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We realize that infertility treatment and the inevitable “waiting game” can be a cause of concern for our patients and those closest to them. That’s why we are here to help you every step of the way with patient education and other valuable resources. We believe that the more you know about the tests and treatments you will receive, the less worry and stress you will experience throughout your fertility journey.

Q. What is infertility?

A. Infertility is commonly defined as “not being able to get pregnant after one year of trying.” Experts often recommend that women who are older than 35 years and have not conceived during a six month period of unprotected sex should make an appointment with an infertility specialist. Women who do not have a regular monthly period should also consider seeing a reproductive endocrinologist because ovulation problems are the most common infertility factor in women.

Q. What causes infertility?

A. About one-third of infertility cases are attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, the inability to conceive is caused by a combination of issues in both partners.

Ovulation disorders are the leading cause of infertility in women. Anovulation (no ovulation) is a disorder in which eggs do not develop properly or are not released from the follicles of the ovaries. Women who have this disorder may not menstruate for several months, while others have periods even though they are not ovulating. Oligo-ovulation is a disorder in which ovulation doesn’t occur on a regular basis. With oligo-ovulation, menstrual cycles may be longer than the normal 24 to 35 days.  Other causes may include blocked fallopian tubes, abnormalities

Problems with sperm quality (concentration, motility and shape) are the most common infertility factors in men. These include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Another cause of male infertility is attributed to sperm cells that are malformed or die before reaching the egg. Sometimes, infertility in men is the result of medical issues, such as low testosterone and varicoceles.

Q. How long should women try to get pregnant before calling their doctors?

A. Most doctors advise women to try conceiving for at least one year. However, women aged 35 years or older should see an infertility specialist after six months of trying unsuccessfully because a woman’s chances of having a baby decrease rapidly every year after the age of 30. Since certain health problems may also increase your risk of infertility, women should also make an appointment with a reproductive endocrinologist if they have been diagnosed with endometriosis or pelvic inflammatory disease, or if they experience painful or irregular periods.

Q. How is infertility diagnosed?

A. A reproductive endocrinologist will conduct a physical examination of both partners to determine their general health and to evaluate any physical disorders that may be causing infertility. If no cause can be identified at this point, more specific tests may be recommended. For women, these tests include x-rays of the fallopian tubes and uterus, and laparoscopy. For men, initial tests will focus on semen analysis.

Q. How do doctors treat infertility?

Infertility can be treated with either medicine, surgery or assisted reproductive techniques—or a combination of treatments. Experts recommend specific treatments for infertility based on the factors contributing to infertility as well as the age of the woman.  A reproductive endocrinologist may recommend intrauterine insemination (IUI) or in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) to help overcome male factor infertility.

Q. What is assisted reproductive technology (ART)?

A. Assisted reproductive technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning the fertilized eggs or embryos to the woman’s uterus. The most common and most effective form of ART is in vitro fertilization (IVF).  IVF means “fertilization outside of the body.” Intracytoplasmic sperm injection (ICSI) is another common procedure indicated for couples with male factor infertility and for those with failed IVF attempts. In ICSI, a single sperm is injected into a harvested egg, as opposed to “conventional” fertilization where the egg and sperm are placed in a culture dish together and the sperm fertilizes an egg on its own.

Q. What is in vitro fertilization (IVF)?

A. IVF involves surgically removing a woman’s eggs from her ovaries and mixing them with sperm outside the body in a culture dish. After about 40 hours, the eggs are examined to see if they have become fertilized and are dividing into cells. Fertilized eggs are then placed directly in the woman’s uterus.

Q. Do insurance plans cover infertility treatment?

A. The degree coverage depends on where you live and the type of insurance plan you have.  Several states have laws that require insurers to cover some form of infertility diagnosis and treatment. Whether or not you live in a state with an infertility insurance law, you may want to consult with your employer’s human resources department to learn the exact coverage your plan provides.

Q. Should we have genetic testing?

A. Pre-implantation genetic testing is a technique in which one or more cells is taken from a fertilized egg for testing to provide information about the genetic make-up of the rest of the cells in that embryo. Testing typically takes place three days after the egg has been harvested and fertilized in an IVF laboratory. Experts recommend pre-implanted genetic testing for couples with several inherited diseases, such as a history of single-gene disorders (ie cystic fibrosis or sickle cell anemia) and or sex-linked disorders (ie Duchenne muscular dystrophy and Fragile X syndrome).  Genetic screening may also be indicated for those with recurrent pregnancy loss, severe male factor infertility or advanced reproductive age.