The following are commonly asked questions from patients at our fertility clinics. While this list is very detailed and is a great resource, you may also find more detailed questions and answers on our discussion boards, or the IVF Authority blog authored by Dr. Geoffrey Sher. In addition to seeing questions, you can post question on the discussion boards, or directly to Dr. Sher who will review the question for inclusion on his blog.
Q: What is infertility?
A: Infertility is defined as the inability to conceive after a year of unprotected intercourse (six months if the woman is over 35). The term “infertility” is very broad and not necessarily related to a specific medical condition. If you fall into this category, you should seek the help of a fertility specialist to diagnose the cause(s) and discuss treatment options.
Q: Is infertility a common problem?
A: It is estimated that 10-15% of women of childbearing age have trouble conceiving.
Q: Is infertility just a woman’s problem?
A: The causes of infertility are fairly evenly divided between men and women. Approximately 40% of infertility cases can be traced to the woman, 40% to the man, and the remaining 20% are a combination of male/female factors or “unexplained.”
Q: What causes infertility in men?
A: Typically male infertility is caused by problems with the sperm – either the quantity or the quality. The root cause can be hereditary/genetic, or the result of an injury or illness.
Q: What causes infertility in women?
A: There are many factors that can lead to infertility in women. These include ovulation problems, blocked or damaged fallopian tubes, egg quality, egg quantity (ovarian reserve) and uterine conditions that hinder implantation of the embryo.
Q: How long should women try to get pregnant before calling their doctor?
A: If a couple is trying to conceive and has been unsuccessful for a year (6 months if the woman is over 35), they should consult with a fertility specialist to formulate the best course of action.
Q: What kind of infertility testing can I expect?
A: There are a wide range of tests that can be performed to diagnose infertility and determine the best course of treatment. They include blood tests that measure hormone levels, ultrasounds that examine the ovaries, tests that image the fallopian tubes and pelvic cavity, and blood tests that measure immune factors that can affect embryo implantation. Each of these tests are explained in greater detailFertility Tests for Women
Q: How do doctors treat infertility?
A: If the diagnosis is comprehensive and accurate, your physician will address each of the affecting factors. This may involve bypassing the fallopian tubes with In Vitro Fertilization, surgery to remove ovarian cysts or endometriosis, simple intrauterine insemination, ovulation induction using fertility drugs, or, in the case of male fertility, direct injection of sperm into an egg to induce fertilization. The key to success is individualizing treatment based on a patient’s personal diagnosis and circumstances. You can find extensive information on infertility treatments here.
Q: What are the risk factors for infertility?
A: Certain factors increase the likelihood of infertility. These include advancing age (beyond 35 years), the presence of Polycystic Ovarian Syndrome (PCOS), endometriosis, smoking, excessive alcohol or drug use, prior miscarriage, a history of autoimmune disease such as psoriasis, Celiac disease, or Diabetes Mellitus Type I.
Q: What are the signs and symptoms?
A: Each cause of infertility has its own signs and symptoms. In general, the main red flags indicating potential infertility are failure to conceive after a year of trying, difficulty staying pregnant, recurrent miscarriage, irregular or painful periods.
Q: How can I find an infertility specialist?
A: It is important to find a fertility specialist that demonstrates medical expertise and excellence, makes you feel comfortable, inspires confidence, and respects your feelings and opinions. Don’t be afraid to consult with multiple fertility specialists until you find one that is right for you. The administrative staff and nurses are also an important component of your treatment, so you should feel comfortable and confident in them as well.
Q: Can my OB/GYN treat me?
A: Most Ob/Gyns don’t have the advanced training in infertility that Reproductive Endocrinologists (RE’s) have. Board Certified RE’s are required to complete a residency in Obstetrics and Gynecology AND an additional three-year fellowship in Reproductive Endocrinology and Infertility, so they have extensive knowledge and experience beyond an Ob/Gyn.
Q: Does the position chosen for intercourse affect fertility?
A: No, the position doesn’t generally make a difference in conception (assuming intercourse is vaginal).
Q: What are some of the specific treatments for male infertility?
