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Starting Your Infertility Treatment
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You aren't alone when it comes to seeking infertility treatment. In the United States, roughly 6.1 million men and women -- ten percent of the reproductive-age population -- are infertile. The causes are found equally among women and men, with nearly 35 percent cases of infertility caused by the woman and 35 percent resulting from the man. (In 20 percent of infertility cases both partners have complications, and ten percent of cases remain unexplained.)
The world of infertility treatments can be confusing and overwhelming, so we have created this step-by-step guide to help you understand how to get started and what to expect at every stage of an IVF treatment cycle.
The financial strain of IVF treatment can be overwhelming and add unwelcome stress to your IVF experience. Before you invest any money, we will, as a courtesy, discuss your fertility care coverage with your health insurance provider and inform you of your specific insurance benefits. When you contact us by phone or email (this can be prior to your initial consultation) we will put you in touch with our billing and insurance coordinator. He or she will do all the investigative research to determine your coverage before you consider treatment with us. Once you have a complete understanding of your health insurance coverage and our potential fees (if not covered by your insurance) we hope you will schedule your initial consultation with one of our fertility doctors. After you begin care, we will also file all insurance claims and obtain necessary pre-authorizations. Click here to see if we accept your health insurance.
Infertility can be a complicated issue and the causes are numerous. According to the Society of Assisted Reproductive Technology (SART), the most common female causes reported include tubal factor (which accounts for about 10% of all female related issues), ovulatory dysfunction (6%), diminished ovarian reserve (12%), endometriosis (5%), uterine factors (1%), and other factors (8%). In 11% of female infertility cases, the causes are unknown. While there are many causes of male factor infertility, some are seen more commonly than others are. These include blockage of sperm, infection (STD, mumps, etc.), chronic disease, erectile dysfunction (which occurs in 50% of men over 40), failure to produce sperm, exposure to harmful substances, injury, or varicocele (varicose veins in the testicle).
During your initial consultation we will complete a comprehensive fertility evaluation to help determine the cause of your infertility and the best treatment program for you. Though this is not necessary, we recommend you schedule this appointment on day 2, 3, or 4 of your menstrual cycle because it will provide us the best picture into your fertility health. It will also help us to get you started right away in case you wish to begin the process.
The Consultation: During your first consultation with one of our fertility doctors and your patient coordinator (your fertility care team), together you will discuss your medical and fertility history, any complications or issues you have been having, and your goals.
Your fertility care team will also explain IVF, the treatment options, and potential solutions to why you may be having trouble conceiving naturally. Some causes that will be discussed include:
| Ovulatory Dysfunction | Tubal Disease | Fibroids |
| Polycystic Ovarian Syndrome | Pelvic Adhesion Disease | Premature Ovarian Failure |
| Recurrent Miscarriage | Hypothalamic Amenorrhea | Hyperprolactinemia |
| Ectopic Pregnancy | | |
If your fertility doctor suspects one of these conditions, tests to determine likelihood may be recommended. Some of those tests include Post Coital Test, Diagnostic laparoscopy and an Endometrial/Endometriosis Biopsy. Click for tests, treatments and surgeries.
Infectious Disease, Hormone, Immunity and Genetic Testing: Once your consultation is complete, a nurse will draw blood for a variety of blood tests needed to determine your fertility health and possible treatment plans. These tests will check for various infectious diseases, immunities, hormone levels and genetic abnormalities that could affect your treatment as well as the health of your offspring. Our tests include the following:
| Infectious Disease Testing |
Immunity Testing |
Genetic Testing |
Hormone Testing |
Gonorrhea
Chlamydia
Cytomegalovirus (CMV)
Hepatitis B & C
Human Immunodeficiency Virus (HIV)
Human T-Cell Lymphocyte Virus Types 1 & 2
Syphilis |
Measles
German measles
Varicella
(chicken pox)
Rubella |
Cystic Fibrosis
Sickle Cell Traits |
FSH
Estradiol
LH
Progesterone |
Antral Follicle Count and Sonogram; Last, we will perform a transvaginal ultrasound (also called sonogram). This painless procedure is a small probe, much like a wand, which is inserted into your vagina. The probe emits information about your female reproductive system-your ovaries, follicles (where eggs are housed), uterus, etc. to a computer screen that both you and the doctor can see. Most women find it very interesting and informative.
Antral Follicle Count. This exam allows the doctor to count the number of antral follicles you have remaining. An antral follicle is a follicle in reserve, not ready to become mature or dominant in the month the exam is done. A follicle is a structure within the ovary that contains an egg. This test gives us an idea of how much more time you have on your fertility clock and roughly a guess at the number of potential eggs you may get each cycle.
General Sonogram. Your doctor will also look for ovarian cysts and over hyper-stimulation syndrome (OHSS), and note the thickness of your endometrial lining (we expect to see a thickness of 7mm at the time of egg retrieval) as well as the overall health of your female reproductive system.
Semen Analysis. If you are a couple planning to conceive, we will also take a sample of the male partner's semen for an analysis of sperm count, motility (movement), morphology (shape), and an analysis of the ejaculate thickness and the sperms' ability to liquefy.
You may begin treatment immediately following your initial consultation, or you might return to discuss the results of your blood tests, initial sonogram, and semen analysis (if this was done) and determine the best fertility care strategy based on your goals. If you choose to begin treatment, then we begin the process on day 3 of your next menstrual cycle.
If it is determined that you or your male partner need a reproductive treatment or surgery to repair a problem causing your infertility, those will most likely be done before an in vitro fertilization cycle begins.
Click here to see a list of Reproductive Repair procedures we provide.
