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.

Are there home fertility tests available?

There are home fertility tests for both males and females. For males, semen analysis tests range from basic to sophisticated. For females, there are tests to determine ovulation, egg reserve, and other hormonal levels through saliva samples. These tests are becoming increasingly accurate.

What are the advantages and disadvantages of home fertility testing?

The advantage is that these tests can alert individuals to potential fertility issues, prompting them to seek specialist help. However, a disadvantage is the possibility of misinterpreting results, leading to unnecessary anxiety or a false sense of security.

Can home fertility tests lead to over-treatment or anxiety?

Yes, for example, a poor ovarian reserve test result doesn’t necessarily predict natural pregnancy chances and could lead to over-treatment and anxiety. Similarly, simple sperm tests might give men a false sense of security without a full analysis.

What is a Reproductive Endocrinology and Infertility Specialist?

A reproductive endocrinology and infertility specialist specializes in infertility and reproductive hormonal imbalances and disorders. They are experts in conditions like thyroid, adrenal diseases, PCOS, and other factors affecting ovulation and fertility.

What are different infertility treatments?

Treatments range from simple timing and ovulation prediction to more advanced techniques like intrauterine insemination (IUI) and in vitro fertilization (IVF). Surgical options like fibroid removal or tubal ligation reversal can also be effective, especially for conditions like endometriosis.

What are the signs of male infertility?

Signs include a history of infertility with previous partners, exposure to harmful environmental factors, erectile or ejaculatory problems, and certain medications affecting sperm count.

What is endometriosis, and how is it diagnosed?

Endometriosis involves the growth of endometrial tissue outside the uterus, causing inflammation and fertility issues. It’s diagnosed through symptoms like painful periods, pain during intercourse, and infertility, as well as through ultrasound and other imaging techniques.

Is endometriosis genetic?

Endometriosis has a genetic component, although it’s not linked to a specific gene. Family history and immunological factors play a role in its development.

How is endometriosis treated?

Treatment depends on whether the patient is in pain and/or infertile. Surgical options can help with pain and infertility, while fertility medications and IVF are preferred when pain is not an issue. Endometriosis has no definitive cure, but symptoms often improve with age.

When should you see a fertility specialist?

If you’re under 35 and have been unsuccessful in conceiving for a year, it’s time to see a fertility specialist. For those older than 35, seeking a specialist after six months of unsuccessful attempts is recommended. However, if you have any concerns or questions about your fertility, it’s advisable to contact a specialist immediately.

What is medical genomics?

Medical genomics is the study of an individual’s genes and their interactions with each other and the environment in relation to complex diseases. This field is crucial for developing diagnostic tools and treatment options, especially for infertility patients.

How does genetic testing benefit fertility patients?

Genetic testing, such as expanded carrier screening, can be conducted before conception to determine if a couple is at risk of having a child with a serious medical condition. This information can guide decisions and treatments to help them have a healthy biological child.

What are some common misconceptions about genetic testing?

A common misconception is that genetic testing can only be done during pregnancy. Genetic testing is also available before conception, like expanded carrier screening, which helps identify the risk of serious genetic conditions in offspring.

Do patients have to experience infertility to undergo pre-conception genetic testing?

No, pre-conception genetic testing, such as expanded carrier screening, is available to all individuals or couples considering starting a family, not just those experiencing infertility.

What are the advancements in genetic testing for fertility?

New molecular biology technologies have led to various genetic testing options. These tests can provide answers to fertility issues, such as the causes of recurrent pregnancy losses or premature ovarian insufficiency, through methods like whole exome sequencing.

What is IVF, and how does it compare with IUI?

IVF (In Vitro Fertilization) and IUI (Intrauterine Insemination) are two different fertility treatments.

IUI (Intrauterine Insemination): This process involves washing sperm in a laboratory and then using a catheter to place the sperm directly into the uterus. This brings the sperm closer to the egg in the fallopian tube, improving the chances of fertilization. IUI can be combined with fertility medications, although not all women require them. It’s often used by single women or lesbian couples, especially around the time of ovulation.

IVF (In Vitro Fertilization): IVF is an assisted reproductive technology first started in 1978. It involves removing eggs from a woman’s body and fertilizing them with sperm in a lab. The fertilization occurs outside the body, and the resulting embryos are transferred back into the woman. IVF can also be used for egg freezing, either for cancer patients or for women who wish to preserve fertility.

In summary, while IUI is a process of directly inserting sperm into the uterus, IVF involves fertilizing eggs outside the body and then implanting the embryos.

What is the prevalence of PCOS among women in their reproductive years

Polycystic Ovary Syndrome (PCOS) is recognized as the most common hormonal abnormality affecting women in their reproductive years. Studies indicate that between 8 to 13 percent of women may have PCOS, with some studies suggesting that up to 1 in 5 women could be affected by the condition. This variation in prevalence may be due to differences in diagnostic criteria and study populations. PCOS is a significant health issue due to its implications for fertility, metabolic health, and other related hormonal imbalances.

