General Fertility Questions
I have unexplained infertility, which means that all my tests have been normal. What types of treatments work best for that?
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.
Is there definite evidence that smoking reduces fertility?
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).
I have had two miscarriages and now I am 42. My doctor says that I should keep trying. Do you agree?
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.
IVF / IUI Questions
What are the potential advantages of intrauterine insemination (IUI) over intercourse?
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.
Will the IVF technique damage my ovaries?
There is no evidence to suggest that ultrasound egg retrieval damages the ovaries.
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.
After the IVF procedure, how long must we wait to have intercourse?
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 theyfeel that this will improve the chances of a pregnancy.
What about other activities? How soon can I resume my normal routine?
Your medical professional will consult with you about your return to normal activities.” Last sentence “add…once the doctor has determined the timeframe. 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 13 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 to 40 days after aspiration.
Is IVF covered by insurance companies?
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.
Will I have an egg in every follicle?
It varies from patient to patient . Follicles will always contain an egg. We may get an egg or the egg may not be mature enough for creating an embryo.
Is there an increased chance of birth defects if I become pregnant through IVF
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.
How much time does the entire procedure require?
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.
What happens to any extra pre-embryos?
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 and Surrogacy Questions
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?
The best way to navigate 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.
How do I know if the donor is available or in cycle or what her status is?
Our website indicates whether the donor has any definite (or even tentative) matching commitments in the months ahead. In addition our donor coordinator will work closely with you to discuss each donor’s specific availability to work with you.
When do I have to let you know if we are matched with a surrogate or does the surrogacy agency do this?
Typically, the surrogacy agency will inform us directly; however sometimes intended parents will let us know that they have chosen a surrogate before the agency sends us the match information and the surrogate’s profile. If you tell us first, we will inform the agency when they send us your surrogate’s information, and we will contact her and get the screening process started immediately.
When can we Skype with a donor?
You can Skype (or speak on the phone with)- or even arrange to meet- your chosen donor at your mutual convenience. In advance please take some time to prepare some thoughts about yourself that will give the donor the opportunity to get to know a little about you.
Why is your donor pool relatively small?
We receive a large number of egg donor applications each week. However, with our rigorous medical and genetic screening, only a small proportion is deemed qualified to proceed. Our donors are all local, which allows us to get to know them very well, and basically eliminates travel costs for you.
Our donor database consists of immediately available, matched, and cycling donors. While the number of immediately available donors may not be very large, keep in mind that new donors are added to the pool regularly and donor status may change often as well.
Who do you recommend we talk to if we don’t like any of your donors?
Please feel very free to discuss your thoughts, feelings and concerns about our donor pool with our donor coordinator. Every day we interview and screen new potential donors to bring on board. If at the time you are ready to match with a donor you find that no CT Fertility candidates are acceptable to you, we can also refer you to some outside donor agencies with whom we have solid working relationships. However we prefer that you do not use the internet directly to recruit donors or work with any agencies that do not meet our standards, especially the ones that do little or no pre-screening of their candidates, as frequently those women do not pass the testing process and you end up wasting time, money and emotional energy.
If my surrogate fails for whatever reason can I still continue with the egg donor?
If the surrogate fails screening, you can still continue with the selected egg donor and freeze (“bank”) the eggs or embryos we produce for later use, but you cannot indefinitely hold the donor until you re-match. In fact many people choose to fertilize and freeze their embryos and do a frozen embryo transfer later on; or even just freeze the donor’s eggs and fertilize them later for a fresh embryo transfer when their new surrogate is ready.
Can I look at your donor database before signing on with CT Fertility?
Yes, you are welcome to review our pool. Many people like to get a sense of the donors in our database even if they are not yet ready to move forward to coordinate an embryo transfer. This will enable our donor matching coordinator to discuss donor candidates who can be a good fit for your preferences.
When should I select my egg donor?
Our matching coordinator will work closely with you to discuss the donor’s personal and medical availability to enable you to officially match when all parties are ready to move forward. This will enable you to view immediately available donors as well as those donors who will soon be available.
Male Fertility Questions
What is the most important part of the semen analysis?
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.
My husband travels a lot and we wondered about freezing his sperm. Does CT Fertility offer that?
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.
How is a semen analysis performed?
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.
What is measured in a basic semen analysis?
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
Do the results of a semen analysis always confirm fertility?
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.
Egg Freezing / Fertility Preservation Questions
How are you different that some of the egg freezing referring networks?
CT Fertility is not simply an intermediary or “middle man” referral agency. We are a highly reputable fertility center with an impressive track record in the field of egg freezing and thawing.
In contrast, most egg freezing companies are non-medical referral agencies that channel clients to a network of clinics in return for a referral fee. Not all clinics have the same level of experience or results, and protocols may vary widely. As a result prices vary while no guarantees are made, and you are asked to trust the intermediaries with regards to the quality of care they will receive.
What is your specific expertise and track record with egg freezing?
Vitrification (the ultra-rapid freezing of human eggs) is a relatively advanced technology. But to fulfill on the promise of extended fertility, freezing is not enough: successful thawing of the fragile eggs needs to be achieved, which is even more challenging, and the birth of healthy babies should follow. As pioneers in this field, Doctor Melvin Thornton and the CT Fertility lab team are proud of their unique track record of over 60 live births resulting from frozen-eggs pregnancies, with success rates that are close to the national average for fresh eggs.
Who will be actually freezing my eggs, and what are their qualifications?
In 2007 CT Fertility recruited two embryologists who were part of the team that achieved the first pregnancy in the USA from vitrified eggs. Since then the clinic has seen the birth of over 60 more babies form the eggs they have frozen and thawed. Even after egg freezing technology was declared non-experimental in 2012, most other fertility centers still do not freeze eggs; and those that have recently embraced it still often lack the experience that the process requires.