Infertility FAQs

Title / Fertility Question Answer
FACT 1: Infertility is the inability of a couple to conceive after a year of unprotected intercourse (six months for women over age 35) or the inability to carry a pregnancy to term. - Fertility Facts
FACT 2: Approximately 15 percent of couples, or one in six, are faced with infertility. - Fertility Facts
FACT 3: Infertility affects 6.1 million people in the United States - about 10 percent of the reproductive age population. - Fertility Facts
FACT 4: Nationwide, millions of women are undergoing infertility treatment. - Fertility Facts
FACT 5: Infertility is a female problem in 35 percent of cases, a male problem in 35 percent of the cases, a combined problem in 20 percent of cases, and unexplained in 10 percent of all cases. - Fertility Facts
FACT 6: Almost 50% of all couples have more than one cause for infertility. - Fertility Facts
FACT 7: Lifestyle issues such as stress, age, smoking, alcohol use, drug use and even nutritional deficiencies can affect fertility. - Fertility Facts
FACT 8: The majority of infertility cases (85-90 percent) are treatable with medication or surgery. - Fertility Facts
FACT 9: The first IVF procedure was performed in the U.S. in 1981 at the Jones Institute for Reproductive Medicine, Eastern Virginia Medical School. Since then, more than 114,000 babies nationwide, and nearly one million babies worldwide have been born as a result of IVF. - Fertility Facts
FACT 10: Approximately 82 percent of pregnancies achieved through IVF result in live birth. - Fertility Facts
If my frozen embryos are with another clinic, can a different doctor perform IVF? If you have frozen embryos at another facility, you can have them shipped to a different clinic to undergo a frozen-thawed embryo transfer with another doctor.  This is commonly done across the country and can be arranged through most fertility clinics and storage facilities. Contact Us for more information. Change Fertility Clinics
Do you review prior testing or start from scratch? Conceptions would not "start from scratch". We would review all your prior testing and treatment responses and decide if any further evaluation is needed. Treatment recommendations would be based on that. Contact Us for more information. Change Fertility Clinics
What Financial & Insurance Options are available? The first thing to keep in mind is that often times some of the costs (initial evaluation, some of the testing, and sometimes medications, etc.) may actually be covered by your insurance.  In fact, some people have insurance coverage for the actual IVF procedure.  Some states have mandates that require some or all of infertility evaluation and treatment be a covered benefit.  Thus, it is incredibly important to call your insurance company or talk to a fertility billing specialist about potential benefits.  This can reduce the cost significantly and individual policies may vary.  At Conceptions, we take most insurance policies and our billing department would be happy to discuss your individual situation over the phone. Also, keep in mind not everyone needs IVF and sometime less invasive and less costly treatments, such as intrauterine insemination, are completely appropriate. More information on our Insurance & Financing Page. Cost / Insurance / Financing
How long should I wait after  breastfeeding before starting another IVF cycle? It is recommended to wait a month after you wean before beginning another IVF cycle.  If periods have already returned, this should be sufficient.  If still not menstruating, then sometimes it can take a little longer to resume  periods.  However, it is technically not required to be menstruating before you start treatment.  It is simply best to avoid starting the IVF medications while you are still breastfeeding.   IVF (In Vitro Fertilization)
Do you do frozen-thawed embryo transfer?   Yes More information on our Cryopreservation Page. IVF (In Vitro Fertilization)
Is acupuncture recommended before an IVF cycle?   Acupuncture can be very helpful for women undergoing an IVF cycle. There are several good studies published in this area, most of which are supportive. The acupuncturist can provide a recommendation on number of treatments required. Most women begin treatment before their IVF cycle, continue through the cycle, and have acupuncture performed before and after embryo transfer. More information on our Complementary Medicine Page. IVF (In Vitro Fertilization)
How long are non-implanted embryos kept frozen? Frozen (cryopreserved) embryos can stay frozen indefinitely.  They will "behave" like the embryo at the time is was initially frozen once they are thawed, meaning they do not really "age" in a liquid nitrogen tank More information on our Cryopreservation Page. IVF (In Vitro Fertilization)
