We’ve compiled a list of fertility FAQs to give you easy access to the questions we get asked most commonly. View a list of financial and insurance FAQ here. If you still have questions, contact us today!
What is infertility?
Infertility is defined as being unable to achieve pregnancy after one year if a woman is under 35 years of age, and after six months if a woman is 35 years or older.
How common is infertility?
At least one in six couples experience difficulty getting pregnant or carrying a pregnancy to term. Approximately 7.4 million women in the U.S. experience infertility. The average young couple without any known reproductive issues has about a 20% chance of achieving pregnancy in any given month, and it is not uncommon for couples to attempt conception six months before achieving pregnancy.
Who experiences infertility more - men or women?
While published statistics tend to focus on the woman, it is important to note that infertility diagnoses are split evenly between men and women. Of all infertility diagnoses, one third are attributed to the man, one third to the woman, and one third are unexplained.
When should I see a doctor?
For couples where the woman is under 35 years of age, it is best to try for a pregnancy for one full year before pursuing the help of a doctor. With couples where the woman is over 35, visit a physician after six months of trying to conceive. For couples with certain issues such as impotence, irregular periods or recurrent miscarriage, it is advised to seek the help of a fertility specialist sooner.
How is infertility diagnosed?
After discussing your medical history and symptoms, your doctor will likely prescribe basic fertility testing. For a female, this will involve an ultrasound to assess ovarian reserve and fertility potential, as well as blood tests to assess ovarian function and reserve. For a male, a physical exam as well as a semen analysis in a laboratory will assess sperm count, shape and movement.
Why does miscarriage occur?
Miscarriage may occur for several different reasons, but the vast majority of miscarriages happen as a result of a genetic abnormality (such as an extra or missing chromosome) with the embryo. Other causes of miscarriage include abnormalities in the uterus, hormone imbalances, untreated medical issues, infection, and immune disorders.
How does age play a role in female fertility?
Women are born with all of the eggs they will have in their lifetime. At birth, a woman has one or two million immature eggs, which reduces to 400,000 by puberty. Only 400 eggs will mature and be released during ovulation in a woman’s lifetime. As a woman nears the end of her childbearing years, ovarian supply and quality declines, which can increase the chance of miscarriage.
Does having an abortion cause infertility?
Millions of women who have had abortions have gone on to have successful pregnancies and deliveries. Undergoing a safe, legal abortion performed by healthcare professionals poses no significant risk to female fertility. As with any medical procedure, there are risks involved. In very rare cases, damage to the cervix may occur or infertility may arise due to a prior post-operative infection or uterine scarring.
Do eating disorders cause infertility?
Eating disorders can impact reproductive potential and fertility. Being underweight can cause absent or irregular periods, interrupting the process of ovulation. The stress of an eating disorder can also impact the reproductive potential of the body. In patients where excess weight is an issue, hormonal imbalances can cause ovulatory disorders and stop monthly periods. Women should strive for a Body Mass Index that falls in a healthy range of 18.5 – 24.9.
Can my thyroid affect my fertility?
Thyroid disorders (hyperthyroidism, hypothyroidism) in women can interrupt the ovulation process, causing irregular or absent periods. Normal thyroid hormone levels are required for sperm production. Through a medical evaluation by a reproductive endocrinologist, thyroid levels can be assessed and treated.
How can I determine if I am ovulating?
Ovulation is the process by which an egg is released from an ovary into the fallopian tubes where it can then be fertilized by sperm. In a normal cycle (21-35 days), ovulation occurs about halfway through the cycle. The best way to determine if you are ovulating is to chart your monthly periods, Basal Body Temperature (BBT) and to use an Ovulation Prediction Kit (OPK). OPK’s measure the luteinizing hormone (LH) in urine, with a spike in LH signaling that ovulation will typically occur within the next 24-36 hours. If you do not experience a spike in LH, ovulation issues may be present. BBT is the practice using a basal thermometer to carefully monitor your temperature daily, it is possible to determine when ovulation has occurred based on a consistent increase in temperature. Two or three days after ovulation, hormones cause a rise in BBT of 0.4 to 1 degree. During a pregnancy, the BBT remains elevated.
