What is infertility?
Infertility is defined as a couple's decreased ability or inability to become pregnant and have children. Most experts consider a couple to be infertile if:
- The couple has not conceived after one year of unprotected intercourse and the woman is less than 35 years old;
- The couple has not conceived after six months of unprotected intercourse and the woman is over the age of 35;
- The woman is incapable of carrying a pregnancy to term.
What causes infertility?
Causes of infertility are different for every couple and there are many medical conditions that can lead to infertility. In women, infertility may be caused by ovulation disorders, blocked fallopian tubes, polycystic ovarian disease, endometriosis or genetically inherited problems. In men, infertility is most commonly a result of abnormal sperm production that could be affected by many things both environmental and genetic.
How common is infertility?
Infertility affects one out of six couples during their childbearing years.
When should a couple be evaluated for fertility problems?
Couples should seek help when:
- They have been trying to get pregnant for one year and the woman is under the age of 35.
- If the woman is over the age of 35 years, the couple should consider seeking help after six months of trying to get pregnant. After a woman reaches 35, fertility often declines quickly.
- Women with a history of pelvic infection, endometriosis or irregular cycles should also seek help sooner.
- Anytime a couple is worried about their ability to conceive.
What causes infertility in women?
Problems with ovulation or blocked tubes account for most cases of infertility in women. Without ovulation, there is no egg to be fertilized. When a woman's tubes are blocked, the sperm are not able to get to an ovulated egg and fertilization can't occur. Other conditions that can cause infertility are endometriosis, premature ovarian failure or the presence of fibroids or polyps in the uterus.
What things can increase a woman's risk of infertility?
Here are some common factors that may increase infertility in women:
- Age. A woman's fertility decreases with age. All women are born with all of the eggs that they will ever have. As a woman ages, so do her eggs. Over time, this causes the eggs to lose their ability to fertilize, implant and make a baby. All women's bodies age at different rates.
- Sexually Transmitted Diseases (STDs). Common STDs that can lead to infertility include chlamydia, gonorrhea, syphilis, HIV, genital warts, trichomonas and genital herpes.
- Smoking. Research shows that smoking is harmful to a woman's ovaries. Nicotine and other chemicals interfere with hormones that affect the growth and release of healthy eggs. While this damage cannot be reversed, stopping smoking will prevent further damage from occurring.
- Weight. Weighing too much or too little may affect a woman's hormone levels, which can cause irregular menstrual cycles and problems with ovulation.
What causes infertility in men?
Infertility in men is most often caused by issues with sperm quality:
- Producing too few sperm or none at all.
- Producing sperm that have very low motility or none at all.
- Producing sperm with abnormal shapes or structure.
- Genetically inherited traits that can affect sperm production or function.
- Abnormal sperm production as a result of illness or injury.
What things increase a man's risk of infertility?
The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may negatively impact sperm production or quality include:
- Drugs (prescription, over the counter, or recreational)
- Environmental toxins
- Radiation and/or chemotherapy treatment for cancer
What type of testing will be performed to evaluate my fertility?
An infertility evaluation usually begins with physical exams on both partners and a review of health and sexual histories. After an initial assessment, more specific testing is usually ordered to help diagnose the cause of infertility.
Female testing may include:
- Hormone level evaluation - Blood tests to measure hormone levels. These tests must be performed on specific days of the menstrual cycle to provide accurate results.
- Laparoscopy - This is a surgical procedure where a tool called a laparoscope is inserted through a small incision in the abdomen and allows the doctor to actually see the parts of the reproductive tract (ovaries, fallopian tubes and uterus) for evidence of disease or physical abnormalities.
- OB panel - This includes tests for the presence of a specific disease that can be fatal to a baby such as syphilis, rubella and varicella.
- Ovulation test kits - These kits are used on specific days of the menstrual cycle to determine if and when ovulation occurs.
- Sonohysterosalpingogram (HSG) - This procedure uses abdominal ultrasound to look at the uterus and to determine if the tubes are blocked. A small amount of sterile saline is injected into the uterus. If the tubes are not blocked, the fluid will move through the tubes and spill into the abdominal cavity.
Male testing commonly includes:
- Comprehensive semen analysis - This is a laboratory test that evaluates the concentration, motility and physical appearance of sperm.
- Depending on the results of a semen analysis, the doctor may call for a referral to a medical endocrinologist or urologist for additional testing.
