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FAQ

What is infertility?

Infertility is a disease of the reproductive system that impairs one of the body's most basic functions - the conception of children. Conception is a complicated process that depends upon many factors, including the production of healthy sperm by the man and healthy eggs by the woman, unblocked fallopian tubes that allow the sperm to reach the egg, the sperm's ability to fertilize the egg, the ability of the fertilized egg (embryo) to become implanted in the woman's uterus and sufficient embryo quality. Finally, for the pregnancy to continue to full term, the embryo must be healthy, and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

What causes infertility?

No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or (in about 20 percent of cases) is unexplained.

The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease, such as cystic fibrosis or a chromosomal abnormality. The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

How is infertility diagnosed?

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. A patient over the age of 35 is encouraged to seek medical help after six months of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception. If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, X-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.

How is infertility treated?

Most infertility cases are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs.

What is in vitro fertilization?

Infertile couples in which women have blocked or absent fallopian tubes or in which men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a biologically related child. In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a petri dish (in vitro is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes. IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatments in the United States.

Is in vitro fertilization expensive?

The average cost of an IVF cycle in the United States is $12,400. Like other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment, and the cycle may need to be repeated to be successful. While IVF and other assisted reproductive technologies are not inexpensive, they account for only three hundredths of one percent (0.03%) of U.S. healthcare costs.

Does in vitro fertilization work?

Yes. IVF was introduced in the United States in 1981. Since 1985, when we began counting, through the end of 2006, almost 500,000 babies have been born in the United States as a result of reported Assisted Reproductive Technology procedures (IVF, GIFT, ZIFT, and combination procedures). IVF currently accounts for more than 99% of ART procedures with GIFT, ZIFT and combination procedures making up the remainder. The average live delivery rate for IVF in 2005 was 40.6 percent per retrieval for women 35 years old or younger -- a little better than the 20 per cent chance in any given month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term.

Do insurance plans cover infertility treatment?

The degree of services covered depends on where you live and the type of insurance plan you have. Fourteen states currently have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. HOWEVER, the laws vary greatly in their scope of what is and is not required to be covered. For more information about the specific laws for each of those states, please call your state's Insurance Commissioner's office or to learn about pending insurance legislation in your state, please contact your State Representatives.

Whether or not you live in a state with an infertility insurance law, you may want to consult with your employer's director of human resources to determine the exact coverage your plan provides. Another good source of assistance is RESOLVE, an infertility patient advocacy and information organization.

Whether or not you live in a state with an infertility insurance law, you may want to consult with your employer's director of human resources to determine the exact coverage your plan provides. If that is not an option, an excellent resource for determining coverage is the booklet Infertility Insurance Advisor: An Insurance Counseling Program for Infertile Couples. This booklet is available for a small fee from RESOLVE, an infertility patient advocacy and information organization.

What is a reproductive endocrinologist?

A reproductive endocrinologist is a doctor who specializes in infertility and hormonal disorders. Many women with premature ovarian failure prefer seeing these doctors because they are specialists who are particularly helpful for patients hoping to pursue a pregnancy.

What tests should I ask my doctor for if I think I am going through early menopause?

The key test to determine whether or not you are in menopause is a FSH test, which measures the blood levels of your follicle-stimulating hormone (FSH). Your FSH levels rise when your ovaries stop producing enough estrogen, so high FSH levels can signal that your body is entering menopause. The best time to get an FSH test for the most accurate reading is on the third day of your menstrual cycle, if you are still getting periods. Another test you might want to consider is a blood test of your estradiol levels. Estradiol is a form of estrogen in your body, and the levels of it drop when your ovaries start to fail. Low estradiol levels, therefore, may indicate that you are entering an early menopause. A thyroid test may also be a wise option. Many of the symptoms of premature and early menopause are the same as those for thyroid disease, so it's a good idea to determine whether your symptoms are due to thyroid problems or menopause.

What about getting an ultrasound of my ovaries?

In some cases, your doctor may perform high-resolution ovarian ultrasound to view your ovaries. This procedure determines whether you still have eggs and follicles, but this information does not help that much. The problem is that even when eggs are detected, attempts to stimulate ovulation through hormones have been relatively unsuccessful. However, ultrasound may make sense if you are in the early stages of premature menopause and are intending to pursue an aggressive fertility program.

I am still getting periods, but I have a lot of symptoms like hot flashes and night sweats. Is this normal?

Yes, it is. Even though the technical definition of menopause is not having your period for at least six months to a year, it is not uncommon for young women going through early menopause or premature ovarian failure to get periods fairly regularly. Hormones often fluctuate erratically at the beginning stages of early or premature menopause, so you may be producing enough estrogen to get periods even while your FSH levels are high. Many times, your cycles will be "anovulatory" (in other words, you are not producing an egg), but you are producing enough estrogen to build up your uterine lining.

