Find Infertility Specialists near you

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FAQs:

What is Infertility?

Infertility is a condition of your reproductive system that causes people to be unable to get pregnant (conceive). Infertility can affect anyone and has many causes. Getting pregnant involves several steps:

1. Your brain must produce reproductive hormones that control ovarian function.

2. An egg must mature in your ovary.

3. Your ovary must release an egg (ovulation).

4. Your fallopian tube must pick up the egg.

5. Sperm must travel up your vagina and through the uterus to your fallopian tube.

6. The sperm fertilizes the egg to create an embryo.

7. The embryo travels through your fallopian tube to the uterus where it implants.

8. A pregnancy can’t occur if anything in this process doesn’t happen.

If you’re younger than 35, your healthcare provider may diagnose infertility after one year (12 months) of trying to conceive. Trying to conceive is defined as having regular, unprotected sex. If you’re 35 or older, your provider may diagnose infertility after six months of regular, unprotected sex.

Infertility is more common than you might think. Fortunately, there are many treatment options available for people who wish to begin or expand their family.

How Common is Infertility?

Infertility affects men and people assigned male at birth (AMAB) and women and people assigned female (AFAB) at birth equally. Infertility is very common. In the United States, 1 in 5 women between 15 and 49 years old struggle with primary infertility and about 1 in 20 women struggle with secondary infertility. Approximately 48 million couples live with infertility around the world.

What are Signs of Infertility?

The main sign of infertility is being unable to get pregnant after six months or one year of regular, unprotected sex. You may not have any other symptoms. But some people may show physical symptoms such as:

- Pelvic or abdominal pain.

- Irregular vaginal bleeding, irregular periods or no periods.

- Penile disorders or issues with ejaculation.

Who is More Likely to be Infertile?

Women's fertility gradually declines with age, especially in the mid-30s, and it drops rapidly after age 37. Infertility in older women is likely due to the lower number and quality of eggs, and can also be due to health problems that affect fertility. Men over age 40 may be less fertile than younger men.

How Do You Know If a Woman is Infertile?

The main symptom of infertility is the inability to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating. There might be no other signs or symptoms.

Does Endometriosis Cause Infertility?

Endometriosis can make it more difficult to get pregnant. Between 30-50% of people with endometriosis may experience infertility. The normal chance of getting pregnant each month for people with no endometriosis is approximately 10-20%, while people with surgically documented endometriosis have a chance of only 1-10%.

Can PCOS Make You Infertile?

PCOS is the primary cause of hyperandrogenism and oligo-anovulation at the reproductive age and is often associated with infertility and clinical and metabolic disorders. The prevalence of infertility in women with PCOS varies between 70 and 80%. According to the American Society for Reproductive Medicine, the evaluation of infertility in women with PCOS or other causes of subfertility should start after six months of attempting pregnancy without success if the couple has regular sexual intercourse (2 to 3 times/week) without using contraceptive methods

Is Infertility Genetic?

Approximately 10 to 15 percent of couples experience infertility, with more than half of these cases being due to an underlying genetic issue. In these instances, the genetic cause could have been inherited. However, infertility is a complex condition, and most cases are not due to a known inherited cause.

What are the Greatest Effects of Infertility?

Research on infertility has found that feelings of stress, anger, guilt, depression, grief, anxiety, withdrawal, decreased self-esteem, loss of relationships, and decreased financial security may result. This includes questioning one’s worthiness as a potential parent and as a spouse, and experiencing a sense of loss of control over one’s life. Relationships with friends, family members, and spouses may be strained as those dealing with infertility may feel misunderstood or uncomfortable in situations, such as baby showers, where they are reminded of their infertility. Changes in lifestyle, such as decreased leisure activities, may also result for various reasons. Furthermore, individuals dealing with infertility might feel a sense of loss over the dream family and life they had in mind for themselves.  Overall, research has shown that approximately half of women experiencing infertility rated it as the most stressful experience of their life, and 18% of couples reported that infertility has had a negative impact on their marriage.

When Should You Seek Help for Infertility?

People who are under the age of 35 and who aren’t pregnant after one year of trying should see a healthcare provider. You should seek help sooner (after six months of trying) if you’re 35 to 39 years old. If you’re 40 or older, you should seek evaluation after fewer than six months of trying. Your chances of getting pregnant decrease with age. For example, a 25-year-old female has a 25% to 30% chance of getting pregnant each menstrual cycle. By the time you reach 40, your chances are less than 5% each cycle.