How do doctors treat infertility?
Most infertility cases can be treated with conventional therapies, such as timed intercourse or surgical repair of the reproductive organs. Some patients will need or want to move up to intrauterine inseminations or assisted reproductive technologies. Doctors recommend treatments for infertility based on:
- How long the couple has been trying to get pregnant
- Overall patient health
- Patient age
- Previous failed treatment
- Patient preference
- Patient test results
What is timed intercourse?
Timed intercourse is often the first treatment attempt for couples that have a good semen analysis and structurally healthy reproductive organs. The doctor may prescribe drugs in order to stimulate the ovaries and help develop one or a few follicles that may contain eggs. Additional drugs can be used to induce ovulation at a specific time or an ovulation predictor kit is used to determine when ovulation has occurred naturally. Sometimes the doctor will want to perform an ultrasound to see how follicles are developing. This will determine the optimal time for a couple to have intercourse, giving the egg and sperm the best chance at meeting and resulting in a pregnancy.
What is intrauterine insemination?
With intrauterine insemination, the provider will stimulate your ovaries, as with timed intercourse, but at the time of ovulation the male partner will provide a semen specimen to our laboratory. The specimen will be processed in a special way and then introduced directly into the uterus using a specially designed catheter.
What is in vitro fertilization?
In vitro fertilization (IVF) is a procedure in which a woman's ovaries are stimulated with fertility medications to produce multiple eggs. The eggs are removed from the ovary and mixed with sperm in the laboratory. The embryos that result are cultured for several days in the laboratory and the best one or two embryos are transferred back into the uterus using a specially designed catheter. If more embryos develop than needed for transfer, they can be cryopreserved (frozen) for use at a later time.
Why do I have to fill out a questionnaire and provide my clinic and hospital information before I make an initial appointment?
Our new patient questionnaire gives our providers insight into any previous medical testing or treatments you may have had that could impact the best course of action to treat your infertility. It is better that we have the information ahead of time so the provider can review your history before your first appointment. This allows you and your provider to focus more on what your treatment options are and develop a plan and not waste valuable time reviewing your previous medical history.
Does my partner have to come to the first appointment?
We strongly recommend both partners attend the first appointment together. Causes for infertility can be due to issues related to the woman, the man, or both. As a result, we may have to prescribe testing and/or treatments for one or both of you. Having both of you at your first visit may allow us to move forward with your treatment more quickly.
How long is the new patient appointment?
The initial consultation usually lasts 45 minutes to an hour.
What are the earliest and latest times to schedule a new patient visit?
The earliest appointment can be scheduled at 7:30 a.m., and the latest at 2:15 p.m.
What is the cost of the initial consultation?
Will insurance cover any of this?
Insurance coverage is different for every patient. You can call your insurance carrier and ask them what your plan covers. After your first visit, we may have you talk to a Fertility Center financial advisor to assist you and develop a plan for payment.
What does the first visit entail?
The practitioner will briefly review your medical history and the information that you have filled out on your questionnaire with you, and then discuss what treatment options are available to you. Specific testing or procedures before your treatment begins may be recommended in order to give you the best chance of success. Your first visit will also give you time to ask questions.
If I have my menstrual cycle with my first appointment, can I get started right away?
This is a possibility, but it depends on what previous testing you have had performed, your age and other potential factors that could affect results over time. If you are on the first or second day of your cycle, it will allow us to order some tests right away that could help develop a treatment plan sooner.
Do I have to repeat tests that have already been done?
This depends on several factors, including the length of time since original tests were performed, your age and other factors that could affect the results over time.
How often do I have to come in for appointments?
This will depend on what treatment plan has been developed for you. There may be lab appointments, ultrasound appointments and appointments to discuss treatment options as your care progresses. Furthermore, as your treatment advances, the need to see you may change as well.
Are there any appointments or tests that I can do close to home so I don't have to keep making the drive?
This will depend on your treatment plan, the type of facilities available for testing and monitoring in your area, and the type of testing you will need. We will try to keep your travel to a minimum. You need to remember that in order to give you the best chance of success, our recommendation is to come to our Clinic.
What are the earliest and latest available times to schedule a semen analysis?
The andrology laboratory accepts specimens for semen analyses from 7 a.m. to 2 p.m., Monday through Friday. If it is not possible for you to schedule within that time, special appointments can sometimes be arranged if you call ahead of time to schedule.