The questions we are asked most often
We know you have lots of questions. Here are answers to questions we are asked most. If you don’t see an answer to your question or you need a deeper explanation, please don’t hesitate to contact us. We’re always happy to assist.
- Infertility Explained
- Infertility and You
- Age and Fertility
- Lifestyle Changes During Treatment
- Counseling and Support
Q: What is infertility?
A: Infertility is a treatable medical condition that results in the inability to conceive naturally.
Q: Who is affected by infertility?
A: Current statistics for the U.S. show that approximately 15 million people are affected by infertility every year, or 1 out of every 6 couples.
Q: Is infertility mostly a female issue?
A: Infertility is a medical issue and can be attributed to men and women almost equally. In fact, the latest studies show that approximately one-third of fertility cases are attributed to men, one-third to women, and the other third is related to both partners or is unexplained.
Q: What causes infertility?
A: There are many causes of infertility. For women it can include reduced ovarian reserve, endometriosis, uterine fibroids, pelvic inflammatory disease, or hormonal abnormalities, and many other issues.
For men the causes may be related to no or low sperm production, abnormal sperm, compromised sperm movement (“motility”) or blockages in sperm transport, hormonal imbalances, or systemic issues.
Issues faced by both men and women may be attributable to genetics, physical abnormalities, or to over-the-counter medicines and prescribed medications like antihypertensives, antidepressants, and other medications. Lifestyle factors like smoking and alcohol consumption can also play a role.
INFERTILITY AND YOU
Q: How long does it take, on average, for someone to get pregnant?
A: For healthy couples trying to get pregnant, it can take up to a year. If you are a woman under 30, one year without conceiving is a good point to visit a fertility specialist. There are some cases, however, where it might be advised to see a fertility specialist sooner. Women over 30 are advised to visit a specialist after 6 months of trying without getting pregnant. Persons with certain health issues should talk with a specialist when they are considering conception. Among those:
- Irregular and/or painful periods
- Endometriosis or history of endometriosis
- A history of pelvic infection or PID (pelvic inflammatory disease)
- Previous miscarriages
- Men or women who have ever had any STDs (sexually transmitted diseases)
- Anyone who has undergone chemotherapy or radiation therapy
- Men with a history of undescended testicles
- Any man who has ever experienced testicular trauma
Q: If I have been on OCPs (oral contraceptives pills) for over 10 years, how long will it take after I stop taking the pills before I can get pregnant?
A: You should begin to ovulate within 2 to 8 weeks after discontinuation of OCPs. But, like many couples trying to get pregnant, including those who have not used hormonal birth control, you may not get pregnant right away. Even without infertility issues, it can still take up to a year for a normal couple to conceive.
Q: How do I know if I’m infertile?
A: It’s nearly impossible to tell without seeing a reproductive specialist. However, if you have been trying for some time, your physician may suggest that you run some preliminary tests or may refer you to a reproductive endocrinologist. If you suspect you are at risk for or may be experiencing fertility issues, you should see a reproductive endocrinologist.
Q: What is a reproductive endocrinologist and why is important to see one?
A: Reproductive endocrinologists are generally members of the Society for Reproductive Endocrinology and Infertility, are medical doctors who have extensive training in the reproductive and endocrine systems, and specialize in fertility treatment. For many couples, seeing a reproductive endocrinologist can help to identify specific issues and treatments to increase the chances of conceiving.
Q: When should I see a reproductive endocrinologist?
A: The following are situations when it would be advisable to see a reproductive endocrinologist:
- If you are over 35 and have been trying to conceive for longer than 6 months without success
- Men and women who have a family history of fertility issues
- Women who had an early or delayed onset of menses
- Even very young women who are not planning to conceive should consider consulting with a reproductive specialist if your periods are irregular or painful
- Men who contracted mumps and/or suffered extremely high temperatures during a previous illness
- Men and women who have a family history of genetic disease
- Anyone who is preparing to undergo cancer treatments and would like to preserve fertility
- Anyone with occupational exposure to potentially hazardous materials such as toxic chemicals or heavy metals like lead
- A woman who has a history of recurrent miscarriage
Q: If I have already had children, then I can’t be infertile, can I?
