Questions and Answers
What should I expect at the first visit to the doctor?
You should anticipate a thorough history and physical examination. It is beneficial to have both partners present at this first visit to facilitate data gathering by the physician. This will also allow your partner to have her questions adequately answered in person.
What causes infertility?
- Age - As we age, it becomes more and more difficult to conceive. A woman’s fertility begins to decline in her late 20’s, while a man’s fertility does not start to drop until about age 35.
- STD’s - Sexually transmitted diseases cause scarring and other damage that can lead to infertility problems in both men and women.
- Reproductive Surgeries - Previous surgery of the reproductive organs can make it more difficult to become pregnant. Discuss any previous surgeries with your doctor.
- Medications - Some prescription medication can cause infertility. For example, in men, some drugs used to treat heart disease and high blood pressure can have detrimental effects on the sperm. Discuss all prescription and over-the-counter drugs with your doctor.
- Cancer Treatments - Cancer treatments such as chemotherapy and radiation can cause damage to the ovaries and testes. Discuss options such as sperm banking with your doctor.
- Environmental Factors - Environmental factors such as exposure to pesticides, herbicides, and industrial chemicals can effect sperm production. Prolonged or repeated exposure to heat, such as frequent use of hot tubs or saunas or wearing tight fitting clothing, can raise the temperature in the testes and effect sperm production.
- Other Causes - A number of other factors can cause infertility. Some of these are endometriosis, polycystic ovaries, and smoking. In other cases, the cause may not be evident.
How common is infertility?
The most recent estimates indicate infertility affects over 6.1 million American women and men, which represent 1 in 7 couples in their childbearing years.
Does infertility only happen to women?
While many people associate infertility with women, it actually occurs equally among both women and men.
What do we do now?
First, realize that infertility, in many cases, is treatable. While your Ob/Gyn can help you with an initial diagnosis of infertility, it is best to seek the advice of a fertility specialist called a Reproductive Endocrinologist (RE). An RE can provide you with testing and diagnosis, a comprehensive range of options, and appropriate “cutting edge” infertility treatments.
What type of tests can we expect?
Once you have decided to seek help from an infertility specialist you can expect a number of things. First, you will make an appointment with your infertility doctor for a consultation to discuss your condition. If you choose to proceed, you will complete a medical history and have a physical exam. Your doctor will then begin with a series of basic tests. Because infertility is a problem of couples, both the man and the woman will undergo testing.
The man will undergo a semen analysis. The women will undergo a blood test and ultrasound to help determine the condition of the uterus and ovaries, and if hormones are at the correct levels. After reviewing the results of these tests, your doctor may determine that further tests are needed. These tests will be discussed with you at that time.
How often should we have intercourse while trying to conceive?
Sperm can live 48 to 72 hours in a women's reproductive tract and can fertilize an egg at any time during this period. This is why sexual intercourse at least every other day around the time of ovulation is adequate.
What affects the ability of sperm to fertilize an egg?
Semen quality and quantity may impact the ability of sperm to successfully fertilize the egg. Sperm movement is an important factor. Even with a low sperm count, men who have highly mobile sperm may still be fertile.
Do all treatments for infertility involve "high tech" experimental procedures?
No. Many couples are successful in their attempts to conceive relatively simple and "low tech" procedures. Less than 5% of all couples pursuing treatment will undergo assisted reproductive technologies(ART). Most of the major ART procedures, like in vitro fertilization (IVF), are now established medical treatments and are no longer considered investigational or experimental.
How successful are treatments for infertility?
Improvements in medication, microsurgery, and in assisted reproductive technologies (ART) make pregnancy possible for a majority of the couples pursuing treatments. In particular, success rates have dramatically improved for couples who require ART, In many cases, the pregnancy rate for an ART cycle exceeds the monthly fertility rate for most couples. Talk to your healthcare provider about your specific case. Success rates vary from patient to patient and from situation to situation.
How can I find out if my insurance plan will cover infertility treatment?
Many insurers now offer coverage for the various stages of infertility treatment- from examinations and tests, to medical procedures and drugs. On top of that, more and more states are requiring that insurers include benefits in their policies.
It can be very helpful to know what your policy covers before you see a healthcare provider. Your coverage may dictate what kind of healthcare provider you see, the kinds of tests yo undergo, the sequence of the testing, and what treatments will be covered.
Look both at your medical coverage and at your prescription coverage. These are some of the things that can be helpful to look for:
- What is the definition of fertility in the contract?
- What coverage is listed?
- What procedures require Pre authorization?
- Are there restrictions on the type of healthcare provider that can perform fertility services?
- What limits, if any, apply to your coverage in terms of treatment cycles, procedures, months in therapy, ect.?
- Is there medication coverage?
- Are infertility medications covered under the pharmacy benefit or medical benefit?
- Are there prescription limits for infertility drugs?
Is ART considered experimental therapy?
For over a decade, IVF, egg donation, embryo cyropreservation, and intracytoplasmic sperm injection (ICSI), have been considered nonexperimental by the American Society for Reproductive Medicine (ASRM), the leading professional organization for reproductive endocrinologists and biologists in the U.S. Success rates are continually improving, and in many cases exceed the pregnancy rates expected for fertile couples.
Are there side effects associated with the use of hormonal therapies?
As with all prescription medications, side effects may occur with the use of fertility drugs. These products should only be prescribed by healthcare providers specializing in infertility or reproductive health. Fertility drugs can cause serious side effects including, ovarian hyperstimulation syndrome (OHSS), with or without blood vessel and lung problems, and multiple births. For complete product details about a specific fertility drug, please refer to the full prescribing information.
I am concerned about my job. How much time should I expect to miss if I have one of the surgical procedures?
The majority of the procedures discussed can be performed on an outpatient basis. The timing of return to work is variable, depending on the nature of the patient's work duties. Generally, even with the more invasive procedures described above patients are able to return to work within several days. There may be some activity restrictions for a few weeks, and these should be discussed on an individual basis with your physician.