Common questions and answers related to Infertility
Did you know that the majority of our patients at NCCRM get pregnant without having to undergo in vitro fertilization (IVF)?
There is an assumption that if you go to a fertility clinic that you’ll have to do IVF to achieve pregnancy. Not so, at NCCRM. There are many reasons why a couple is not conceiving. And there are many treatments that can be done to solve various fertility problems in women and men that don’t require IVF. A consultation with our specialists can identify what steps need to be taken to uncover the reasons for infertility in a couple.
What is infertility?
Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. If you have been trying to conceive for a year or more, you should consider an infertility evaluation. However, if you are 35 years or older, you should begin the infertility evaluation after about six months of unprotected intercourse rather than a year, so as not to delay potentially needed treatment. If you have a reason to suspect an underlying problem, you should seek care earlier.
What are some common problems in women that can result in infertility?
Anovulation – Anovulation means lack of ovulation, or absent ovulation. Ovulation, which is the release of an egg from the ovary, must happen in order to achieve pregnancy. If ovulation is irregular, but not completely absent, this is called oligovulation. Both anovulation and oligovulation are kinds of ovulatory dysfunction. Ovulatory dysfunction is a common cause of female infertility, occurring in approximately 25% of infertile women. Click here for more information about anovulation and it can be treated.
Polycystic Ovary Syndrome (PCOS) – Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects 5-10% of women. Click here for more information about PCOS and how it can be treated.
Abnormal Body Weight – Obesity immediately brings to mind associations with hypertension, diabetes and heart disease. Yet, most people are surprised to learn that there is an association between obesity and infertility. Epidemiological data confirm that obesity accounts for 6% of primary infertility, and even more surprising, that low body weight in women accounts for 6% of primary infertility. Thus, 12% of primary infertility results from deviations in body weight from established norms, and that this infertility can be corrected by restoring body weight to within normal established limits. More than 70% of women who are infertile as the result of body weight disorders will conceive spontaneously if their weight disorder is corrected through a weight-gaining or weight-reduction diet as appropriate.
Endometriosis – Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region. Click here for more information on endometriosis and how it can be treated.
Fibroids – Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas, leiomyomas or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer. Fibroids that change the shape of the uterine cavity (submucous) or are within the cavity (intracavitary) decrease fertility by about 70% and removal of these fibroids increases fertility by 70%. Other types of fibroids, those that are within the wall (intramural) but do not change the shape of the cavity, or those that bulge outside the wall (subserosal) do not decrease fertility, and removal of these types of fibroids does not increase fertility. Click here for more information about fibroids and how they can be treated.
Medication Injection Lessons – click here to view videos on how to administer some of the more common fertility medications.
Common questions related to In Vitro Fertilization (IVF) and Pregnancy
Will the IVF technique damage my ovaries?
There is no evidence to suggest that either normal laparoscopy or ultrasound egg retrieval damages the ovaries. In fact, some reports in the medical literature suggest that following ovarian biopsy, pregnancies occur in couples with a long-term history of infertility.
Will scar tissue around my ovaries make it impossible to retrieve the eggs?
Not ordinarily. The surgeon must be able to see the follicles in order to guide the needle to the proper spot for retrieval of the eggs whether by sonographic (ultrasound) or surgical methods.
How many embryos do you transfer?
That depends on each patient and embryo quality. Our team at NCCRM will meet with you to make this decision. Ultimately, it is up to each couple.
What if I ovulate before oocyte (also called egg or ovum) retrieval?
Once ovulation has occurred it is impossible to retrieve the eggs. The entire team of physicians, nurse and embryologist will monitor your cycle very carefully to avoid premature ovulation.
If an egg is not retrieved or if the technique does not produce a pregnancy on the first attempt, how soon can the procedure be repeated?
This depends on the individual. The primary reason for delay is to allow the patient’s normal menstrual cycle to resume, which may take 2 to 3 cycles.
How many times will IVF be repeated per couple?
There is no specific number. This is determined by the couple together with the physician.
Can we have intercourse during the two-week period before an IVF procedure is performed?
Yes. We recommend that the husband refrain from ejaculation for at least 48 hours, but for no more than 5 to 6 days preceding egg retrieval. This precaution assures that the semen sample obtained for IVF will contain a maximum number of healthy, motile sperm. For those couples who have male factor issues, please speak with your IVF coordinator for more information.
After the IVF procedure, how long must we wait to have intercourse?
A: Although a definite time of abstinence to avoid damage to the embryo has not been determined, most experts recommend abstinence for two to three weeks after egg retrieval. Theoretically, the uterine contractions associated with orgasm could interfere with the early stages of implantation.
What about other activities? How soon can I resume my normal routine?
At NCCRM, our physicans recommend that the patient be sedentary for a full 72 hours following the transfer process. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities.
How soon will I know if I’m pregnant?
Pregnancy can be confirmed using blood tests about 14 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 to 40 days after aspiration.
I had my tubes tied (tubal ligation) several years ago. Would I be a candidate for IVF?
Yes. You may also be a candidate for tubal reversal surgery which we perform here at NCCRM. Depending on how your tubes were obstructed can determine the success of tubal reversal surgery. Our physicians will help determine the best course of action, IVF or tubal reversal.
Is IVF covered by insurance companies?
A: Unless your health insurance policy provides fertility coverage it is unlikely that IVF coverage is provided. Frequently, insurance policies will cover fertility diagnosis but exclude IVF. If, however, IVF is combined with surgical procedures used for diagnosis, insurance carriers may pay for much of the procedure. However, coverage will depend on the terms of your policy. For infertility alone, most insurance policies will not provide coverage. Our financial coordinators can help determine what your policy allows for treatment and medications.
