If you have been having trouble conceiving and your doctor recommends that you should get help, request a referral to an endocrinologist. Keep in mind that although Assisted Reproductive Technology (ART) has advanced and improved with time, that a recent study by the CDC in 2014 showed that only 1.6% of babies born in the United States were conceived using ART. ART is incredibly expensive, and not guaranteed to be successful.
Therefore, you should take some time to consider whether this is an option that you are able to invest your time, finances and emotions into. The good news is that 15 states have laws that require health insurance companies to provide some coverage for fertility treatments. They are:
- 10.New Jersey
- 11.New York
- 13.Rhode Island
- 15.West Virginia
This article’s purpose is to provide you with current ART procedures that are used, along with their descriptions, benefits, risks,approximate success rates, and average costs. Feel free to explore the links that provide access to very accurate and useful information.
8 Fertility Testing
Here are some basic procedures that you can expect to have done at the OB or specialists office to evaluate if you are suffering from any impairment known to impede fertility.
- A physical and pelvic exam, including a pap smear. This will detect any abnormal cells in your cervix and STD infections.
- Blood test-to check your thyroid, hemoglobin, hormones
- Ultrasound-to check the follicles (sacs in the ovaries that are stimulated by hormones that cause ovulation), and to examine your cervix and uterus
- Hysterosalpingogram (HSG) a 5-minute x-ray examination (fluoroscopy) that uses dyes inserted vaginally to check your uterus and fallopian tubes for injuries such as blockage, scarring, polyps, and fibroids.
- A physical exam-checking the penis, scrotum, and testes. A swabbing sample is taken from the top of the penis
- A semen analysis-to check for low sperm count and quality
- Having a blockage in his reproductive organs from allowing sperm to flow out
Habits known to cause infertility
- Obesity or being overweight- Not maintaining healthy eating habits causes risk of diabetes, which can cause up to 10% of infertility in men, and produces too much estrogen in women-causing up to 30-40% of the population to not ovulate on a regular basis.
- Smoking nicotine/marijuana it ages your eggs, and causes low-quality sperm/sperm count.
- Alcohol-Very heavy or binge drinking disrupts normal ovulation cycles, giving lesser probabilities in conceiving
Conditions known to cause infertility
- Age- Fertility declines with age, particularly around the mid 30’s.
- Untreated STD’s, especially chlamydia and gonorrhea-causing 40% to develop PID. (see below)
- Pelvic Inflammatory disease-an infection of a woman’s reproductive organs, mostly caused by STD’s
- Endometriosis- when tissues from the uterus spread to other parts of a woman's reproductive organs during menstruation
- Fibroids-benign tumors that grow within the walls of the uterus
- Ovarian cysts- fluid filled sacs that grow within or on top of the ovaries, causing irregular menstruation
- Polycystic Ovarian Syndrome-a very common condition of infertility where the ovaries produce too much testosterone, leading to consistent & unexplained weight gain or obesity, acne, hair growth, and an inability to ovulate.
- Thyroid disorder- it can disrupt ovulation cycles so maintaining healthy thyroid levels are crucial and can be treated with medication
- Irregular Menstruation
- Radiation and chemotherapy used to treat cancer
- Being exposed to toxic environments
- Scrotum Varicocele-veins around a testicle that disrupts sperm production
- Erectile dysfunction
- Blockage of a man's reproductive track, so no sperm is found in his semen
- Retrograde ejaculation-where semen does not flow out from the penis
7 Some Basics About Assisted Reproductive Technology
There are about 460 fertility clinics throughout the United States that are part of the Society of the Assisted Reproductive Technology (SART). About 90% of all fertility clinics belong to SART, and it is highly advised that you seek assistance from clinics that are apart of this organization.
The reasons for this are that these clinics are one, they are professionally licensed and accredited by the American Medical Association (AMA), and two, they provide data reporting on their success rates where you can easily access through their website.
Be very cautious in how you interpret the results, as the #1 factor that attributes to the success of an ART procedure is a woman's age. Other varying factors include a woman’s overall health and cause of infertility, reproductive history,quality of the eggs and sperm, whether the eggs are used frozen or fresh, or whether they are from a donor.
