Question 1

How long should we try before seeing an infertility specialist?

Accepted Answer

General guidelines recommend seeking evaluation after 12 months of regular, unprotected intercourse without pregnancy if you're under 35, or after 6 months if you're 35 or older. However, you should seek earlier evaluation if you have known issues like irregular periods, PCOS, endometriosis, prior pelvic infections, or your partner has known sperm problems. Women over 40 should consider immediate evaluation. Earlier evaluation leads to earlier treatment and better outcomes, particularly for age-related fertility decline.

Question 2

What is the difference between an infertility specialist, OB-GYN, and reproductive endocrinologist?

Accepted Answer

A general OB-GYN provides routine women's health care and basic fertility guidance. An OB-GYN with infertility expertise (often called an infertility specialist) provides comprehensive fertility evaluation and first-line treatments like ovulation induction and IUI. A reproductive endocrinologist (REI) is an OB-GYN who completed an additional 3-year fellowship specifically in reproductive medicine and performs advanced treatments like IVF. Many patients start with an infertility specialist and are referred to an REI if they need IVF or have complex cases.

Question 3

What tests will be done during a fertility workup?

Accepted Answer

A complete fertility workup typically includes: blood tests on day 2-3 of your cycle (FSH, estradiol, AMH) to assess ovarian reserve; progesterone level mid-cycle to confirm ovulation; thyroid and prolactin tests to rule out hormonal causes; a hysterosalpingogram (HSG) to check if fallopian tubes are open; pelvic ultrasound to evaluate ovaries and uterus; and semen analysis for your partner. Additional tests may be ordered based on your specific history and initial findings.

Question 4

What are the success rates for fertility treatments like ovulation induction and IUI?

Accepted Answer

Success rates vary based on age, diagnosis, and treatment protocol. For ovulation induction alone with timed intercourse, pregnancy rates are about 10-20% per cycle for women under 35 with ovulatory dysfunction. IUI combined with ovulation induction increases rates to approximately 10-20% per cycle for unexplained infertility and mild male factor. Success rates decrease with age: women under 35 have the highest success, while women over 40 have significantly lower rates and may benefit from proceeding to IVF more quickly.

Question 5

What is IUI and how is it different from IVF?

Accepted Answer

Intrauterine insemination (IUI) involves placing washed, concentrated sperm directly into the uterus around the time of ovulation, bypassing the cervix. It's less invasive and much less expensive than IVF, typically done in an office visit without anesthesia. In vitro fertilization (IVF) involves stimulating the ovaries to produce multiple eggs, retrieving them surgically, fertilizing them in a laboratory, and transferring embryos back to the uterus. IUI is typically tried first for 3-4 cycles before moving to IVF, unless there are indications for IVF from the start.

Question 6

Can lifestyle changes improve fertility?

Accepted Answer

Yes, lifestyle modifications can significantly impact fertility for both partners. For women: achieving a healthy BMI (being overweight or underweight affects ovulation), quitting smoking (which accelerates egg loss), limiting alcohol and caffeine, taking prenatal vitamins with folic acid, and managing stress. For men: maintaining healthy weight, avoiding excessive heat to testicles, limiting alcohol, quitting smoking and cannabis, avoiding testosterone supplements or anabolic steroids (which dramatically reduce sperm production), and managing stress. Even modest weight loss of 5-10% can restore ovulation in women with PCOS.

Question 7

What medications are used to induce ovulation?

Accepted Answer

The two most common oral ovulation-induction medications are letrozole (Femara) and clomiphene citrate (Clomid). Letrozole is now often preferred, especially for PCOS, due to higher ovulation and pregnancy rates with fewer multiple pregnancies. Both are taken early in the menstrual cycle for 5 days. If oral medications don't work, injectable gonadotropins (FSH and LH hormones) provide stronger stimulation but require more monitoring due to higher risk of multiple pregnancy and ovarian hyperstimulation. A trigger shot (hCG) is often used to precisely time ovulation.

Question 8

How does PCOS affect fertility and how is it treated?

Accepted Answer

PCOS causes irregular or absent ovulation, making it difficult to predict fertile times or achieve pregnancy. However, PCOS is one of the most treatable causes of infertility. Treatment typically starts with lifestyle modifications (even 5-10% weight loss can restore ovulation). Medications like letrozole or clomiphene induce ovulation, often combined with metformin to improve insulin sensitivity. Most women with PCOS conceive with these relatively simple treatments. If unsuccessful, injectable medications or IVF may be recommended.

Question 9

When should I be referred to a reproductive endocrinologist for IVF?

Accepted Answer

Referral to a reproductive endocrinologist is typically recommended when: IUI hasn't succeeded after 3-4 cycles; you have blocked fallopian tubes; there's severe male factor infertility requiring ICSI; you have diminished ovarian reserve; you're over 40; you have moderate-to-severe endometriosis; you've had recurrent pregnancy loss requiring preimplantation genetic testing; or you're seeking fertility preservation. Don't delay referral if these factors apply, as time is critical for fertility success.

Question 10

Does insurance cover infertility treatment?

Accepted Answer

Coverage varies dramatically by state and employer. Twenty states have some form of infertility insurance mandate, but coverage levels differ significantly. Most plans cover diagnostic testing to determine the cause of infertility. Coverage for treatment (medications, IUI, IVF) varies widely; some plans offer comprehensive fertility benefits while others exclude fertility treatments entirely. Many employers now offer fertility benefits through specialized programs. Always verify your coverage before starting treatment, use HSA/FSA funds when possible, and ask about financing options if paying out of pocket.

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