Questions and Answers

Infertility affects approximately one in eight couples in the United States, or about 15% of the population.

Infertility is found in both men and women, and it affects nearly an equal number of men and women. Approximately one-third of infertility is attributed to the female partner, one-third is attributed to the male partner and one-third is caused by a combination of problems in both partners. However, about 20 percent of infertility cases remain “unexplained” even after a full diagnostic work-up.

If the woman is under the age of 35 and has been trying to conceive for more than one year, we recommend that the couple consult a fertility specialist.

If the woman is over the age of 35 and has been trying to conceive for more than six months, we recommend that the couple consult a fertility specialist.

Symptoms for women can include:

• Abnormal, irregular or painful periods
• No periods
• Skin changes, including more acne
• Changes in sex drive and desire
• Dark hair growth on the lips, chest and chin
• Loss of hair or thinning hair
• Unexplained weight gain
• Hot flashes
• Painful intercourse or inability to have intercourse
• Milky breast discharge

Symptoms for men can include:

• Pain, lump or swelling in the testicles
• Problems with erections and ejaculations
• Small, firm testicles
• Changes in hair growth
• Changes in sexual desire

Yes. Age is the single most important factor that influences a woman’s fertility. A woman is born with all the eggs she will ever have. As a woman ages, her eggs also age, and they diminish in quantity and quality. Currently, there are no methods or treatments available to stop or reverse that process. At age 30, a woman’s chance of conceiving each month is about 20 percent. At 40, it’s about 5 percent.

A fertility evaluation should begin with a medical history of both the female and male partners. Both partners will then be asked to undergo a physical exam, including a gynecological exam and pelvic ultrasound for the woman.

A semen analysis will be performed on the man, and a hormone screening will be performed on the woman.

A woman may also undergo an evaluation of tubal patency (whether the fallopian tubes are open or blocked) and the uterine cavity.

The most common treatments for infertility are intrauterine insemination (IUI) and in vitro fertilization (IVF). The fertility specialist will evaluate each couple individually and discuss a personalized treatment plan with each couple based on their specific circumstances. In some cases, reassurance may be all that’s needed.

Infertility affects approximately one in eight couples in the United States, or about 15% of the population.

It typically takes 2-4 weeks to prepare for IVF, and the stimulation phase entails about 8-10 days of fertility shots and an egg retrieval is performed 2 days later.

Most patients do not report significant discomfort during the IVF process. Some women may feel bloating during the ovarian stimulation phase, and light bleeding or cramping may occur after egg retrieval.

Given streamlined changes in the process, most patients tolerate the process really well. We rarely see ovarian hyperstimulation these days, since we changed our medication protocols. Since we use sequencing technologies to identify healthy embryos, we can now avoid twins and triplets. In other words, aside from bloating and inconvenience, IVF is now really well tolerated.

Given the decline in egg quality that occurs with age, women who are older or who experience premature ovarian aging often take more attempts to produce a healthy egg. By maintaining a healthy life style, a healthy body weight, and a focus on health and wellness, success rates can be optimized.

At RMA of New York, gametes and embryos are stored in our andrology and embryology laboratories. Eggs, sperm, and embryos are stored in liquid nitrogen. The duration of time gametes and embryos are frozen does not affect the success rate of the procedure using the frozen specimen. At RMA of New York all frozen specimens are located on-site in a secure room equipped with a 24-hour-a-day, 7-day-a-week alarm-monitoring system to alert embryologists regarding any change in temperature.

Historically, embryos were transferred after 3 days post retrieval, because our ability to culture embryos beyond this point wasn’t efficient. Today, given advances in culture techniques and clean room technology, most top centers are able to culture until the blastocyst stage (day 5-7). Extended culture enables us to better select embryos for transfe,r as they are at a more advanced stage of development. An additional benefit of extending culture to the blastocyst stage is that placental cells (trophectoderm) can be biopsied and analyzed, allowing us to confirm that the healthiest embryos are the ones selected for transfer.

No, IVF can be used with donor sperm – which freezes and thaws well – or a patient can opt to use an egg donor if necessary for a successful outcome.