Keep in mind that yes, some clinics have professionals that are more experienced and skilled than others.
Some clinics have more patients or do more IVF cycles than average. Also, other clinics also are more likely than others in declining patients whom they predict will have low chances in successful fertility.
There are varying aspects of a fertility clinic that make their outcomes successful, so choosing a clinic based solely on their birthrate numbers is not ideal or recommended. FYI please read an article posted on the CDC website that shows you how to read a Fertility Clinic Table here
- The SART website states that about 15% of couples struggle with infertility
and about6.7 million women are foundto be infertile. According to the CDC, the most recent research completed in 2014 showed that there were over 208,786 ART cycles done resulting in 57, 332 live births.
6 Medications You Need to Know About
If you decide to try ART procedures, your doctor will likely prescribe you medications to instigate healthy ovulation cycles. Here are some common meds that your doctor will likely prescribe to you during this process.
- Clomid/Serophene- known to elevate levels of follicle stimulating hormone (FSH) and (LH) luteinizing hormone to cause a woman to ovulate and produce fertile eggs. It is usually prescribed at 50 mg on the 3rd to 5th day of your period.
- Hormone injections- done by yourself with a mix of hormones prescribed by your doctor. You use the syringe to insert the medication(s) in your buttocks, stomach or thigh. Injections have the same goals as Clomid, but are done as a more intensive step to get the ovaries to work. Here are some hormones that your doctor may elect you to receive
- -Progesterone- improves the lining of your uterus
- -HcG- the pregnancy hormone detected in your blood and urine after conceiving helps in beginning ovulation
- -Human Menopausal Gonadotropin (hMG)- acts on the follicles in the ovaries and stimulates them for women who do not ovulate regularly
- -Gonadotropin Releasing Hormone Agonists (GnRH agonist)- works in on the pituitary gland and prevents the ovaries from releasing eggs too early
- -Gonadotropin Releasing Hormone Antagonist (GnRH antagonist)- work faster than agonists and prevents a pre-mature LH surge
5 Surgery is also an option
Doctors are depending much more and more on IVF procedures to achieve pregnancy and live birth. However,if you are suffering from anatomical complications in your reproductive organs-such as the cervix, uterus, and vagina, surgery is a very good solution and may enable you to conceive naturally. Here are some complications that can be fixed with surgery:
- Tubal ligation
- Scar tissue
- Endometrial lesions
- Benign tumors
4 In Vitro Fertilization (IVF)
This is the most used procedure and constitutes 99% of ART procedures couples use to conceive. It is a costly procedure, averaging $12,400. You can expect to pay another 3k to 5k for medications. Success rates vary, but the most important contributing factor is age. Here are some of those success rates provided by American pregnancy.org.
Under 35 41-43%
- Success has increased with advanced practice and time. There is a 30% chance of success currently compared to 10% 10 years ago.
- Studies show that 1 in 100 babies are born using ART
- Multiples of triplets, quadruplets (4’s), quintuplets (5’s) are down to a 1% likelihood, based on the preference of patients.
How it is conducted
- It is a 4-6 week process
- You are given hormone shots between days 12-14 of your cycles
- Eggs are received transvaginally with a needle that is poked into the follicles within the ovary, under the guidance of an ultrasound. It takes between 30-40 minutes
- The eggs are evaluated and chosen based on their grades.
- Your partner needs to provide a sperm sample
- They are fertilized in the lab by mixing sperm and egg with an 80% success rate
- You and your dr will decide how many embryos you would like to implant, according to the ASRM, typically it is 1-2 embryos in women younger than 35, 2-3 embryos are transplanted in ages 35-37, no more than 4 for 38-40, and 5 is the max for 40+
- 3 OR 5 days later your doctor will insert a catheter into your vagina and with a syringe inserts the embryos into your uterus. The other embryos can be saved for future cycles, called cryopreservation.
- You will recover in the office and be sent home on the same day 1-2 hours later, you should limit your physical activity for the next 24 hours
- It will be another 2 weeks before you can take a blood or pregnancy test
Risks and Side Effects
- Feeling tired
- Your doctor can elect to cancel the procedure for various reasons. See them here.