A: Because there are many factors that contribute to fertility issues, reproductive problems can arise at any time, in both men and women. If you have been trying to get pregnant for longer than one year or are over 35 with no pregnancy occurring in 6 months, we recommend a complete medical evaluation.
AGE AND FERTILITY
Q: How does age affect fertility? What are the fertility rates, percentage of miscarriages, rates of genetic disorders by year? I’d like to know if after you hit 35 it’s like falling off a cliff or it’s more like a gradual but steady decline year by year.
A: A woman’s fertility begins to rapidly decline at age 35. For men, this decline begins much later, at around age 50. Age is clearly a bigger factor in a woman’s ability to conceive than a man’s. In fact, the statistics for a woman’s ability to conceive are as follows:
- Up to age 25 – only 4% of women have difficulty
- Age 26-34 – this number increases to 13%
- From age 35-39 – nearly 25% of women will find it difficult to conceive
- After age 40 – as many of 34%, or even more, will have problems getting pregnant
- After age 45 – pregnancy is very hard to achieve
Q: Can you track signs of decreasing fertility at home over time? Are there associated changes in body characteristics or menstrual cycle symptoms?
A: There are some at-home test kits for both men and women; however, it is more important that you talk to your physician about your fertility concerns, based on your age and results of your annual exams and medical history. If you have any doubt about your ability to conceive, the staff at the Texas Center for Reproductive Health can evaluate your particular case and give you guidance regarding your evaluation and care.
Q: I’m not ready to have a baby yet, but I’m getting older. When would it be appropriate to freeze eggs as a precaution?
A: Because eggs have greater reproductive potential when you are in your 20s than when you are in your 30s or 40s, freezing your eggs sooner helps increase your chance for a positive outcome later. However, eggs that have been frozen at an older age still have the potential to produce the desired results later in a woman’s life. If you know you want to postpone motherhood, you should talk to a physician specializing in reproductive medicine about egg cryopreservation. And sooner is better than later.
Q: Does age increase the risk of birth defects?
A: The risks of having a child with birth defects does tend to increase with age. A common chromosomal birth defect related to maternal age is Down syndrome. If you decide to wait until after your mid-30s or later to begin a family, you may want to consider cryobanking eggs or embryos when you are younger to enhance the chance of a successful pregnancy in the future. Many potential parents, particularly those with a family history of genetic disorders, may choose to screen embryos for chromosomal genetic defects using PGD (preimplantation genetic diagnosis). It is important to note here that there are factors other than age that are associated with birth defects, including general health, medical conditions you may have (such as diabetes mellitus), and lifestyle exposures (alcohol, tobacco, and other toxic exposures).
Q: How does the age of the mother and/or father affect the success of IVF?
A: As a general rule, egg and sperm quality and quantity decrease with age. That said, some people stay very fertile well past their 30s, and others may experience decreased fertility in their 20s and even as early as their teens. A successful pregnancy depends on both a healthy egg and sperm uniting. That is why it is important to see a reproductive specialist if you are 35 or over or if you are having difficulty becoming or staying pregnant. It is important to know if your eggs and/or sperm are healthy. If they are not, you may consider donor eggs and/or sperm to allow improved chances for conception. Once an embryo is implanted, the age of the mother and her uterus are still factors that may influence the chances of a successful birth. At the Texas Center for Reproductive Health, we take all of these factors into consideration when determining the strategy for the most optimal outcome. In some cases, the treatment we provide can improve both the egg and sperm regarding their quality and function.
Q: What is biological age vs. chronological age and which is more important to an IVF treatment?
A: Biological age is as important as chronological age in delivering optimal outcomes in an IVF treatment. There is significant variation among individuals in the rate reproductive systems age, so some patients will begin experiencing fertility issues at a time before chronological age would dictate that problems should occur.
Q: What is cryobanking or cryopreservation?
