General Fertility Questions
Q - I have unexplained infertility, which means that all my tests have been normal. What types of treatments work best for that?
A - For women with unexplained infertility, the goal of treatment is to increase the likelihood that pregnancy will happen in any given month. This usually involves increasing the number of eggs available while increasing the number of sperm present within the fallopian tubes at the most appropriate time. This is called superovulation with an insemination. For some with unexplained infertility, IVF can increase the likelihood of pregnancy by ensuring that many steps in the process occur-we ensure that eggs and sperm come into contact with each other in the laboratory, we ensure that fertilization takes place, we ensure that embryos are growing normally, and we ensure that quality embryos are present in the uterus. Through these controls, we see excellent pregnancy rates even with unexplained infertility.
Q - Is there definite evidence that smoking reduces fertility?
A - Yes, both tobacco and marijuana affect fertility in both men and women. Cigarette smoking in women accelerates the depletion of eggs in the ovaries. This makes it more difficult for a female smoker to conceive and also increases the risk of miscarriage. Nicotine, the main component in cigarettes, increases the risk of genetic abnormalities in eggs. Women who smoke also enter menopause on the average a year and a half earlier than nonsmoking women. Men who smoke also have problems with their sperm. Smoking one to two packs of cigarettes daily increases the possibility of abnormal sperm motility (movement) and morphology (shapes of sperm).
Q - I have had two miscarriages and now I am 42. My doctor says that I should keep trying. Do you agree?
A - I don't agree with your doctor. To have one miscarriage is common, with 25% of pregnancies ending this way. However, to have two or more miscarriages is very uncommon and should be investigated. Testing for a possible clotting, hormonal, immune or chromosomal problem is recommended before trying to conceive again. There are treatments available, depending on what the problem might be. Women are born with all their eggs, and as they age, the eggs inside their ovaries age along with them. As a result, chromosomal mistakes and breaks become more common with advancing female age. This causes difficulty getting pregnant for some women and for others, leads to miscarriage. A woman who is forty years or older should not just keep trying to conceive on her own. She should undergo fertility testing and treatment to optimize her chance of achieving a healthy pregnancy as soon as possible.
Basic Treatment Questions
Q - What are the potential advantages of intrauterine insemination (IUI) over intercourse?
A - IUI helps deliver much more motile sperm to the fallopian tubes at the critical times around ovulation, and is recommended to improve pregnancy rates in many instances, including: unexplained infertility; sperm issues (such as count, motility or morphology); when fertility medications (including Clomid or injectable medications) are being used; or when a cervical mucous abnormality blocks the ability of the sperm to swim in to the uterus. The sperm is first "washed" to improve the motility and to filter out the abnormal sperm which all men have, concentrated, and then placed into the uterus by the doctor. This is a painless procedure which is performed in the office in less than 5 minutes.
Q - Will the IVF technique damage my ovaries?
A - There is no evidence to suggest that ultrasound egg retrieval damages the ovaries.
Q - 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?
A - 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.
Q - How many times will IVF be repeated per couple?
A - There is no specific number. This is determined by the couple together with the physician.
Q - After the IVF procedure, how long must we wait to have intercourse?
A - Although a definite time of abstinence to avoid damage to the pre-embryo has not been determined, most experts recommend abstinence for two to three weeks. Theoretically, the uterine contractions associated with orgasm could interfere with the early stages of implantation. However, intercourse the night before preembryo transfer is acceptable. Some physicians will advise intercourse before transfer as they feel that this will improve the chances of a pregnancy.
Q - What about other activities? How soon can I resume my normal routine?
A - The IVF team recommends that the patient be sedentary for a full 24 hours following pre-embryo placement in the uterus. 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.
Q - How soon will I know if I'm pregnant?
A - Pregnancy can be confirmed using blood tests about 13 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 to 40 days after aspiration.
Q - Is IVF covered by insurance companies?
A - Unless your health insurance policy provides infertility coverage it is unlikely that IVF coverage is provided. Frequently insurance policies will cover infertility but exclude IVF. This has been successfully challenged in the legal system. Consultation with your lawyer may be necessary to review you insurance companies refusal to provide IVF coverage. 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.
Q - Will I have an egg in every follicle?
A - It varies from patient to patient . As many as half of the follicles may not contain an egg in some patients.
Q - Is there an increased chance of birth defects if I become pregnant through IVF?
A - There are no known ill effects. Abnormal pre-embryos, even those produced through normal fertilization, do not seem to mature. However, any long-term effects of IVF remain to be determined.
Q - How much time does the entire procedure require?
A - Approximately three weeks (all as an outpatient). Fertility drugs are administered to stimulate the ovaries. Then during the four to six days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels.
Q - What happens to any extra pre-embryos?
A - A maximum of four pre-embryos will be transferred to the uterus for possible implantation. Patients will have several other options regarding the disposition of the remaining pre-embryos. One option is to freeze pre-embryos for your later use. Other options are to donate or simply dispose of them. Excess pre-embryos, if any, belong to you, and you will determine what is to be done.
Egg Donation / Surrogacy Questions
Q - I am about to embark upon my egg donation / gestational surrogacy journey. It seems like there are so many steps. What should I expect, and how do I keep it as simple as possible?
A - The best way to naviagate a treatment as complicated as egg donation or surrogacy is to break it down into small individual steps that you can understand and manage, and remember that the CT Fertility team is here to support you at every step of the way:
Male Infertility Questions
Q - What is the most important part of the semen analysis?
A - Abnormalities which may not allow enough sperm cells to "swim" to an egg and fertilize that egg are crucial to identify. It is necessary to know how many sperm cells are present in a sample (concentration), how much sample is typically produced (volume), and how many of the sperm cells are actually swimming (motility.) There are normal ranges for all of these aspects below which pregnancies happen less often. In addition, the shape of the sperm cell helps us understand how easy or difficult it may be for a sperm to actually bind to and fertilize an egg. The morphology score is the percentage of normally shaped cells in a sample, and as the percentage of normally shaped sperm declines, fewer pregnancies are seen.
Q - My husband travels a lot and we wondered about freezing his sperm. Does CT Fertility offer that?
A - Sperm can be frozen and stored indefinitely, and this process works very well, as long as the original sperm counts are good. There is always a loss of some sperm during the freeze-thaw process, so if the count is low to begin with, sometimes after the thaw there are too few sperm to help achieve pregnancy without more advanced techniques. Sperm cryopreservation can be used to help with timing issues, as well as to pre¬serve the ability to achieve pregnancy in men planning treatment with chemotherapy. This is available to all couples at CT Fertility.
Q - How is a semen analysis performed?
A - A semen analysis evaluates many aspects of the semen, including the sperm, which comprises approximately 1 to 2 percent of the semen volume. The remainder of the fluid is composed predominantly of secretions from other male glands. These secretions are also tested, as they can also affect the sperm's movement and function.
Q - What is measured in a basic semen analysis?
A - World Health Organization (WHO) has established six semen parameters which are being used by CT Fertility's Conception Laboratories. These are:
- sperm concentration
- overall motility
- total motile count
Q - Do the results of a semen analysis always confirm fertility?
A - While a normal semen analysis cannot absolutely guarantee fertility, abnormal results usually do reflect an underlying problem. Nonetheless, there are no "cutoff " values that can definitively predict who will conceive. Generally though, men with "good" semen analysis results will usually be fertile and conceive at higher rates than those with suboptimal results.