Infertility can be confusing, frustrating, belittling and stressful. Understanding the risk factors, causes and treatment options can help you through this difficult process.
Our patients keep us on our toes, with challenging cases, complex treatment options and with their questions. We encourage the men and women who see us for infertility to ask us any questions they have. And boy, do they.
Tennessee Reproductive Medicine (TRM) staff members and physicians came up with the questions our patients, and prospective patients, ask us. Some are frequently asked, some are not, but should be. Some are general questions about causes of infertility and treatments, some are specific about more emotional aspects.
How do I know if I am infertile and not just unlucky?
When you (woman or couple) are doing everything right to get pregnant but start doubting that it will happen, it is a turning point for many people. The definition of infertility is a condition of the reproductive system diagnosed after a couple has had one year of regularly occurring, unprotected intercourse without establishing pregnancy.
Women older than 35 in the above scenario are considered infertile after six months. And a woman who has suffered multiple miscarriages and is under 35 years old is also defined as infertile.
The cause of infertility is approximately evenly split between men and women: one-third men, one-third women, one-third both. The most likely cause in women is an ovulation problem, and with men it’s testicle problems that disrupt sperm production or delivery.
If you fit in one of those categories, you would do best to have a specialist evaluate your reproductive system. That could be infertility specialist like us, board-certified in reproductive endocrinology and infertility (REI), or an OB/GYN for a woman and a urologist for a man. For several reasons, we recommend seeing an REI.
Can I do anything about possible infertility causes?
Yes, some people can. Infertility chances can increase due to lifestyle choices and possible environmental factors such as exposure to chlorinated hydrocarbons. Common risk indicators include alcohol consumption, smoking, being overweight or obese can effect both women and men, and sexually transmitted diseases (STDs) can affect a woman’s fallopian tubes. For a woman, advanced age is a major factor in fertility, but that’s not something you can change, though it is something we can often work around.
What are the primary infertility treatment options?
There are many options to treat infertility including in vitro fertilization (IVF), hormone treatments, intrauterine insemination, embryo donations, surrogacy and more.
- Intrauterine insemination (IUI) involves placing sperm into the woman’s uterus by means other than intercourse. The sperm is obtained from the male partner or donor. It is then counted, washed, concentrated and placed into a small syringe. A small tube (catheter) is attached to the syringe, then placed through the cervix and into the lower part of the uterus where it is deposited. The success rate of this treatment is generally moderate, but will vary by the couple, influenced by age and other factors contributing to their infertility.
- Ovulation induction procedures are oral and injectable medication treatments that involve stimulating ovulation in women who don’t regularly ovulate, which is the release of a mature egg during the menstrual cycle. The most commonly used medications for this type of treatment include Clomid (clomiphene citrate), Nolvadex (tamoxifen) and Femara (letrozole). If oral medications do not work, we may try injections of gonadotropins, including follicle stimulating hormones (FSH) and luteinizing hormones (LH).
- Superovulation induces a woman to release multiple eggs in one month. This process is also known as a controlled ovarian hyperstimulation. Women who opt for superovulation will often have to take hormone injections to encourage egg growth.
- Male infertility treatments can begin with a semen analysis to identify the problem and move on to sperm retrieval procedures, corrective surgeries or medication.
- Tubal reversal surgery is a procedure to reverse a tubal ligation method of birth control, often called having one’s fallopian “tubes tied.” The success rate of tubal reversal is 70-80 percent chance of pregnancy within a year after the surgery. IVF is another option for women who have had a tubal ligation.
- Standard IVF is one of the most talked about options for dealing with infertility and it is also the most effective treatment. With IVF, fertilization takes place in a lab (in vitro means “in glass” and refers to a lab petri dish) in order to increase the chance of pregnancy in an individual or couple having trouble getting pregnant. IVF involves a woman taking medication to increase the number of eggs she produces beyond the normal one egg per cycle. Those eggs are then retrieved and fertilized in the lab. One of the resulting embryos is implanted into the uterus, and any others can be frozen for future use. A standard IVF cycle costs roughly $15,000 with medication included. There are different options for IVF as listed below.