FERTILITY CARE PROVIDED BY VIOS
What services does Vios provide?
Vios provides a range of services, including family planning consultation, infertility diagnostic testing, surgical procedures (ex: fibroid removal) to optimize treatment success, and treatment options to achieve pregnancy and preserve fertility.
What treatments does Vios provide?
Vios utilizes a variety of treatment options individualized to your specific needs, including: ovulation induction and timed intercourse, intrauterine insemination or IUI (formerly known as artificial insemination), fertility preservation (egg/embryo freezing), in vitro fertilization (IVF), fresh embryo transfers, frozen embryo transfers (FET), third party reproduction (including the use of donor eggs, donor sperm, and/or a gestational carrier), and genetic testing.
Can Vios assist me with the selection and use of donor eggs, donor embryos (embryo adoption), and/or gestational carrier selection?
Yes, we have a robust third party reproduction team and select business partners who can assist individuals and couples utilizing third party reproduction options through their entire journey.
Does Vios accept tissue donation (sperm, eggs, embryos)?
Vios does not accept sperm donations. We do however, work closely with an agency who does accept egg and embryo donations.
Can I become a gestational carrier (surrogate) for a patient in need?
While Vios does have patients who need a gestational carrier. We do not specifically screen and accept candidates. We can refer you to trusted agencies who we work closely with.
Does Vios provide gynecology care?
No, our clinic doesn’t provide gynecological care to patients.
Does Vios provide endocrine services not related to achieving pregnancy (now or in the future)?
No, we only provide endocrine services for patients looking to conceive. Those with non-fertility related or hormone therapy endocrine needs will need to seek an alternative provider for care.
Does Vios provide obstetrics care?
While our physicians are board certified ob/gyns (in addition to being board certified/board eligible reproductive endocrinology and infertility specialists), we do not provide long term OB care. After a patient achieves pregnancy via a fertility treatment at our clinic, we monitor the development of the pregnancy until approximately week 8-12 before discharging the patient to the care of their OB who will monitor the remainder of the pregnancy and delivery.
Does Vios perform tubal ligation reversals?
No, we do not perform tubal ligation reversals. If a woman has previously had her tubes tied, IVF can be considered as a potential treatment to achieve pregnancy. Schedule a consultation to learn more about your specific chances of success.
Does Vios provide natural IVF (no medications)?
No, we do not utilize natural IVF as a treatment option for our patients.
CARE LOGISTICS & REQUIREMENTS AT VIOS
What occurs at the new patient consultation and how long should I expect to be there?
During the new patient visit you will meet with several members of our team including our providers, clinical team, and admin staff. The provider and clinical team will review your family planning goals, medical history, and discuss potential treatment options. The administrative team will coordinate future appointments and discuss insurance and financial details. The new patient visit lasts approximately one hour, but can be shorter or longer depending on the specific situation and needs of the patient. We also recommend that patients bring along a list of specific questions they would like to cover.
Does my partner need to be at the first visit with me or can I come on my own?
While it is not required for your partner to come with you to the new patient consultation, we strongly recommend it. During the consultation we will share a lot of information; which can be overwhelming even for two people listening. If your partner is not able to attend, we suggest asking a trusted family member or friend to attend with you. This person can help you absorb and relay the information to your partner and be a source of support during the consultation.
Do you request my medical records or is that something I have to do?
We ask that all patients contact their doctor(s) and have any relevant medical records faxed to our office BEFORE their new patient consultation. This allows our providers to review your medical history prior to your consultation and have a better understanding of potential treatment options. If you are unable to get your medical records faxed prior to your consultation, please bring them with you to the consultation.
Is there ever weekend availability or weeknight evenings for consultations?