Regardless of sex, you should seek help early if you have a risk factor or medical condition that affects fertility. Seek prompt evaluation if you have a history of risk factors for premature ovarian failure, severe endometriosis, or known or suspected uterine/tubal disease.

Primary care providers and gynecologists may recommend couples see a fertility specialist, urologist or reproductive endocrinologist for help with infertility diagnosis and treatment.

Types of Infertility

Types of infertility include:

Primary infertility: You’ve never been pregnant and can’t conceive after one year (or six months if you’re 35 or older) of regular, unprotected sexual intercourse.

Secondary infertility: You can’t get pregnant again after having at least one successful pregnancy.

Unexplained infertility: Fertility testing hasn’t found a reason that a person or couple is unable to get pregnant.

Infertility Causes for Women

Ovulation disorders are the most common cause of infertility in people with ovaries. Ovulation is the process in which your ovary releases an egg to meet sperm for fertilization.

These factors can contribute to female infertility:

- Endometriosis.

- Structural abnormalities of your vagina, uterus, or fallopian tubes.

- Autoimmune conditions like celiac disease or lupus.

- Kidney disease.

- Pelvic inflammatory disease (PID).

- Hypothalamic and pituitary gland disorders.

- Polycystic ovary syndrome (PCOS).

- Primary ovarian insufficiency or poor egg quality.

- Sickle cell anemia.

- Uterine fibroids or uterine polyps.

- Thyroid disease.

- Prior surgical sterilization (tubal ligation or salpingectomy).

- Genetic or chromosomal disorders.

- Sexual dysfunction.

- Surgical or congenital absence of your ovaries.

- Infrequent or absent menstrual periods.

Infertility Causes for Men

The most common cause of male infertility involves problems with the shape, movement (motility), or amount (low sperm count) of sperm.

Other causes of male infertility include:

- Enlarged veins (varicocele) in your scrotum, the sac that holds your testicles.

- Genetic disorders, such as cystic fibrosis.

- Chromosomal disorders, such as Klinefelter syndrome.

- High heat exposure to your testicles from tight clothing, frequent use of hot tubs and saunas, and holding laptops or heating pads on or near your testes.

- Injury to your scrotum or testicles.

- Low testosterone (hypogonadism).

- Misuse of anabolic steroids.

- Sexual dysfunction, such as erectile dysfunction, anejaculation, premature ejaculation or retrograde ejaculation.

- Undescended testicles.

- Previous chemotherapy or radiation therapy.

- Surgical or congenital absence of testes.

- Prior surgical sterilization (vasectomy).

7 Reasons You May Want to See a Fertility Doctor

Planning for pregnancy can be challenging. If you are ready for a baby but seem to be having trouble getting pregnant, it might be time to explore your options. Many people forget that infertility affects both men and women equally. In all couples, there's a 50/50 chance that a man or woman will have fertility problems. Here are seven reasons you may want to see a fertility specialist.

1. You Have Had Sex Without Birth Control for 12+ Months & No Conception

The average rule of thumb is that it takes a couple five to six months to conceive. If you are under 35 and have been having unprotected sex (sex without any form of birth control) for 12 months, you may want to see a fertility specialist.

2. You Are 35+

As women get older the quality and number of our eggs drop. If you are 35 or older and have been trying for six months to get pregnant without birth control, you may want to see a fertility specialist. If you are 40 or older, you are technically in the high risk-pregnancy category, and you might want to start by seeing a fertility specialist. Your risk of miscarriage is greater at this time.

3. You Have Had Three or More Miscarriages

Miscarriage is when you lose the pregnancy within 20 weeks of getting pregnant. Most often, miscarriage happens because the egg or sperm had the wrong number of chromosomes so the fertilized egg can’t develop normally. Miscarriage can also be caused by early development problems: the egg doesn’t implant properly in the uterus or has structural defects. If you have had two or more miscarriages, you should consider working with a specialist to monitor your health while you are trying to conceive. If there is a larger condition causing these miscarriages, you want to be aware of it.

4. Your Partner Has Trouble Achieving or Maintaining an Erection

It’s easy to make an appointment with a male fertility specialist. Called urologists or andrologists, these specialists are experts in the male reproductive system. They can guide you to finding a solution for these conditions.

5. You Have No Period, Irregular Periods, or Heavy Bleeding

Any of these symptoms could be caused by a fertility issue:

- No period: It’s possible that you are not ovulating

Irregular periods: Your brain could be sending the wrong hormone signals, or this could be caused by an ovulation disorder.