A: Cryobanking is the process of storing frozen eggs, sperm, embryos, or tissue for use at a later time. The tissue is frozen using a specialized process to store the specimens at ultralow temperatures using liquid nitrogen or nitrogen vapor. The specimen vials are then stored in our embryology/andrology lab in specially marked tanks filled with nitrogen. When it is time to use a frozen specimen, the vials containing the cells and tissues to be used will be identified and thawed using specific protocols for the type of specimen involved. Our cryofacility is monitored continually for appropriate temperature in the stored specimen containers. At the Texas Center for Reproductive Health, our expertise in cryopreservation, storage, and thaw dates back more than 22 years, and our pregnancy rates following embryo cryopreservation are excellent.
Q: Who should consider cryobanking?
A: Men or women who have been diagnosed with cancer and who will receive treatment that may be damaging to the ovaries or testes. Patients undergoing surgery or treatment that may affect the reproductive system. Women who wish to postpone parenthood. Couples undergoing fertility treatments may want to preserve eggs, embryo, or sperm for use in future IVF cycles. If you are considering the cryopreservation of reproductive tissue, we recommend a consultation with our specialist here at the Texas Center for Reproductive Health.
Q: What is the procedure like and how much does it cost for egg retrieval and the storage of sperm, eggs, embryos, or other tissues?
A: For those wishing to preserve fertility for a later date, we will collect and/or use the sperm and eggs to produce embryos and then freeze and store these cells for later use. When the appointed time comes we can thaw the tissue for use. During an IVF cycle, if there are embryos that aren’t used during that cycle, we can freeze and store them for later usage. A cryocycle with thaw of embryos and embryo transfer can take place when a subsequent pregnancy is desired. Costs for retrieval and storage of cells vary depending upon the type of cells, number of specimens, and length of storage. At your request, our staff will provide a current fee schedule. This information will also be given to you during your consultation.
Q: What are the most common treatments for infertility?
A: Of course, each couple’s and person’s treatment plan is specific to their situation. Based on your diagnosis you may require only one or a combination of treatments. That said, the treatments we utilize the most are:
- Treatment of medical conditions not previously treated
- Fertility medications to allow for correction of several different diagnoses
- Ovulation induction to help women not ovulating to produce multiple eggs to enhance fertility
- IVF (in vitro fertilization) in cases of unexplained fertility or in cases where the fallopian tubes are not functional
- Egg retrieval and ICSI in cases of male factor infertility or cases of unexplained infertility
- Surgical procedures such as removal of polyps in the uterus, fibroid tumors distorting the endometrial cavity, uterine septum, and other anatomical disorders
- Sperm retrieval in cases of male factor infertility where count is low or there is ductular obstruction
Q: Do all fertility treatments require IVF?
A: Not at all. There are many issues that can be treated without in vitro fertilization (IVF). That is why it is so important to see the right reproductive endocrinologist. We suggest you make an appointment and come in for an evaluation as soon as possible, as your diagnosis may result in successful treatment without needing IVF.
Q: What are “fertility drugs,” and how are they used?
A: Fertility medications are used in the treatment of both male and female patients. For women, they may be prescribed for help with ovulation problems, follicle stimulation, and to prepare the body to receive and accept an embryo. For men they may be given to improve sperm production and treat male issues related to hormone imbalances, infections of the reproductive tract, or erectile dysfunction (ED).
Q: Are the treatments painful?
A: Hormones and some other medicines may require administration by injection. Sometimes the tissue at the injection site becomes tender. As far as surgical treatments, we use anesthetics that are appropriate for each treatment and that we deem safe. If a surgical procedure is required, you will be properly anesthetized as with any other surgical procedure.
Q: Does IVF mean that we are likely to have a multiple birth?
A: In the last couple of years the media has focused its attention on fertility treatments that result in multiple births and the benefit of pregnancies with one fetus. Multiple gestation is associated with increased complication issues including premature labor. Prior to the transfer of your fertilized eggs, many factors are taken into consideration to determine the number of embryos to be transferred to ensure the best possibility of conception while minimizing the chance of a high-risk multiple pregnancy. For example, in women over the age of 40 or in cases where there have been 3 previous IVF cycles not resulting in pregnancy, we may recommend implanting more than the age-suggested embryos.
