Fertility FAQs

We’ve put FAQs for IVF appointments to help patients have as much information as possible for upcoming visits.

If you have a question not addressed below, please feel free to reach out to our office by contacting us here.

What Happens During My Fertility Evaluation?

When you come to see us for a fertility evaluation, we perform a complete medical history of you and your male partner, if you have one. We look at your menstrual history, prior fertility evaluations, and any procedures or surgeries that you’ve had.

Afterward, you’ll undergo a complete physical examination as well as a pelvic ultrasound. We’ll examine the anatomy of your uterus for fibroids and your ovaries for any concerning cysts. We may also look at your ovarian age on the ultrasound by counting the numbers of tiny cysts. 

The three basic fertility evaluation tests include:

• A hysterosalpingogram, or HSG, to check your tubes
• A blood progesterone test to verify ovulation
• A sperm analysis

Once we obtain all that information, you’ll come back into the office for further discussions.

What Is a HSG?

A hysterosalpingogram (HSG) is the oldest test available to see if a woman’s tubes are open. When your tubes are blocked, sperm can’t get together with the egg. For women trying to conceive, there is a tubal problem 40% of the time. 

During an HSG, we insert a little cannula into your cervix and then inject contrast dye to verify, via x-ray pictures, if your tubes are open. Tubes that are blocked at the beginning are called proximal tubal occlusion and may arise from tubal spasm. A procedure performed in the operating room, called tubal cannulation (with a guide wire), can correct the blockage.   

A blockage at the end of the tube is called a hydrosalpinx. It gets blocked and swollen at the end, and dramatically reduces the ability for the embryo to implant, even if the other tube is normal. For a hydrosalpinx, the tube is often completely removed because of the impact that it has on implantation.

What Is Diminished Ovarian Reserve (or Ovarian Aging)?

There are two aspects involved with diminished ovarian reserve, or ovarian aging: quality and quantity. A woman is born with all the eggs she’s ever going to have. She possesses one to two million at birth and down to around 10,000 eggs at age 37, decreasing by the hundreds every month after that.

Quality is based on a woman’s age. As you get older, the quality of your eggs tends to decrease. Pregnancy rates also go down gradually from age 30, and more so in your late 30s and accelerating thereafter. 

How can you determine the quantity of your eggs? The first way is through an antral follicle count on ultrasound. The lower the number of tiny cysts on the ovary, the lower the number of eggs. The second way is through anti-Müllerian hormone or AMH. AMH is produced in the cells around the eggs. Therefore, the fewer cells around to make AMH, the lower the number of eggs. However, AMH cannot predict your fertility, so even if you have a lower AMH count, you should not worry about it.

What Is PCOS?

Polycystic ovary syndrome (PCOS) is the most common hormone problem with women during their reproductive years, affecting 5% to 20% of women. It’s the number one ovulation dysfunction and also a major cause of infertility. 

A diagnosis of PCOS requires having two out of the following three criteria:

• Irregular periods
• Dark hair growth or elevations in testosterone
• The presence of too many tiny cysts on the ovary during an ultrasound

Irregular periods are normal. Some women bleed every few months, once or twice a year, or hardly ever. The key is when a woman does not ovulate. Women who have more testosterone than they need will display dark hair growth in sex-dependent regions, the upper lip, the chin, around the breast, lower belly, or lower back.

Small cysts on the ovaries are normal. They contain eggs that all reproductive women need to have. However, women with PCOS have at least twenty tiny cysts on one ovary, and the volume of the ovary needs to be more than 10 centimeters cubed.

Do Men Have a Biological Clock?

Yes, they do. For years, it was thought that men could have children well into the late years of life. However, over the last decade, there has been increasing evidence of advanced paternal age. At about age 40 to 45, men take five times as long to be able to conceive than men less than 25-years-old. 

Moreover, older men have increased risks of infertility, miscarriage, and congenital disabilities. They are twice as likely to have a child with autism, and four to five times as likely to have a child with schizophrenia. 

Should men freeze their sperm when they are younger? Although no one has come directly out and said it, the option may be worth considering.