No. Women lose the same number of eggs each month regardless of any medications that alter how many fully mature and ovulate (or are retrieved during an IVF cycle). Fertility drugs rescue more eggs that are destined to die off (called atresia) that month. Incidentally the converse also holds in that oral contraceptive use, which prevents an egg from ovulating altogether, doesn’t protect eggs from being lost each month. Use of fertility drugs and oral contraceptives don’t affect the age at which a woman will reach menopause (when eggs have been depleted).

The human reproductive process is inherently inefficient. Some eggs are immature. Some mature eggs won’t fertilize normally. A proportion of embryos arrest – presumably due to some inherent abnormality in the embryo. A proportion of embryos that do well in culture are genetically abnormal. So while the number of eggs necessary to achieve a live birth depends in part on a woman’s age, the fact remains that in all women most eggs will not lead to live births. Also, importantly, extra embryos can be frozen for future use. This enables more than one attempt at pregnancy per egg retrieval in many cases, and more than one child from one retrieval cycle if extra embryos are available for cryopreservation.

Consider a couple that has been recommended to do IVF. So the first thing they must ask the IVF specialist is, "Why are they undergoing IVF?" Is it due to sperm factor since the sperm count is low? Is it the result of several failed attempts or what we call unexplained infertility? Is it because the tubes are blocked, there is endometriosis, or advanced age? It is important to understand the indication. Then one can ask: Is IVF really necessary or can intrauterine insemination be performed if it's just a question of lack ovulation?

These tests will be undertaken to evaluate your heath - blood sugar level, check blood group, presence of sexually transmitted infections and liver damage among others.

For women, the doctor will make sure that your body is healthy enough to carry a pregnancy to full term. They may be required to undertake a series of tests to rule out PCOS, ovulation status, and ovarian reserve. Men may also undergo a series and semen analysis before starting IVF treatment.

Is it a short-cycle IVF or a long-cycle IVF? There are different types of stimulation. In a short cycle, the stimulation is short, fewer eggs are produced, and IVF is performed. In a long cycle, the woman takes the medicines for a longer time and get more eggs.

The IVF specialist should be able to provide a general sense of whether or not the treatment is likely to work based on your disease history, fertility rate, blood tests, weight and overall health.

It's a matter of determining the most viable option for you. Both procedures can result in a clinical pregnancy depending on the case.

Your doctor will make more specific recommendations based on your personal medical history, but there are a few things you may do to increase your chances. For example- doing low intensity exercise, eating well, maintaining healthy weight and BMI for your age and height.

Are you going to do pre genetic diagnosis of the embryos? Suppose there's some genetic or inheritable disorder or the mother’s age is old, then are you going to do pre-genetic diagnosis? This means that the embryo itself is genetically screened.

This is commonly known as FET or frozen embryo transfer. Presently the majority of people are undergoing FET they are not transferring the embryo within the same cycle.

Increase intake of substances such as alcohol, tobacco and smoking hamper the reproductive health. Therefore, it is advised to strictly keep off smoking and alcohol. Also ensure to keep your stress levels low because high cortisol (stress hormone) levels can make it difficult to conceive.

In women with PCOS, Ovarian hyper-stimulation syndrome (OHSS) is a possibility. Some women may also experience minor side effects such as fluid discharge, mild cramps, bloating, and constipation due to regular hormonal injections. If you experience any unusual symptoms such as fever, severe abdominal discomfort, headache, swelling, or redness in your legs, you should contact your doctor immediately.

Is it going to predispose to cancer of the ovary or are the hormonal effects going to be permanent. In other words, what are the long term effects of IVF treatment?

While, advanced technology has resulted in more couples conceiving in the first cycle itself, the success rate of IVF is not 100 per cent. If first cycle of IVF may not result in a pregnancy, you may be able to attempt again at a later period, depending on the cause of the treatment's failure.

Inquire with your doctor about the specifics of what is included in each treatment cycle as well as any additional costs on medicines, surgeries and if they have any instalment options and other schemes to ease the financial burden.