- Miscarriage rate is up to 60%+ for women 44 and older, 29% at age 40,15% for women under 35
- Mild to Moderate cramping/pain
- Rare pelvic infection (but is cured with use of antibiotics)
- Nausea or vomiting
- Ovarian hyperstimulation syndrome
- Having multiples (multiples increase pregnancy risk such as hemorrhaging, necessary C-section, gestational diabetes, premature birth)
3 Techniques that Take Extra Steps in Addition to IVF
For couples who have failed to conceive on their first cycle of IVF, your doctor may recommend an “add on” procedure for future cycles that can help them achieve success. There are other more invasive procedures than IVF, although they are rarely used.
- The outer shell (zona pellucide) of an embryo is softer when it is naturally conceived opposed to when it is done in the lab. The softer the shell is, the easier it is for cells to “hatch” and multiply.
- Embryos with hard shells can be a cause for IVF failure
- With the use of a laser, makes a tiny hole in the shell of an embryo to allow the cells to emerge and attach themselves to the walls of the uterus.
- Costs are anywhere from $400-$1000 more.
Intracytoplasmic Sperm Injection (ICSI)
- Commonly used for complications of sperm. This could mean a low sperm count or disfigured sperm
- Costs an extra $1500
- Instead of mixing egg and sperm, a single sperm is slowed down with a chemical(to make it easier to catch) injected into an egg that is “washed” and shed of its hard protective coat.
- Hopefully successful fertilization will occur.
Gamete Intrafallopian Transfer (GIFT)
- Eggs and sperm are received identically to IVF
- More expensive and intensive, costing $15-20K, but with a higher success rate of 36% for pregnancy and at 82% for live birth
- It allows fertilization to occur naturally by mixing eggs and sperm and immediately injected into your abdomen, (laparoscopically) and placed within the fallopian tubes.
- Fertilization is hoped to have taken place in its natural setting which is perceived to be healthier, than in a laboratory.
Zygote Intrafallopian Transfer (ZIFT)
- Similar to IVF and GIFT but eggs are fertilized in the laboratory but placed in the fallopian tubes a few hours, later on, the same day
- Fertilization has been guaranteed to have taken place
- Recovery period, cost and success rate is the same as IVF
2 Egg Donation - Fresh or Frozen?
Freezing your eggs, or cryopreservation is a good idea to do if you plan on using them at a later date as fertility takes a rapid decline during your mid 30’s. Expect to pay about $10k to harvest your eggs and another $5k when you are ready to transplant them into your ovary. Here are some quick and recent facts about eggs.
A donor can be received at either a sperm bank or a fertility clinic, where he gives up all parental rights to his biological children. Here are some quick facts about sperm donation.
- Very easy to collect and non-invasive
- Are screened for STD’s, genetic diseases, and chromosomal abnormalities
- Can be done by masturbation or by using a special condom during intercourse
- Cryopreservation is possible up to 20 years
- Extracting sperm is definitely cheaper and easier than egg extraction
- Can be done through artificial or natural insemination.
This is a very expensive procedure, costing about $100,000-$150,000 on average, and has been a way for gay couples to conceive a child that is related to them. There are two different types of surrogacy, including:
- Commonly used for women who have problems with their uterus, who have had a hysterectomy, which is the removal of the uterus, or those who have a very low chance of becoming pregnant, but still have viable eggs.
- A woman uses her own eggs and her partner’s sperm using IVF procedures
- The baby is not genetically related to the surrogate in her own way
- It is used more throughout the U.S. as the baby is genetically tied to both intended parents, making legal issues less complicated.
- A woman uses her own eggs and is artificially inseminated through IVF from the semen of the father-to-be.
Keep in mind that if you do decide to receive some help, to be responsible and to research all your options very thoroughly. Do not be afraid to ask questions, or get a 2nd or 3rd opinion before you select your doctor and/or fertility clinic. Be sure to consult your insurance company, if you live in one of the 15 states that provide coverage and acquire exact numbers to determine your expenses.
This will most likely be a very stressful and emotional journey, and to understand that in some cases, you will just need to prepare yourself for the worse. Do not be afraid to seek counseling as it can work wonders for those who need it. However, always try to remain positive, and always have hope and follow your faith in your heart.