What are natural and mini IVF?
- Natural cycle: A woman grows an egg without taking any drugs to enhance egg production. We harvest the egg in a retrieval procedure and attempt to fertilize it through IVF, implanting a resulting embryo in the woman’s uterus. Natural cycle IVF is the least expensive form of IVF treatment at $6,000. It is not as successful as standard IVF.
- Minimal stimulation or mini-IVF: A woman is given medication, a smaller dose than in standard IVF, in order to produce more eggs, which are then retrieved, fertilized and one of the embryos, sometimes two, is implanted into the uterus. This process produces fewer eggs than standard IVF and therefore less opportunity for embryos to develop. Mini-IVF is around $7,000-9,500, depending on the amount of medication the patient requires.
If implanting more than one IVF embryo increases chances of success, why implant just one?
The ultimate goal of IVF, and assisted reproductive technology overall, is a single healthy baby, which is why we encourage elective single embryo transfer (eSET). By implanting two embryos, you can slightly increase the chance of at least one embryo resulting in a successful pregnancy, but a pregnancy with twins can also occur, which can be more dangerous. A pregnancy of twins, triplets or more, known as a multiple pregnancy, can have many potential health problems for both the baby and mother.
Is it wrong to use preimplantation genetic testing to choose the sex of your baby?
Do you want a baby boy or girl? It’s a simple question with a complicated answer when you are using IVF and preimplantation genetic diagnosis (PGD). Sex selection, or gender selection, is done by evaluating the genetic makeup of embryos selected during the IVF process and choosing which to implant based on the desired sex of the child.
In deciding to do sex selection or not, many patients have ethical questions surrounding the choice. Some common questions we help patients consider are: What happens to the embryos that are not of the desired sex? What if the woman has a miscarriage? What if the only normal embryos are of the unselected gender?
Are IVF success rates the best way to evaluate a fertility clinic?
While TRM has some very high success rates, it is not fair to focus solely on numbers. We take the time to make sure there is a clear understanding of the chances and the challenges a patient may face when dealing with infertility. We do not turn away individuals who have poor prognoses due to FSH or anti-Müllerian hormone levels, or previous failed IVF attempts. We have no strict guidelines on helping older women who have less chance of pregnancy attempting IVF, but handle such cases on an individual basis, carefully weighing the issues with each woman.
At TRM we want to make sure we are doing what is best for the patient, regardless of the revenue it might generate for the clinic. Some clinics may encourage patients to try IVF first when a less aggressive treatment may be successful, and less costly for the patient. Because of actions like these, it is difficult to compare clinics based on success rates.
Numbers cannot capture all aspects of infertility treatment and the nuances of success. Numbers cannot measure the education shared with a patient. They cannot quantify the satisfaction with the choices patients made or opportunities given. Most important, success rates cannot measure the patients’ satisfaction with their choices, no matter the final outcome.
I’m having trouble talking about my infertility. What can I do?
As with most difficult situations, honest and loving communication is important. Whether you are talking with friends, family or your partner, being open and clear about your struggles is vital. Infertility can feel very lonely. Talking about it helps minimize that loneliness.
Infertility strains relationships, as it deals with the loss of a dream. A couple or individual has a dream of a family and are dealing with that loss when infertility steps in. Infertility often feels like a secret loss, as there is something lost that is not tangible. Not talking openly about these issues can be emotionally damaging – to the individual and the couple.
There are additional layers of struggle, as infertility deals with the often-taboo topics of sex and money. These two common stressors come together in the most unfortunate of circumstances. It is crucial for couples to not allow their infertility struggles to become an obsession or turn to blaming one another.
Tricia Henderson, LPC-MHSP, stresses the importance of honesty, “Be open about your emotions and talk about where you need support and what that support looks like. Your partner doesn’t know how to help support you without you telling him or her. If you need to seek couples counseling or counseling on your own, it isn’t admitting defeat. It shows your strength.”
Discover more tips on coping with infertility in a relationship in these blogs: Couples Counseling When Infertility Dashes Their Dream and Coping with Infertility by Addressing Shame, Couples Communication & Fielding Others’ Questions.