Are IVF injections ok to do if a cyst exists on the ovary? If the cyst is small, "simple" (filled with clear fluid), and not producing estrogen, it is probably safe to proceed with IVF.  Different doctors have different thresholds for defining small. Other reassuring signs would include a thin endometrium at the screening ultrasound. Cysts can be problematic if they are estrogen producing or if they are large. Large cysts could prevent good follicular development on that ovary or increase your risk for ovarian torsion (twisting of the ovary). IVF (In Vitro Fertilization)
How many follicles can I expect from my ovaries?   In general, a total antral follicle count (resting follicle count) of 10 or greater between both ovaries is considered normal.  If you have at least 5 or 6 on the one ovary, that would be acceptable. The odds of pregnancy in IVF go up with a larger number of eggs retrieved.  Even if the number (quantity) is a little lower than usual (maybe due to only having one ovary), if the quality is good, you can still be successful. More information on our In vitro fertilization (IVF) Program Page. IVF (In Vitro Fertilization)
How do you treat male infertility from anxiety issues and retarded ejaculation?   It is recommended to see a male infertility specialist (urologist specializing in male infertility). He or she may be able to assist with evaluating the ejaculation concerns. Sometimes other mind-body approaches such as counseling, acupuncture, etc. may be helpful, especially if there is anxiety. There are surgical procedures available to extract sperm (PESA, MESA, TESA) but they are fairly invasive and those specimens can only be used in conjunction with IVF. More information on our Male Infertility Page. Male Infertility & Vasectomy
What options are available after a vasectomy?     Options for treatment after a vasectomy include IVF with a sperm extraction procedure (called a MESA), donor sperm inseminations, vasectomy reversal, or adoption. The success rates for vasectomy reversal vary and depend on the surgeon doing the procedure, length of time from initial vasectomy, etc. Other things to consider for the best treatment option include the age of the woman and timeframe for conceiving. If a woman is older (35 and up) and/or has abnormal ovarian reserve testing, then the best option may be IVF since the time to conception is the quickest with this route. More information on our Male Infertility Page. Male Infertility & Vasectomy
After how many miscarriages do you recommend looking into IVF? This is actually a fairly controversial topic.  For women with recurrent pregnancy loss (defined as 3 miscarriages although as noted by the American Society for Reproductive Medicine, evaluation may be recommended after 2 losses), the causes are manifold.  These include but are not limited to genetic abnormalities,  autoimmune disorders, anatomic abnormalities, hormonal abnormalities, and possibly clotting disorders (again, controversial). Typically we would first initiate an evaluation for the specific cause of the miscarriages as IVF may not be the best treatment.  For some women with unexplained recurrent miscarriage, IVF may be helpful.  The studies are mixed in regard to the actual benefit from an obstetric standpoint.  Most miscarriages are due to the embryos being chromosomally abnormal.  We have new technology that is now able to test the embryos during IVF before we replace them in the uterus (called preimplantation genetic screening).  Because this technology now is able to screen all the chromosomes, it has the potential to improve the ultimate live birth rates for women in this situation. Previously, the technology was limited to a procedure called "FISH" which was only able to screen about half of the chromosomes. Miscarriage
Can you tell me about AMH levels and miscarriage? AMH is a marker for ovarian reserve.  It is an indirect way of evaluating how well the ovaries are working.  The most common cause of miscarriage is chromosomal abnormalities, which can go hand in hand in women with diminished ovarian reserve.  Typically, we like to see the AMH level > 2.0 (it depends on the lab) and 1.0 - 2. 0 is generally low.  An AMH below 1.0 is rather consistent with diminished ovarian reserve and may very well increase the likelihood of miscarriage due to chromosomally abnormal eggs. Miscarriage
Bleeding in Early Pregnancy Bleeding and cramping in early pregnancy can be very scary. What many patients don’t know is mild spotting and cramping is relatively common in the fertility treatment world. The following IS cause for concern and should be discussed with a healthcare provider- heavy bleeding that saturates a maxi pad every hour, passing clots, extreme cramping, 10/10 pain unrelieved by Tylenol, rest, and change in position. If you are experiencing these symptoms, contact your healthcare provider for further evaluation.

Subchorionic Hematoma (SCH)- like a bruise (accumulation of blood) between the placenta and the uterus may cause mild bleeding, might be seen on your initial ultrasound, and typically resolve on their own.
