Frequently Asked Questions About Infertility

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Q01: What is Infertility?

A: Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality.

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

Q02: What Causes Infertility?

A: No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.

The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

Q03: How is Infertility Diagnosed?

A: Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception.

If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis. 

Q04: How is Infertility Treated?

A: Most infertility cases -- 85 to 90 percent -- are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. 

Q05: What is In Vitro Fertilization?

A: In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes.

IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatment in the United States.

Q06: Is In Vitro Fertilization Expensive?

A: The average cost of an IVF cycle in the United States is $12,400. Like other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment, and the cycle may need to be repeated to be successful. While IVF and other assisted reproductive technologies are not inexpensive, they account for only three hundredths of one percent (0.03%) of U.S. health care costs.

Q07: Does In Vitro Fertilization Work?

A: Yes. IVF was introduced in the United States in 1981. Since 1985, when we began counting, through the end of 2006, almost 500,000 babies have been born in the United States as a result of reported Assisted Reproductive Technology procedures (IVF, GIFT, ZIFT, and combination procedures). IVF currently accounts for more than 99% of ART procedures with GIFT, ZIFT and combination procedures making up the remainder. The average live delivery rate for IVF in 2005 was 31.6 percent per retrieval--a little better than the 20 per cent chance in any given month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term. In 2002, approximately one in every hundred babies born in the US was conceived using ART and that trend continues today.

Q08: Do Insurance Plans Cover Infertility Treatment?

A: The degree of services covered depends on where you live and the type of insurance plan you have.  Fourteen states currently have laws  that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. HOWEVER, the laws vary greatly in their scope of what is and is not required to be covered. For more information about the specific laws for each of those states, please call your state's Insurance Commissioner's office or to learn about pending insurance legislation in your state, please contact your State Representatives.

Whether or not you live in a state with an infertility insurance law, you may want to consult with your employer's director of human resources to determine the exact coverage your plan provides. Another good source of assistance is RESOLVE, an infertility patient advocacy and information organization.

The desire to have children and be parents is one of the most fundamental aspects of being human. People should not be denied insurance coverage for medically appropriate treatment to fulfill this goal.

Q09: What impact does infertility have on psychological well-being?

A: Infertility often creates one of the most distressing life crises a couple has faced. The long-term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. Many couples experience anxiety, depression, and feelings of being out of control or isolated. For more information, view the FAQs About the Psychological Component of Infertility.

Q10: What if my eggs don’t fertilize?

A: Most eggs will fertilize when they are placed in a culture dish with several thousand normal sperm. This process is called “in vitro fertilization” or “IVF.” When there are not enough normal functioning sperm for IVF, fertilization will usually occur after a single live sperm is injected into each egg, termed “intracytoplasmic sperm injection” or “ICSI.” On rare occasions, fertilization does not occur even with ICSI, presumably because of a problem inherent to either eggs or sperm. In these cases, the use of donor sperm or donor eggs will usually result in fertilization. Your fertility specialist and IVF laboratory personnel will help you determine which approach is most likely to result in egg fertilization.

Q11: What are my options if I decide not to use my stored embryos?

A: If you have stored embryos that you have decided not to transfer into your uterus to attempt pregnancy, you have four options for their final disposition. First, you can donate your embryos to another woman with fertility problems that you don’t know so that she can attempt pregnancy through a process called “anonymous embryo donation.” Second, you can donate your embryos to another woman that you do know so that she can attempt pregnancy though a process called “directed embryo donation.” Third, you can donate your embryos for laboratory research to help improve pregnancy rates for infertile couples in the future. Finally, you can ask that your embryos be thawed and discarded. In both of these last two situations, your embryos will not be transferred into another person and no child will be born as a result.

Q12. What if I don’t respond to the drugs for ovarian stimulation?

A response to ovarian stimulation depends on a number of different factors, the most important include available eggs, appropriate hormone levels, proper administration of any medications and lifestyle/environmental factors.

In order to respond to ovarian stimulation, a woman must have eggs available to respond; this is sometimes referred to as ovarian reserve. If a woman has diminished ovarian reserve (identified by a high blood levels of follicle stimulation hormone (FSH),  low blood levels of anti Müllerian hormone (AMH) or a low antral follicle count on ultrasound), she may not have as robust (or any) response to stimulation. For these patients, an alternate stimulation protocol may be tried or donated eggs may be used (from a woman known or unknown to the patient).

It is possible that a woman does have the necessary eggs but lacks the appropriate pituitary hormones to respond. In this case, using a different medication- one which may contain both FSH and luteinizing hormone (LH) may allow for an optimal response.

Lifestyle factors can also affect a woman’s response to stimulation. Optimizing weight, diet and stress and cessation of use of tobacco, alcohol and recreational substances can also improve a response to ovarian stimulation.

Speak to your physician regarding improving your particular response to ovarian stimulation.

 

Q13. Should we have genetic testing?

Preimplantation genetic testing (PGT) is a technique in which one or more cells is taken from an egg or embryo (fertilized egg) for testing to provide information about the genetic make-up of the rest of the cells in that embryo. In order to utilize PGT, couples must undergo in vitro fertilization (IVF), where the eggs (oocytes) are removed from a woman’s body and mixed with her partner’s sperm in a laboratory.  The embryos which are created can be tested on Day #3 after egg harvest and then implanted back into the uterus on Day #5.  Alternatively, the embryos can be frozen after the cells are removed for testing and implanted in a subsequent menstrual cycle.

Patients with many inherited familial diseases can have their embryos tested to determine its genetic make-up. Specifically, this would include patients with a history of single-gene disorders (such as cystic fibrosis or sickle cell anemia) and patients with a history of sex-linked disorders (such as Duchenne muscular dystrophy and Fragile X syndrome). In addition, even families in search of a bone marrow donor may be able to use PGT to bring a child into the world that can provide matching stem cells for an affected sibling.

Other patients may also decide to use genetic screening. For some patients with recurrent pregnancy loss, severe male factor infertility, advanced reproductive age or recurrent IVF treatment failures, genetic screening may be used. Genetic screening is different than other types of genetic testing because the testing is looking for any abnormality instead of a specific disease, and as a result is associated with higher rates of false results. At this time, ASRM considers genetic screening for this indication experimental.

If you are uncertain about genetic testing for you, speak with your physician about whether preimplantation genetic testing is right for you.

 

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