How is PCOS diagnosed?

The diagnosis of Polycystic Ovary Syndrome (PCOS) is based on the presence of at least two out of three specific criteria:

Ovulation Dysfunction: This includes irregular or absent menstrual cycles, indicating that ovulation is not occurring regularly. Women may experience very infrequent periods, no periods at all, or bleed erratically.

Elevated Male Hormones (Androgens): This can be identified either through blood tests showing elevated levels of hormones like testosterone or through physical signs such as hirsutism (excessive hair growth in a male pattern, such as on the face, chest, lower abdomen, and lower back).

Polycystic Ovaries on Ultrasound: An ultrasound of the ovaries showing many small cysts is a key indicator. While it’s normal for ovaries to have cysts, women with PCOS typically have a higher number and increased ovarian volume.

Meeting any two of these criteria generally leads to a diagnosis of PCOS. This approach allows for a comprehensive assessment of the syndrome, which can vary significantly in its presentation.

What steps can be taken to manage PCOS?

Managing Polycystic Ovary Syndrome (PCOS) involves a combination of lifestyle changes and, in some cases, medication. Here are key strategies to manage PCOS:

Weight Management: Working towards a healthier Body Mass Index (BMI) can significantly improve PCOS symptoms if you’re overweight. Weight loss can reduce metabolic issues associated with PCOS and improve fertility.

Addressing Metabolic Syndrome: Women with PCOS are at a higher risk of developing metabolic syndrome, which includes elevated blood pressure, abnormal HDL cholesterol levels, elevated triglycerides, pre-diabetes or diabetes, and increased waist circumference. Managing these factors is crucial.

Exercise: Incorporate both strength training and cardiovascular exercises. Strength training helps reduce insulin resistance and pre-diabetes, which are common in PCOS. Cardiovascular exercise is important for overall health and can aid in weight loss.

Diet: Adopting a Mediterranean diet, which is rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, can be beneficial. This diet helps in managing weight and improving insulin sensitivity.

Medical Intervention: Depending on the severity of the symptoms, medications may be prescribed to manage specific aspects of PCOS, such as menstrual irregularities, hirsutism, or fertility issues.

It’s important to consult healthcare professionals for personalized advice and treatment plans. If you have more questions about managing PCOS, don’t hesitate to ask for professional guidance.

What are common misconceptions about PCOS, and what is the reality of fertility treatment outcomes for women with PCOS?

There are several misconceptions about Polycystic Ovary Syndrome (PCOS), one of which is regarding body weight. It’s a common belief that all women with PCOS are overweight, but this is not true. The proportion of overweight individuals in the general population is similar to that in the PCOS population, indicating that PCOS affects women of all body types.

Another important point is regarding fertility outcomes for women with PCOS. While it’s true that women with PCOS may take longer to conceive, with appropriate fertility treatment, their overall chances of conception are comparable to those of women without PCOS. This means that PCOS, although it may pose certain challenges, does not necessarily diminish the likelihood of successful conception with the right treatment and management.

What does being diagnosed with PCOS mean for a person, and how can it be managed?

Being diagnosed with Polycystic Ovary Syndrome (PCOS) means that you have a condition that needs ongoing management, as it is typically a lifelong condition. The management strategy for PCOS depends on your symptoms and personal goals:

For Those Not Seeking Pregnancy: Birth control pills are commonly used to regulate menstrual cycles and manage hormonal imbalances. Additionally, medications that counteract male hormones (anti-androgens) might be prescribed to address symptoms like excess hair growth.

For Those Seeking Pregnancy: Treatment usually involves medications to induce ovulation, helping you to conceive.

Addressing Metabolic Issues: PCOS is often associated with several metabolic issues, including high blood pressure, pre-diabetes or diabetes, and increased risks of uterine cancer, anxiety, sleep apnea, and abnormal cholesterol and triglyceride levels. Managing these conditions is an integral part of PCOS treatment.

A comprehensive approach is essential in managing PCOS, and it’s important to find a healthcare provider or a specialized center that understands the complexity of the condition and can offer the necessary resources and support.

What is PCOS, and how does it develop?

Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder with unclear origins. It may begin with certain exposures during fetal development, possibly including exposure to increased levels of male hormones or Anti-Müllerian Hormone (AMH). The disorder involves a disruption in the communication between the brain and the ovaries. This miscommunication leads to the ovaries not receiving the correct signals to ovulate regularly.

In PCOS, the ovaries are essentially ‘victims’ of this hormonal miscommunication. They become unable to ovulate regularly, leading to multiple small cysts. This hormonal imbalance creates a vicious cycle, contributing to various reproductive and metabolic consequences. A combination of symptoms and findings, including irregular menstrual cycles, signs of high male hormone levels, and polycystic ovaries on ultrasound, characterizes the syndrome.