What drugs are given to stimulate the ovarian follicles and to maintain the lining of the uterus prior to implantation of the embryo(s)?
Depending on your plan of care determined by the NCCRM fertility specialists, four to five medications normally are given: 1. Leuprolide acetate (Lupron), an injectable drug that blocks secretions of the pituitary gland, thereby optimizing the number of oocytes retrieved; 2. Human menopausal gonadotropin (Pergonal or hMG) or Follicle Stimulating Hormone (Metrodin or FSH), hormones that stimulate ovarian activity, are injected daily for about 6-10 days prior to the procedure; 3. Human chorionic gonadotropin (hCG), a hormone that mimics the action of the hormone which naturally induces ovulation, is injected 34 to 36 hours before retrieval and may be used after retrieval to supplement natural progesterone production; 4. Progesterone, a natural hormone that enables the uterus to support pregnancy, may be used as a daily injection after egg retrieval.
What side effects, if any, can these drugs cause?
No pronounced side effects have been associated with any of these drugs. However, the patient should inform the physician of ANY allergies she has or of any previous adverse reactions to drugs. Our staff at NCCRM monitors our patients very closely during their cycles to make sure they don’t experience hyperstimulation, which can happen when using follicale stimulatling hormones. We typically treat those patients in our office and, on occasion, in the hospital.
Will I have an egg in every follicle?
It varies from patient to patient . As many as half of the follicles may not contain an egg in some patients.
Is there a possibility of multiple births with IVF?
Yes, when multiple embryos are transferred 25% of pregnancies with IVF are twins. (In normal population, the rate is one set of twins per 80 births.) Triplets are seen in approximately 2-3% of pregnancies.
Is there an increased chance of birth defects if I become pregnant through IVF?
There are no known ill effects. Abnormal embryos, even those produced through normal fertilization, do not seem to mature. However, any long-term effects of IVF remain to be determined.
How much time does the entire IVF procedure require?
Approximately three to six weeks (all as an outpatient). Fertility drugs are administered to stimulate the ovaries. Then during the four to ten days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels.
What happens to any extra embryos?
Patients will have several options regarding the disposition of the remaining embryos. One option is to freeze embryos for your later use. Other options are to donate or simply dispose of them. Excess embryos, if any, belong to you, and you will determine what is to be done.
Will I need a high risk OB because I conceived with an IVF procedure?
A high risk OB is only needed when there are complications that put the mother or baby at increased risk, or in the case of multiple births. Other than a higher incidence of multiple births, IVF does not increase the risk to the baby.
Is there a higher miscarriage rate for IVF patients?
The miscarriage rate is about the same for IVF as the general population. Many times older females undergo IVF and their miscarriage rates are naturally higher. Since pregnancy testing is done two weeks after embryo transfer, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed in the general population.
Am I depleting my store of eggs by undergoing IVF?
A woman is born with a full complement of eggs. There are far more eggs than will ever be used during a normal lifetime and IVF procedures have no measurable “lowering” effects.
How much does IVF cost?
At NCCRM, the cost varies depending if you qualify for our shared risk plan and on how much medication you will need for stimulation. Please look at the financial page of our website to see a breakdown.
What can be done to improve sperm quality?
Sperm quality on the day of egg retrieval is often related to what happened in the male’s body 3 months ago. This is because sperm development takes 3 months. Listed below are guidelines to help ensure the semen specimen is of the best possible quality.
- A fever of 101 degrees Fahrenheit or higher within 3 months prior to IVF treatment may adversely affect sperm quality. Sperm count and motility may appear normal, but fertilization may not occur. If you become sick during the IVF cycle, please notify the nurse, and take Tylenol to keep your temperature below 101 degrees Fahrenheit.
- Keep the use of alcohol and cigarettes to a minimum before and during IVF treatment. Do not use any “recreational” drugs.
- If any prescription medication has been taken during the last 3 months, notify the IVF nurse.
- Do not sit in hot tubs, spas, Jacuzzis, or saunas during or 3 months prior to the IVF cycle.
- Do not begin any new form of endurance exercise during or 3 months prior to the IVF cycle. Physical activity at a moderate level is acceptable and encouraged.
- Avoid all testosterone, DHEA, and Androstenedione/Androstanediol hormone containing supplements.
- Tell your infertility physician if you have ever had genital herpes, or suspect you may have been exposed to genital herpes in the past. Also tell your physician if you have pre lesion symptoms, develop a lesion, or have healing lesions before or during the IVF cycle.
- Refrain from ejaculation for 2-3 days, but not more than 5 prior to collecting the semen sample for the IVF cycle. The IVF nurse will have your specific instructions from the embryologist.
Can being over weight affect my chances of conceiving?
Yes. Obesity has reached epidemic proportions in this country, with 31 percent of white, 38 percent of Hispanic, and 49 percent of African American women considered overweight or obese (2002 Statistics). Obesity is defined as a body mass index (BMI) greater than 30kg/m2 while overweight is defined as a BMI of 25 –30 kg/m2. (Calculate your body mass index here.) Obesity has been linked to multiple medical problems including infertility. Infertility in obese and overweight women is primarily related to ovulatory dysfunction. Read more.
The information provided within this website is not intended as medical advice. It should never be substituted for a consultation with a healthcare professional. Please contact your physician or visit NCCRM with questions or concerns about your health condition.