Miscarriage/Bleeding in Pregnancy
How long should I try to conceive before contacting a fertility doctor? Typically the recommendation for waiting one year is intended for women who have regular cycles, ovulate regularly, and are less than 35 years old.  Occasional months without ovulation should also lead to a visit with your ob/gyn or fertility doctor.  If you are 35 years or older, it is recommended to see a physician for evaluation if you have not conceived after 6 months of unprotected intercourse with regular cycles.  If you are 35 and your cycles are irregular, or you have a family history of early menopause, you should see a physician right away. Trying to Conceive / When to contact a Fertility Doctor
How long should someone wait before they seek specialized infertility care?  Is it safe to assume that age should play a role in our urgency in asking for your advice? A woman's age plays a huge role in her fertility.  The typical recommendations are to seek care after one year of unprotected intercourse if the woman is less than 35 years old (and having regular cycles).  For women aged 35 and older, we recommend being evaluated after 6 months of unprotected intercourse.  These are the typical recommendations by the American Society for Reproductive Medicine.  In addition, any woman age 40 and older should seek evaluation sooner as fertility substantially declines for most people in this age group.  Keep in mind being evaluated doesn't necessarily mean you will need to start treatment. Trying to Conceive / When to contact a Fertility Doctor
What can I do if I've had primary ovarian insufficiency (previously called "premature ovarian failure" or "early menopause")? Primary ovarian insufficiency was previously called "premature ovarian failure" or "early menopause".  The most common cause is autoimmune and the clinical symptoms can actually fluctuate throughout your life.  There is about a 10% lifetime chance of spontaneous pregnancy after you are diagnosed with ovarian insufficiency.  There are several other health concerns associated with this and some genetic testing that should be done.  Fertility potential could be assessed by blood work and an ultrasound.  It is highly recommended that someone with this see a reproductive endocrinologist (infertility doctor). This is a relatively rare situation and is best served by seeing a specialist who has significant experience with treating it.  In general, the best treatment for fertility it utilizing IVF with donor eggs. Trying to Conceive / When to contact a Fertility Doctor
Does excess weight affect fertility? Weight certainly plays a role in fertility.  There are multiple studies showing a decline in pregnancy rates with increasing weight and obesity.  In addition, the miscarriage rates are higher.  Excess weight loss with lifestyle intervention through diet and exercise is typically recommended. Even losing 5% of your body weight can be helpful. Trying to Conceive / When to contact a Fertility Doctor
Do you recommend temperature charting? Temperature charting can be helpful to establish whether a woman has ovulatory cycles.  However, temperature charting can be difficult and frustrating.  I would try using ovulation predictor kits (over the counter) to better time intercourse. Trying to Conceive / When to contact a Fertility Doctor
What natural options are available to help our chances of getting pregnant? Keep trying on your own, monitor ovulation, adhere to a healthy weight and lifestyle, stay on your prenatal vitamins, etc. Some people use progesterone supplementation in the second half of your cycle also for luteal support, and many women feel this is more "natural" than Clomid (although this doesn't help you conceive like Clomid does). Trying to Conceive / When to contact a Fertility Doctor
How soon can a pregnancy test be done? Pregnancy tests vary but  sensitive ones can probably pick up pregnancy as early as 10-11 days after ovulation.   Read the test instructions and recommendations for further guidance. Trying to Conceive / When to contact a Fertility Doctor
Is over the counter hormone balancing cream harmful? We typically recommend avoiding the over-the-counter hormone creams since we don't know exactly how much or what you are absorbing.  You may ask you doctor to go on progesterone suppositories for luteal support.   Trying to Conceive / When to contact a Fertility Doctor
Can you help us have twins or increase our chances of a multiple pregnancy? Many ob/gyns use a fertility medication called clomiphene (Clomid).  This is used both for unexplained infertility and in women who do not ovulate regularly.  The risk of twins is about 8-10%, and the risk of triplets is about 1%.   Generally speaking, most fertility medication will increase the risk of multiple pregnancy.  Keep in mind, however, that multiple pregnancies carry more risk (preterm delivery, gestational diabetes, etc.) thus the best outcome is usually a healthy, singleton baby. Twins / Multiples
Is clomiphene (Clomid) effective for unexplained infertility? Yes, it can be.  It depends on some other factors such as a woman's age and ovarian reserve testing.  However, in general, it has been studied in women with unexplained infertility and found to be an effective initial treatment option, assuming the rest of the evaluation was normal. More information on our Unexplained Infertility Page. Unexplained Infertility & Clomid
Do kidney stones cause infertility? There are no published data finding a link with kidney stones and infertility, so it is not likely to be a cause of the infertility. Unexplained Infertility & Clomid