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Steps of Our Infertility Treatment
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Usually on Day 2 or 3 of your menstrual cycle, you'll come to our office for a sonogram & blood test. Based on the sonogram & blood results, you might begin a cycle of IVF, in which case, on Day 3 of your cycle or sometime thereafter, you will begin a daily course of oral Clomid medication (50mg clomiphene citrate).
Sonogram. You and your doctor will immediately see, via the ultrasound computer screen, the total number of follicles and the follicle sizes inside your ovaries. This helps determine a baseline and additional sonograms throughout your cycle will help determine when your egg retrieval will be done (usually when the dominant follicles reach 17mm). We will also record your endometrial lining thickness, as a baseline for your system and monitor it through the cyle to determine the likelihood that an embryo will implant in the wall of the uterus. We will check for ovarian cysts that may affect your cycle. We will then plan to retrieve the eggs when we expect them to be 17mm in size or greater.
Blood Test. Blood tests will be performed throughout to monitor your hormone levels of FSH, Estradiol, LH, and Progesterone. The results of these tests will indicate your fertility hormone levels and determine the medication and treatment to be followed. With our in-house lab, you and your fertility care team will know your blood results the same day.
If you have not already attempted time intercourse and you wish to pursue this option prior to beginning IVF, we will help you to chart your cycle (by day and basal body temperature) and locate the window in which ovulation occurs. With this information you will begin a program of timed intercourse. Should you not become pregnant by this method, you can begin a course of IVF in the next cycle.
You will repeat these routine sonograms and blood test office visits several times until the egg is ready for retrieval. This allows us to track the growth of your follicles and likely timing of your ovulation. You will consume upto 1 oral pill of Clomid daily until your follicles have developed sufficiently for egg retrieval. For some patients, when indicated, we supplement the Clomid treatment with a small dose of injectable gonadotropins (just 3 shots of 150 IU of Menopur) on Days 8, 10, and 12 of their menstrual cycles.
When the follicles have reached the desired size and prior to ovulation, they are retrieved by needle aspiration. An ultrasound-guided needle is directed to the ovaries through the vaginal canal. The procedure is fairly painless when compared to the discomfort of a pap smear. You will have the sensation of being bitten by a mosquito each time an ovary is punctured and you can watch each egg being aspirated through the needle on a viewing screen, as we report how many eggs were collected. The actual procedure takes just 3-10 minutes depending on the quantity of eggs collected and is performed under the pain management of your choice, ranging from local anesthesia (the most common) to IV sedation or general anesthesia (which requires a longer recovery period). The procedure leaves virtually no pain after it is completed and you can, if you choose local anesthesia, carry on with your day as normal.
Your male partner has a role, albeit an easier one. Once egg retrieval is completed, we will collect the male partner's sperm, obtained by ejaculation. This can be done in convenient collection rooms in our offices or in the privacy of your home, if you live within an hour of center. If you are a single woman, a lesbian couple or a heterosexual couple dealing with male infertility you wish to use donor sperm. Our fertility care team can help you make arrangements with donor banks, prior to the egg retrieval. At New Hope Fertility Center, roughly ten percent of our patients make use of donor sperm.
After collecting the eggs, we will examine them to confirm that they are mature. If any of your eggs were not fully mature at the time of egg retrieval, we will place them in a maturation medium in our laboratory for 24-48 hours. It must be recognized that not all will mature. While most clinics do not offer this service to their clients, we are pleased to provide you with the best and most complete treatment available.
After egg collection, the eggs and sperm are brought together in the laboratory where the eggs will be fertilized with the sperm and the resulting embryos cultured for between three and five days, depending on your particular medical history and the recommendation of your doctor. Collected eggs are placed in Petri dishes that contain culture medium, which provides nutrients necessary for growth, and your partner's sperm is added (about 100,000 sperm are added to each Petri dish). Dishes are placed in incubators overnight for fertilization. When there are too few sperm or too few quality sperm to achieve fertilization, Intracytoplasmic Sperm Injection (ICSI) is used to fertilize eggs. This involves a single sperm being injected into each egg. Learn more...
After ICSI or fertilization by other means is complete and embryos are created, Laser-Assisted Hatching is performed on each embryo in our labs. An embryo that has been transferred to the uterus must "hatch" or escape from the Zona Pellucida (the protective shell of cells surrounding the embryo) before it can implant for pregnancy. The technique of Assisted Hatching has been developed to enhance implantation during the hatching process.
If you elected for Preimplantation Genetic Diagnosis(PGD) or gender selection, it will be done during the assisted hatching stage. Learn more...
If, based on your clinical history, your doctor has recommended that your embryos be cultured for five days, we will perform "embryo selection", when, the embryos have reached the blastocyst stage on the fifth day, Embryo selection allows us to select the best quality embryos to transfer. Selection is the only advantage of blastocyst culture, and this selection has nothing to do with the specific traits of the resulting baby, but rather just with the viability of the embryo to undergo gestation and live birth. More...
The embryo transfer is a simple procedure needing no incision and no medication. You'll come back 3-5 days after the eggs are retrieved to have the embryo(s) placed very simply into the uterus through the cervix with a tiny catheter. They are then injected gently into the uterus. It takes only a few minutes and is usually about as uncomfortable as a pap smear. An hour later you are able to go home. There is no pain from the procedure. If there are more than two or three embryos, you can choose to freeze them for later transfer, which adds to your chances of pregnancy. Learn more about freezing embryos for your Embryo Bank...
A pregnancy test is performed two weeks after the transfer. An ultrasound scan is usually scheduled two weeks after a positive pregnancy test to confirm the on-going pregnancy.
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