FAQs

Since infertility and the accompanying diagnosis and treatment process can cause anxiety, stress, insecurity, feelings of inadequacy and loss, it can often take a severe emotional and psychological toll on a couple. When dealing with infertility, couples should make sure they have a support system in place and openly discuss their concerns. Professional help and counseling is available to those dealing with the anxiety related to infertility.

In an IVF context, a surrogate is a woman who carries a baby for another couple. This typically happens when a woman is not able to carry a baby on her own – either because of problems with the implantation of an embryo, or because of physical problems or limitations that make it dangerous or impossible to maintain a pregnancy. They are referred to as gestational surrogates or gestational carriers. A surrogate can be a friend or family member of a couple, or can be found through a surrogacy agency or private channels. There are many legal issues involved in gestational surrogacy, so a contract is usually drawn up using an attorney that specializes in surrogacy.

Most experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile.

No, infertility is not always a woman’s problem. In about one-third of cases, infertility is due to the woman (female factors). In another third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.

Infertility in men is most often caused by:

• Problems making sperm — producing too few sperm or none at all
• Problems with the sperm’s ability to reach the egg and fertilize it — abnormal sperm shape or structure prevent it from moving correctly

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

The number and quality of a man’s sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include:

• Alcohol
• Drugs
• Environmental toxins, including pesticides and lead
• Smoking cigarettes
• Health problems
• Medicines
• Radiation treatment and chemotherapy for cancer
• Age

Problems with ovulation account for most cases of infertility in women. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods. Less common causes of fertility problems in women include:

• Blocked fallopian tubes due topelvic inflammatory disease,endometriosis, or surgery for anectopic pregnancy
• Physical problems with the uterus
• Uterine fibroids

The most fertile time of a woman’s cycle is just before or on the day of ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time. Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32-day cycle would likely ovulate around day 18 (32-14=18), while a woman with a 28-day cycle would ovulate around day 14 (28-14=14). We recommend every other day intercourse around the day of ovulation. That would mean days 12, 14 and 16 for women with 28 days cycles.

Many things can affect a woman’s ability to have a baby. These include:

• Age
• Stress
• Poor diet
• Athletic training
• Being overweight or underweight
• Tobacco smoking
• Alcohol
• Sexually transmitted diseases(STDs)
• Health problems that cause hormonal changes

Most healthy women under the age of 30 shouldn’t worry about infertility unless they’ve been trying to get pregnant for at least a year. At this point, women should talk to their doctors about a fertility evaluation. Men should also talk to their doctors if this much time has passed. In some cases, women should talk to their doctors sooner. Women in their 30s who’ve been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman’s chances of having a baby decrease rapidly every year after the age of 30. So getting a complete and timely fertility evaluation is especially important.

Some health issues also increase the risk of fertility problems. So women with the following issues should speak to their doctors as soon as possible:

Irregular periods or no menstrual periods
Very painful periods
Endometriosis
Pelvic inflammatory disease
More than one miscarriage
No matter how old you are, it’s always a good idea to talk to a doctor before you start trying to get pregnant. Doctors can help you prepare your body for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

Your doctor should do the following:
Blood tests to check reproductive hormone levels in the woman; estradiol (E2), progesterone, follicle stimulating hormone (FSH), anti mullerian hormone (AMH),luteinizing hormone (LH), thyroid hormone, prolactin, and possibly male hormone levels.
Complete semen analysis on the male partner
Hysterosalpingogram (HSG), an x-ray or a Saline Infusion Ultrasound (also called a Sonohysterogram or SHG) to evaluate if the woman’s fallopian tubes are open
Ultrasound to confirm the normal appearance of the uterus and ovaries in the woman

PCOS is a problem in which a woman’s hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS also may cause unwanted changes in the way you look. If it isn’t treated, over time it can lead to serious health problems, such as diabetes and heart disease.

• Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances.
• Early diagnosis and treatment can help control the symptoms and prevent long-term problems.
• Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.