Does "gluten free" lifestyle help with the unexplained fertility issues? A Gluten free diet is typically a treatment for Celiac disease.  Celiac is an autoimmune disease that affects the small intestine.  It is diagnosed by blood tests and occasionally a biopsy. The primary treatment is adhering to a gluten-free diet. Several studies have shown a potential association between Celiac and infertility, although a true cause-and-effect relationship is not clear. In addition, the study results vary when looking at the prevalence of Celiac in women with unexplained infertility, ranging from 1-8% (sometimes very similar to the general population).  Screening for Celiac is not universally performed, but it could certainly be considered if the rest of the evaluation is normal (unexplained infertility), particularly if the patient has malabsorption symptoms or a history of anemia. Unexplained Infertility & Clomid
Is Clomid the only option for low progesterone?     Low progesterone levels are often correlated with a "luteal phase defect".  This means the ovulatory cyst is not producing enough progesterone to support a pregnancy.  There are several different ways to treat this, including clomid.  Other options include progesterone support or using a shot called hCG in the luteal phase (second half of your cycle).  Progesterone comes in many different forms including suppositories, vaginal gels, injections, creams, etc. Reproductive endocrinologists tend to use the vaginal routes or injections most often. Oral routes are less effective.     Unexplained Infertility & Clomid
How many tries with Clomid is appropriate?   If clomid is the appropriate treatment option, we typically recommend trying this for 3-4 cycles before moving on with another treatment plan.  The majority of patients who will conceive on Clomid will do so in the first 3 cycles.  A recent study was just published showing that the maximum benefit of intrauterine inseminations was also seen within the first 3 cycles. Unexplained Infertility & Clomid
Is clomid recommended for someone ovulating on their own?   Clomid can be used for unexplained infertility and has been shown to be successful.  However, it does not work for everyone.  It is recommended that testing be completed for ovarian reserve.  In addition, partners should have a formal semen analysis (SA).  Some other things associated with unexplained infertility may be endometriosis, Celiac disease, thyroid disease, etc. For some couples, we simply cannot identify a cause.  When Clomid/IUI doesn't work, then you might want to consider moving on to something more aggressive such as in vitro fertilization.  We can use "stronger" medications than Clomid in conjunction with IUI, but the costs go up significantly as does the risk of multiple pregnancy.  If using Clomid IUI, it is recommended to monitor with an ultrasound to measure follicular growth. In addition, this allows for a look at the lining of the uterus which can sometimes be thin in women who are on Clomid.  A thin lining could impair implantation. Another alternative to Clomid is a medicine (pill) called letrozole. Unexplained Infertility & Clomid
How much does it IVF Cost? The overall cost for an IVF cycle varies from clinic to clinic, but ballpark ranges are $10,000- $15,000.  This typically does not include the cost of medication, which can range from about $2000-$6000.  It is important to again talk directly to a billing specialist about what specifically is included in the total package cost as the items included (some pre-IVF testing, a procedure called ICSI, etc.) can vary and may not be included in the package price. More information on our IVF Costs Page. Cost / Insurance / Financing
Where can I find a Sperm Donor? There are several sperm banks available across the country.  One of the most well known and reputable is California Cryobank.  Our clinic uses California Cryobank (and others) for several patients who want or need to utilize donor sperm.  The process is relatively straight-forward and not difficult or painful. Insurance policies vary with coverage and do not always cover donor sperm inseminations.  They may, however, cover some of the evaluation and testing costs. Donor
What is the difference between a endometrial biopsy and IUI procedure?    The biopsy actual takes tissue from the lining of the uterus and thus, can cause significant cramping.  The IUI procedure is simply placing a small catheter through the cervix and injecting a small volume of fluid with sperm in it.  An IUI is much better tolerated than an endometrial biopsy for most women.   It may cause mild cramping, but nothing like the endometrial biopsy.  For women who have a very stenotic cervix (small opening), then occasionally we can prescribe medicine to help with anxiety but this is rarely needed. More information on our IUI Page. IUI (Intrauterine Insemination)
What is the difference between IUI and IVF?    IUI is "intrauterine insemination" and IVF is "in vitro fertilization".  IUI is when we prepare sperm from an ejaculate in a lab and then place a concentrated amount in a small volume of media and replace it into a woman's uterine cavity.  It is performed in the office and it not painful.  It is helpful for mild semen abnormalities, unexplained infertility, and other causes. IVF is when we place women on injections of hormones to stimulate egg production in the ovaries.  The eggs are then removed through a minor surgical procedure (no incisions), and then inseminated in a petri dish in the lab.  The fertilized eggs are grown in the lab for several days (usually 3-5) and then the embryo(s) is/are placed back inside the uterus in a procedure very similar to the IUI procedure (no anesthesia, well tolerated, takes about 10 minutes).  The reasons to undergo IVF are manifold.  IVF is more invasive than IUI but it is also much more successful for most couples. More information on our IUI Page.
More information on our IVF Page.
IUI (Intrauterine Insemination)
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