We do have some availability for weeknight and weekend consultations. This availability varies by doctor and location. When contacting our office, please let them which office you would like to attend and that you are interested in weeknight/weekend hours. They will let you know what options are currently available.
FERTILITY MEDICATION & SIDE EFFECTS
Is fertility medication safe?
While fertility medication has helped hundreds of thousands of couples achieve parenthood, all medication comes with potential risks and side effects. When prescribed appropriately and with proper monitoring, the risks and side effects are minimal. Fertility medication can increase the chance of multiples (twins) and in rare cases, can cause ovarian hyperstimulation.
What side effects will patient experience from the medications?
Side effects are usually mild with the most common being pain and redness at the injection sites. The ovaries enlarge during stimulation, so the woman will likely feel bloated and full. The most concerning potential side effects are the possibility of developing ovarian hyperstimulation syndrome (OHSS) or developing ovarian torsion.
What is ovarian hyperstimulation syndrome (OHSS)?
OHSS can occur when a woman responses excessively to the medication used to make her eggs grow. OHSS can cause fluid in the abdomen and around the lungs causing nausea, abdominal bloating, and weight gain. Women with an increased response to the medication are more closely monitored and are instructed to decrease activity and increase electrolyte-rich fluid intake. In some cases, fluid may be drained using a syringe to provide symptom relief. In a small percentage of cases, hospitalization may be required to alleviate symptoms.
What is ovarian torsion?
Ovarian torsion is when an ovary twists on itself and cuts off its blood supply. The risk for ovarian torsion increases as the ovary gets bigger, so the more a woman responds to the stimulation, the greater her risk for torsion. We strongly encourage women to abstain from sex or any activity which could make the ovaries bounce and twist such as running, jumping, or bending over which would increase the risk for torsion. If a woman develops torsion, it is considered a surgical emergency to untwist the ovary.
INTRAUTERINE INSEMINATION (IUI)
Is there an ideal sperm count for IUIs?
Ideally > 5 million total motile sperm count.
Will I experience any discomfort during or after the procedure?
Generally, no. Some patients have slight cramping when the catheter enters the uterus, but this usually subsides right after the procedure.
Are there any risks associated with an IUI?
IUIs carry a major risk of multiple gestation as well as a slight risk of infection.
What is the likelihood of success with an IUI?
It depends on the underlying infertility diagnosis of the patient, but generally 10-15%.
At what age should women consider freezing their eggs?
The best time to freeze eggs is late 20s or early 30s. During this time, her egg quantity and quality is usually at its best yielding maximum results.
Is there an age that is too old to freeze eggs?
Women can freeze eggs even in their late 30s or early 40s; however, as women age, the number of eggs retrieved lowers and the eggs do not freeze as well as eggs retrieved at a younger age.
How many eggs are needed for one live birth? What is the chance the egg will make a baby?
The number of eggs needed for a live birth varies by the age of the eggs. A woman in her mid-20s may only need 10 eggs to have a good chance of a live birth while a woman in her early 40s may need upwards of 25 eggs.
When should freezing embryos be considered?
While new technology has allowed frozen eggs to work almost as well as fresh eggs, embryos are always going to be a more reliable predictor of a live birth. If a woman has a partner whom she plans on having children with in the future or knows she will need donor sperm, the option of freezing embryos is discussed. As women get into their late 30s or early 40s, the quality of eggs decreases and they do not freeze or thaw as well, so freezing embryos is strongly recommended for these women.
What is oncofertility?
Oncofertility is the medical specialty that bridges oncology and reproductive endocrinology with the goal of preserving fertility in cancer patients and survivors.
How does cancer treatment affect fertility?
Chemotherapy drugs can damage eggs, often resulting in problems with fertility. Age also plays an important role as younger patients with healthier eggs typically have their fertility impacted to a lesser degree. Radiation involves high energy rays that can damage your ovaries. Additionally, radiation to the uterus can cause scarring, making it difficult to conceive. As a result, most women undergoing pelvic radiation will lose their fertility. Also, radiation to the brain can affect the pituitary gland, which controls the release of the hormones most closely linked to fertility. Surgical treatment, including hysterectomy (uterus removal) and oophorectomy (ovary removal), impacts the ability to conceive and to carry a child. Immune therapies have also been found to negatively impact fertility.