Q: I’ve heard I’ll be confined to bed rest during fertility treatments. Is this true?
A: Once the embryo(s) is implanted we recommend bed rest. You will rest quietly in our embryo transfer suite for about 1 to 2 hours. You will then return home where you will remain on full bedrest for 3 days, getting up only for meals or to use the bathroom.
Q: What are the chances of successful conception for us?
A: The chance a pregnancy will occur in your particular case varies depending on your age and diagnosis. What we can tell you is that here at the Texas Center for Reproductive Health we have treated quite difficult cases with positive results. Our success rates have generally been above the national average. But high success rates do not tell the whole story. We specialize in reproductive medicine and endocrinology, and we often see the most complicated cases, including couples who have had several failed IVF cycles at other centers.
Q: What medical records should I provide?
A: Any medical records that you provide are considered helpful because the information they contain assists the doctor in evaluating your health history. This includes records from your family physician as well as your OB/GYN and any other fertility specialist or physician you or your partner may have seen.
LIFESTYLE CHANGES DURING TREATMENT
Q: Can I smoke during fertility treatments?
A: It is highly recommended that both male and female partners avoid cigarette smoking during fertility treatment and at all times. Smoking is associated with an increase in pregnancy complications.
Q: Is it okay to consume alcohol?
A: It is preferable that neither partner consume alcoholic beverages during fertility treatment. Alcohol exposure to a fetus is known to increase pregnancy complications.
Q: Do I have to give up my morning cup of coffee and my afternoon caffeine drink?
A: You do not have to give up your caffeinated coffee, tea, or soft drinks completely; but it is highly recommended that you limit them to a total of two 8 oz. drinks per day.
Q: Are there any environmental adjustments we need to make?
A: There are many things we use in our daily lives that contain chemicals we don’t normally think about. You will want to avoid using pesticides, herbicides, and fungicides. Direct exposure to certain industry chemicals and petroleum products, such as gasoline, should also be avoided.
Q: What about medications?
A: It is very important that you provide us with a list of all medications—prescription, over-the-counter, supplements, homeopathic—that you are taking at your initial appointment. Most of these items are safe, but not all, such as pain relievers, antihistamines, certain decongestants, and many herbs and minerals that are found even in everyday supplements and vitamins. Together we will discuss use of these medications and supplements to maximize the chance for success in your fertility treatment
Q: I’ve heard exercise can interfere with fertility. Is this true?
A: In general, if you already have an exercise routine, it is fine to continue it. That said, there are some limitations, and because each person is different these should be discussed during your initial visit with the Texas Center for Reproductive Health fertility specialist.
Q: Can stress affect the outcome of my treatments?
A: Indeed, stress may cause problems. We will help guide you about ways to reduce your stress. It may be helpful to join or develop a support group and to attend individual and couples counseling to help you keep your perspective during this important time. We can recommend help based upon your situation and personal preferences.
COUNSELING AND SUPPORT
Q: How can a support group or counseling help?
A: By the time most couples arrive at our center, their emotions are a tangle of uncertainty and confusion, self-doubt, and even blame. No doubt you’ve heard all the “advice” and “suggestions” of well-meaning family and friends. This only serves to add to your stress levels and can add strain to a couple’s relationship. Support groups can be a tremendous help. By sharing with others who are in your situation, it is possible to lighten the emotional strain of reproduction treatment. Likewise, having a counselor with whom you can share your deepest feelings without fear of judgment will lift significant pressure from your shoulders. Finding the right emotional support can help enhance your chances of a successful outcome.
Q: Is financing available?
A: If you need help meeting fertility treatment costs, there are several financing options that may be available to you:
- Springstone Patient Financing
- Second Mortgages/Home Equity Loans
- Informal Low/No-Interest Borrowing (from friends/family)
- Revolving Credit Lines (credit cards)
- The type of financing you choose and are eligible for will depend on your individual circumstances.