or during the ART cycle. Refrain from ejaculation for two to three days, but not more than days, prior to collecting the semen sample for the ART cycle.
Will ART deplete my store of eggs?
ART procedures have no measurable effects of depleting your egg count. You are born with more eggs than will ever be used during your lifetime.
Also visit our Glossary of Terms to help identify medical terminology, and our List of Acronyms to help you understand the abbreviations used.