A: If the root of the infertility is a quantity/count problem, that is, if not enough sperm is present, IVF with Intracytoplasmic Sperm Injection (ICSI) can assure that the egg is fertilized and that it develops over the first 5 days after fertilization. If a man has no sperm in the ejaculate, an attempt can be made to retrieve sperm cells directly from the testicle by a process known as Testicular Sperm Extraction (TESE). This process uses a needle to extract a tissue sample from the testicle, then the sample is examined under a microscope for live sperm. If even just a few sperm cells can be found, they can be used to fertilize the partner’s egg(s), often just as successfully as conventional fertilization.
If the root of the fertility problem is sperm quality (motility, morphology), IVF with ICSI can help by selecting the “best” sperm and injecting it directly into the egg. Some improvements in sperm quality have been observed through the application of a regimen of oral antioxidants over a period of six months. In some cases, quality improves enough to induce a natural pregnancy.
Q: Can you find out earlier if you have fertility issues?
A: There are a number of tests that can be done to gauge a woman’s fertility, even when she isn’t trying to conceive. In fact, undergoing periodic fertility evaluations is a good way for a woman to know her options when it comes to planning for her future. If she knows in advance that fertility may be a challenge, she can plan accordingly, seek out a specialist earlier, and adjust her time frame to compensate. The basic tests include the following:
- Blood FSH, AMH. These simple blood tests give an indication of “ovarian reserve” or how many eggs a woman has left. Follicle Stimulating Hormone (FSH) is what prompts the ovarian follicles to develop. A high FSH level indicates that the ovaries are not responding as well as they once did, hence, more FSH is required to stimulate the ovaries. Antimullerian Hormone (AMH)
- Antral Follicle Count (AFC): This test is performed via vaginal ultrasound and visualizes the ovarian follicles – the chambers in the ovary where eggs form. The number of follicles gives an indication of how many eggs are present in a given month.
- Hysterosalpingogram (HSG). This is a test where dye is introduced into the uterus and an X-ray is used observe the flow of dye through the fallopian tubes. It can identify obstructions, abnormalities and blockages that may keep the eggs from making it to the uterus or attaching to the uterine wall after fertilization.
Q: Is your IVF laboratory accredited?
A: All of our embryology labs undergo a rigorous accreditation and licensing process that assures that we have proper clinical, health, and procedural precautions in place. Accreditations have to be renewed on an ongoing basis, so our labs are continuously monitored for quality control.
Q: What increases a man’s risk of infertility?
A: Many cases of male infertility are caused by genetic or hereditary factors, so having a family history of male infertility can be a risk factor. In addition, other external factors can increase a man’s risk of infertility – injuries to the groin/testicles, illnesses such as mumps, presence or history of sexually transmitted diseases, smoking, alcohol or drug use, exposure to toxins such as pesticides and other chemicals, radiation therapy for cancer treatment, excessive heat exposure (hot tubs or extended use of laptop computers), or activities that cause trauma to the groin like bicycle or horseback riding.
Q: What is assisted reproductive technology (ART)?
A: Assisted Reproductive Technology is a general term that refers to advanced medical treatment that assists in conception/reproduction. It refers to procedures including Intrauterine Insemination, In Vitro Fertilization, and all related diagnostic and preparatory procedures and treatments.
Q: How often is assisted reproductive technology (ART) successful?
A: Success rates can vary greatly depending on the type of procedure and who performs it. IVF success rates average around 40% nationally. This can be much lower for women over 38 years of age, or those with complex diagnoses.
Q: What are the different types of assisted reproductive technology (ART)?
A: ART procedures include In Vitro Fertilization and associated processes including administration of fertility medications, egg retrieval, fertilization of eggs, and embryo transfer. It also includes Intrauterine Insemination, and related procedures.
Q: Do Insurance Plans Cover Infertility Treatment?
A: Most insurance plans don’t offer coverage for advanced infertilty treatment such as IVF or IUI. Certain employer plans include an option for infertility coverage which may be based on the number of IVF or IUI attempts, or on a lifetime dollar maximum payout. Currently, 15 states mandate that employers offer some degree of infertility benefits in their health insurance plans. Mandated benefits range from multiple attempts at IVF, to medications, to IUI only.
Q: What medicines are used to treat infertility in women?