How long will my symptoms last?

Some women get symptoms for only a short time, while others get intense symptoms for years. Most women get symptoms for a few years, and then they fade out. The real key to making your symptoms go away now is by either going on hormone replacement therapy (HRT) or by using alternative treatments, like phytoestrogens, herbs and vitamins.

Does going through menopause early mean I am aging more quickly?

No. Going through menopause years before you expected does not mean you are suddenly older. It does mean that your ovaries are not functioning the same way as those of most women in their 20s and 30s. Early or premature menopause does not mean that you have a shorter life span or that you have fast-forwarded to the body of an older woman. Yes, there are certain health risks that you now face, like the threat of osteoporosis. You might also notice your skin getting drier or a change in your body shape, but if you go on HRT, you can minimize those risks, reverse those symptoms and feel like yourself again!

What is endometriosis?

The endometrium is the tissue that lines the uterus. Endometriosis is the presence of endometrial tissue in places where it is not normally found. Common sites of involvement are the ovaries, space behind the uterus (cul-de-sac, rectum, uterosacral ligaments) and urinary bladder. Endometriosis is usually confined to the pelvis.

What causes endometriosis?

Research has shown that many women with endometriosis appear to have a defect in their immune system. Other causative factors may be: spillage of menstrual blood into the pelvis through open fallopian tubes; movement of endometrial cells throughout the pelvis (and even outside of the pelvis) through blood and lymphatic systems; and the ability of certain cells to change into endometrial cells, hence endometriosis.

Does endometriosis cause infertility?

Endometriosis has been identified as a major cause of infertility. However, having endometriosis does not mean that a woman will have trouble conceiving. Some women with endometriosis conceive without trouble.

Will any medical or surgical treatment cure endometriosis?

There is no known cure for endometriosis. Hormonal and other medical treatments can be useful in most situations, such as controlling pain, but as with surgical therapies, it does not eradicate the disease. In general, endometriosis is managed most effectively with a combination of properly performed surgery and the use of appropriate medical therapies.

I have been diagnosed as having endometriosis. Do I have a greater chance of developing ovarian cancer?

No. Endometriosis is not thought to be associated with increased risk of ovarian cancer.

I have been diagnosed as having advanced endometriosis. Will I need hysterectomy?

Usually not. A maximal surgical effort in conjunction with medical and other treatments will often prevent the need for hysterectomy. Whereas the disease may not be curable, it is usually controllable.

I am 32 years old and have been trying to conceive for two years. I have been diagnosed as having advanced endometriosis. I have never been pregnant, and my partner's sperm count is excellent. Should I be optimistic that I will conceive?

Absolutely! Studies have shown that properly performed surgery can improve the chance of pregnancy in women with endometriosis. You should seek the medical support of a reproductive endocrinilogist so that you can benefit from having a specialist treat your endometriosis and your fertility concerns.

I have advanced pelvic endometriosis and severe pelvic pain. What chance do I have of pain relief after resection of endometriosis?

Approximately 50% of patients experience major pain relief, a further 30% have adequate improvement and the final 20% are not improved. Often the latter group has additional problems.

What about holistic treatments?

Diet, massage therapy, acupuncture and other holistic approaches have been used in endometriosis patients with varying degrees of success.

How common is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome affects approximately five percent of women of childbearing age, and it is a leading cause of infertility. Many more women may exhibit one or more characteristics of the syndrome.

What are the symptoms of PCOS?

Women with PCOS may have some of the following symptoms:

Abnormal lipid levels
Acne/oily skin/seborrhea
Baldness or thinning hair
Chronic pelvic pain
Cystic ovaries
Enlarged ovaries
Excess body hair
High blood pressure
Increased levels of male hormones
Infertility
Infrequent or absent ovulation
Insulin resistance, overproduction of insulin and diabetes
No menstrual period, infrequent menses and/or irregular bleeding
Obesity or weight gain

Are there other names for PCOS?

This syndrome is also known as Stein-Leventhal Syndrome, hyperandrogenic chronic anovulation, functional ovarian hyperandrogenism and polycystic ovary disease.

What causes PCOS?

The exact cause of PCOS is unknown. Some studies are looking at the possibility of a genetic link. Just as one might have a genetic predisposition to diabetes, one might also have a disposition to PCOS.

Is there a cure for PCOS?

No. PCOS is a condition that can be managed, but currently no cure exists. Treatment of the symptoms can help reduce risks of future health problems.

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