IN VITRO FERTILIZATION (IVF)
What can I expect during IVF?
One full In Vitro Fertilization cycle typically requires two months to complete and involves preparation for ovarian stimulation, ovarian stimulation and monitoring, egg retrieval, sperm collection, egg fertilization, monitoring of embryo development and an embryo transfer procedure.
What are the risks associated with IVF?
In general IVF is a safe procedure. However, it is still a surgical procedure and as such the risks include the risk of anesthesia, infection, bleeding, potential injury to nearby structures, torsion of ovaries and ovarian hyperstimulation syndrome (OHSS).
What is the likelihood of success with IVF?
The success of IVF is much higher than the majority of other fertility treatment options, however this success rate is individualized based on age (both chronological and ovarian (reflected by hormones such as AMH)), genetic testing of the embryo and so on and so forth. In general, it can range anywhere from 40-70%.
Why would you do a day 3 transfer vs. a day 5 transfer?
In certain situations, you might opt for a day 3 transfer if you have previously done IVF and your embryos have failed to develop to day 5. On day 3 the embryos are usually 4-8 cell stage, so their developmental capability is unknown. Often times in order to improve implantation rate you can wait till day 5 so the embryos are at the blast stage giving a better idea of their quality and developmental potential.
How do you decide on a single embryo transfer vs. a multiple embryo transfer?
This is based on multiple factors. When debating on a single embryo transfer you have to take into account embryo quality (grade and day 3 vs day5), whether it has been PGS tested, and the patient’s history (previous transfers and any pregnancies).
Why should one consider genetic testing?
One should consider preimplantation genetic testing (PGT) if they have had previous failed transfers, multiple miscarriages, are of advanced maternal age (which increases the likelihood of chromosomal abnormalities), have a known genetic disease, or are wishing to select the sex of the embryo transferred. Genetic testing allows patients to transfer the best quality embryo with the highest chance of success first.
EGG/EMBRYO CRYOPRESERVATION & STORAGE
How are my eggs/embryos frozen?
Eggs and embryos are frozen by a senior embryologist in liquid nitrogen using a freezing process called vitrification. This means they are quickly frozen and stored at a temperature of -320F (-196C).
How do you decide which eggs/embryos will be frozen?
Only eggs/embryos that have reached certain stages of development will be frozen as they have a strong chance of surviving the freeze/thaw process. Embryos that made it to the blastocyst day (typically a day 5, day 6 or day 7 embryo) have the best post-thaw survival and pregnancy rates. However, your physician may choose to freeze embryos at other stages as well and can discuss this further on an individual basis.
Are there any negative side effects for the eggs/embryos with extended periods of storage?
There do not seem to be any negative effects on eggs/embryo viability with long-term storage. In fact, a baby was born from an embryo that was frozen for just over 24 years. Once the embryo is thawed for transfer, it regains its strength and can have the same chance of pregnancy as a fresh embryo.
Where are my embryos stored?
All eggs and embryos are stored at one of our Vios IVF centers with well-designed cryopreservation tanks. There are national storage banks as well where some patients choose to store their eggs/embryos for long-term storage.
Can I ship my embryos to Vios from other fertility centers?
Vios does accept tissue from other centers as well as prior locations that the physician practiced. The appropriate FDA requirements and paperwork must be completed, and they will need to be shipped in cryopreservation tanks. We often receive eggs, embryos and/or sperm from other clinics as many come to us at Vios to receive care. Special attention and care are given to optimizing this transfer and safely bringing the tissue to our lab.
Schedule a consultation today.
At Vios, our team approach focuses on helping you navigate the journey and make your dreams of parenthood a reality.
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