A: Fertility medications fall into several categories. The first are medications that regulate or induce ovulation by triggering the release of certain hormones. The most widely used of these medications is clomiphene citrate (Clomid or Serophene). Clomiphene is taken orally. Next are injectable hormones including Follicle Stimulating Hormone (FSH), which increases the number of eggs produced by the ovaries; Luteinizing Hormone (LH) and Human Chorionic Gonadotropin (hCG), which induce ovulation; and Gonadotropin Releasing Hormone (GnRH), which triggers the release of LH. At the beginning of an IVF cycle, a Gonadotropin Releasing Hormone Antagonist (GnRHa) is typically given to keep the patient from ovulating during stimulation. In addition, progesterone and estrogen may be used to prepare the uterus for embryo transfer and implantation. Your fertility doctor will prescribe a specific regimen of medications and you will be given a detailed calendar that will guide you through the administration of the medications on a daily basis.
Q: What impact does infertility have on psychological well-being?
A: Since infertility and the accompanying diagnosis and treatment process can cause anxiety, stress, insecurity, feelings of inadequacy and loss, it can often take a severe emotional and psychological toll on a couple. When dealing with infertility, couples should make sure they have a support system in place and openly discuss their concerns. Professional help and counseling is available to those dealing with the anxiety related to infertility.
Q: What if my eggs don’t fertilize?
A: The normal fertilization rate for IVF using intracytoplasmic sperm injection (ICSI) is approximately 70-80%. If an abnormally high percentage of eggs fail to fertilize, there is likely an egg quality issue, which may be due the protocol of ovarian stimulation, genetic factors, or timing of the egg retrieval. Failure of a large number of eggs to fertilize is a strong indicator that you should reevaluate your approach with your doctor. Unfortunately, if no eggs fertilize, your cycle will be cancelled.
Q: What are my options if I decide not to use my stored embryos?
A: When a couple undergoes IVF and has embryos left over, they have three basic options:
- Have the clinic discard/destroy the embryos.
- Donate the embryos to a research facility or clinic for research purposes.
- Donate the embryos to another couple for use in IVF.
The decision is usually a tough one for couples that have struggled to have a baby – often for many years. For some, donating them to another couple raises the prospect of having biological children being raised by another couple – people they may or may not know. There is also the issue of whether it will be an “open” or “closed” embryo donation/adoption. In an open adoption, the couple that donates the embryos will have the opportunity to meet the child(ren) born to another couple using their embryos. This may be emotionally tough for the couple to deal with. For other couples, donating the embryos for research may be the best resolution, while some may find discarding the embryos the most fitting solution.
Q: What if I don’t respond to the drugs for ovarian stimulation?
A: If you were taking clomid and didn’t respond, your doctor might start you on injectable medications or recommend that you undergo IVF. If you are not responding well to your injectable IVF medications,your doctor may prescribe new drugs, or increase the dosage, depending on the circumstances. Ultimately, failure to respond to fertility medications can cause your IVF cycle to be cancelled.
Q: What is a surrogate?
A: In an IVF context, a surrogate is a woman who carries a baby for another couple. This typically happens when a woman is not able to carry a baby on her own – either because of problems with the implantation of an embryo, or because of physical problems or limitations that make it dangerous or impossible to maintain a pregnancy. They are referred to as gestational surrogates or gestational carriers. A surrogate can be a friend or family member of a couple, or can be found through a surrogacy agency or private channels. There are many legal issues involved in gestational surrogacy, so a contract is usually drawn up using an attorney that specializes in surrogacy.
Q: How is egg donation different from surrogacy?
A: Egg donation is a process whereby a woman provides her own eggs to another woman/couple, who for a number of possible reasons, hasn’t been able to conceive using her own eggs. The reasons can range from age related egg quality problems to absent or non-functioning ovaries, to genetic disease or defects. The woman who wishes to donate her eggs undergoes a regimen of fertility medications to stimulate her ovaries to produce multiple eggs. She then undergoes an egg retrieval where the doctor extracts the eggs from her ovaries via a hollow needle. In most cases, egg donation is managed by an agency who screens prospective donors for physical, psychological, and health issues, and maintains a database of donors that is made accessible to women/couples interested in donor eggs.
Surrogacy is the process of carrying a baby for a woman that is unable to successfully carry a baby on her own. See prior question on surrogacy.