Frequently Asked Questions

Infertility means that you have had regular intercourse, for one year if you’re younger than 35 years old or six months if you’re older than 35 years, without birth control and have not become pregnant. Birth control includes birth control pills, diaphragm, condoms, or rhythm. Infertility is not the same as being sterile. Sterility is when you cannot get pregnant and the problem cannot be corrected. Fifteen to 20 percent of healthy adults have fertility problems. With help, many fertility problems can be treated.

This largely depends on your age. If you are less than 35 years old, it is reasonable to try for one year before getting a medical evaluation. However, as a woman ages, her chances of getting pregnant decrease, and an earlier evaluation is recommended.

• Age of woman - Less than 35 years old When to seek evaluation by an infertility specialist - After one year of trying
• Age of Woman - 35-40 years old When to seek evaluation by an infertility specialist - After six months of trying
• Age of Woman - Over 40 years old When to seek evaluation by an infertility specialist - Begin evaluation immediately

Other indications of infertility:

• Men and women who have concerns about their reproductive health
• Women who have had two or more miscarriages
• Women with irregular or painful menstrual cycles
• Women with endometriosis, uterine fibroids, or problems related to menstrual disorders

There are many causes of infertility. Often there are several infertility causes in one couple. These include:

• Male factor infertility
  In about 25-40 percent of couples, a problem with the sperm is the cause of the infertility. The problem may be the number of sperm, the shape of the sperm, or their ability to move effectively.
• Ovulation
  In 25-30 percent of couples, there are problems with the production of the woman's egg, or ovulation. This may be the result of an abnormality in the woman's ovary (such as polycystic ovary syndrome), or other hormonal causes.
• Tubal defect
  Infertility is caused by an abnormality of the Fallopian tubes, the tubes that connect the ovaries to the uterus, in 20-30 percent of couples. Tubal defects can be caused by scarring from previous surgery, infection, or a previous tubal ligation ("tying of the tubes").
• Unexplained infertility
  There is no obvious cause of infertility in about 10-20 percent of couples.
• Endometriosis
  This is a disorder in which pieces of the lining of the uterus implant themselves onto pelvic organs, including the Fallopian tubes, the ovaries, and sometimes even the intestines. This is the cause of infertility in 5-10 percent of couples.

Under normal circumstances, each month a woman develops a single egg that ovulates (i.e. is released by the ovary) and is captured by one of her Fallopian tubes. In the tube, the egg may be fertilized by a sperm. The newly formed embryo moves down the tube into the uterus where it may implant to establish pregnancy.

For a woman undergoing In Vitro Fertilization (IVF), each step of this process has been fine-tuned to augment her chance of pregnancy. The IVF process can be considered to involve 4 steps:

• Recruitment of multiple eggs from the ovaries using several different medications
• Collection of the eggs from the ovaries using vaginal ultrasound with the patient under light anesthesia
• The mixing of sperm and egg to facilitate fertilization while in culture
• The placement of the embryos into the uterus using a fine catheter (tube)

Watch the In Vitro Fertilization Class video on what you need to know about IVF and other fertility treatments, including length of treatment, medications, laboratory tests, and procedures.

IVF is the most commonly recommended therapy for patients who have been diagnosed with infertility. The treatment was originally designed for women with Fallopian tubes that are either blocked, severely damaged, or absent. In Vitro Fertilization is now also a therapy for patients with endometriosis, immunological infertility, cervical factor infertility and unexplained infertility. In addition, IVF is an excellent choice for couples with mild to moderate male factor infertility. One of the advantages to selecting IVF is that fertilization of the egg can be identified, and embryo quality can be assessed in the IVF laboratory. Such assessment may provide insight regarding possible causes of infertility and the direction of any future treatment.

Many factors may influence a couple's chance for success, including the age of the woman, the couple’s diagnosis, the quality of the sperm and the response of the woman's ovaries to medication. In addition, each phase of the IVF cycle may or may not be successful. For example, if the ovaries have a poor response to medication, few or no eggs may develop resulting in cancellation of the cycle.

Although exceedingly rare, problems may also arise during the egg retrieval—it may be technically difficult or impossible to retrieve the eggs. There is also a small chance that fertilization may not occur due to either sperm and/or egg defects. Furthermore, eggs may be retrieved and embryos obtained, but the embryos may be of poor quality and lack the ability to develop. Finally, embryo transfer may be technically difficult or impossible (extremely rare). The most common reason for failure in an IVF cycle is failure of the embryo(s) to implant within the uterus.

Most patients want to know the chance of taking home a baby after their IVF treatment. While this is an important statistic, it is also relevant to look at the number of pregnancies that involve triplets or more (high order multiple birth rate). Since these pregnancies involve risks to both the mother and the fetuses, IVF clinics strive to maximize pregnancy rates while minimizing the number of high order multiple pregnancies established. Therefore, when reviewing program statistics, the most important figures to assess are the percent of live-births per treatment cycle and the percentage of pregnancies with triplets or more.

We are a member of the Society for Assisted Reproductive Technology (SART) and report our success rates to the Center for Disease Control (CDC) on an annual basis.

Although you will be having daily injections, the majority of these injections will be subcutaneous. This means that the needle is very thin and short and causes minimal discomfort. Technique is a very important part of the injection. Discomfort is greatly reduced with proper technique.

We are committed to helping you develop proper technique. A nurse is available to meet with you and your partner to provide private injection teaching. You will be performing a return demonstration injection. The nurse will observe your technique and provide support and reassurance. When you leave the office, you will have the necessary skills and confidence to perform injections properly.

The IVF procedure (egg retrieval) is not painful, anesthesia is provided during the procedure and you will be monitored very closely to assure that you are comfortable. As with any surgical procedure, some postoperative discomfort is expected. However, most patients have minimal discomfort following the procedure. The most common complaint is cramping. An anesthesiologist and nurse are present to assess your comfort and provide you with any pain relief you may require.

There is evidence that postmenopausal hormone replacement increases the risk of breast cancer. Since premenopausal women make their own estrogen, there is no evidence at this time that use of fertility medications increases the risk of cancer or other medical illnesses. As the medications used for fertility treatments have been FDA approved since approximately 1970, it is possible that more years of use are required to see long-term problems arise.

Egg freezing is a fertility preservation option for women who may need to put parenthood on hold while they undergo cancer treatment or if they face other conditions that may harm their fertility. The first step involves taking injections of fertility medications for about two weeks to stimulate egg production (ovarian stimulation). Once tests indicate that eggs have developed in the ovaries, the eggs are removed by a fertility specialist using a small ultrasound guided needle.

Pregnancy and live birth rates using frozen eggs are excellent. As a result, in 2012 the American Society of Reproductive Medicine removed the experimental label for egg freezing. A woman’s eggs can also be fertilized with sperm from the male partner or sperm donor, using IVF, and frozen for future use, a process known as embryo cryopreservation.