- Bleeding between periods: Bleeding between your periods or after sex could be caused by a uterine polyp or fibroid, or cervical lesion.

- Very heavy periods: If you bleed for more than seven days, go through more than one pad or tampon an hour for several hours, or pass blood clots larger than the size of a quarter, your period is unusually heavy. This can be caused by a uterine fibroid or an endocrine abnormality. We highly recommend you see your doctor.

6. You or Your Partner Have a History of Sexually Transmitted Infections

Formerly known as sexually transmitted diseases, sexually transmitted infections (STIs) spread through sexual contact. They can cause inflammation and infection. For women, they can cause scarring in the fallopian tubes, which may prevent the egg and sperm from ever meeting. For men, they can cause reoccurring infections, which can damage sperm mobility, function, and sperm count.

7. You Have a Chronic Medical Condition

As you already know if you have a chronic or long-lasting medical condition, you pretty much are on first-name terms with your care provider/specialist. It’s no different with fertility. If you have any of these conditions or diseases, we recommend you see a fertility specialist:

- Diabetes

- Genetic disorders

- Heart disease

- Hypertension

- Kidney disease

- Thyroid condition

You may also want to see a specialist if you have had cancer (chemotherapy treatment) or if your mother had early menopause.

While this process can seem overwhelming, there are many caring providers who will help you navigate it. By seeing a specialist if you identify with any of the above reasons, you can get answers to your questions about fertility.

Common Fertility Treatments

Some couples need more help conceiving using assisted reproductive technology (ART). ART is any fertility treatment that involves a healthcare provider handling the sperm or egg. To increase pregnancy odds, you can take medications to stimulate ovulation before trying one of these options:

1. In vitro fertilization (IVF): IVF involves retrieving eggs from your ovary, then placing them with sperm in a lab dish. The sperm fertilizes the eggs. A provider transfers one to three of the fertilized eggs (embryos) into your uterus.

2. Intracytoplasmic sperm injection (ICSI): This procedure may be performed during the IVF process. An embryologist injects a single sperm directly into each egg. Then, a provider transfers one to three of the embryos into your uterus.

3. Intrauterine insemination (IUI): A healthcare provider uses a long, thin tube to place sperm directly into your uterus. IUI is sometimes called artificial insemination.

4. Assisted hatching: A process that involves opening the outer layer of an embryo to make it easier for it to implant in your uterine lining.

5. Third-party ART: Couples may use donor eggs, donor sperm or donor embryos. Some couples need a gestational carrier or surrogate.

Infertility Treatment for Women

Treatments for infertility in women and people assigned female at birth include:

1. Lifestyle modification: Gaining or losing weight, stopping smoking or using drugs, and improving other health conditions can improve your chance of pregnancy.

2. Medications: Fertility drugs stimulate your ovaries to ovulate more eggs, which increases your chance of getting pregnant.

3. Surgery: Surgery can open blocked fallopian tubes and remove polyps, fibroids or scar tissue.

Providers may make suggestions on how you can improve your odds of conceiving. These may include things like:

1. Tracking ovulation through basal body temperature, using a fertility tracking app and noting the texture of your cervical mucus.

2. Using a home ovulation kit, a kit you can purchase at the drug store or online to help predict ovulation.

Infertility Treatment for Men

Treatments for infertility if you have a penis or testes include:

• Medications: Medications can raise testosterone or other hormone levels. There are also drugs for erectile dysfunction to help you maintain an erection during sex.

• Surgery: Some men need surgery to open blockages in the tubes that carry sperm or to repair structural problems. Varicocele surgery can make sperm healthier and improve the odds of conception.

Risk Factors for Both Male and Female Infertility

Many of the risk factors for both male and female infertility are the same. They include:

1. Age. Women's fertility gradually declines with age, especially in the mid-30s, and it drops rapidly after age 37. Infertility in older women is likely due to the lower number and quality of eggs, and can also be due to health problems that affect fertility. Men over age 40 may be less fertile than younger men.

2. Tobacco use. Smoking tobacco or marijuana by either partner may reduce the likelihood of pregnancy. Smoking also reduces the possible effectiveness of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men.

3. Alcohol use. For women, there's no safe level of alcohol use during conception or pregnancy. Alcohol use may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.

4. Being overweight. Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. For men, sperm count also may be affected by being overweight.

5. Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and those who follow a very low-calorie or restrictive diet.

6. Exercise issues. A lack of exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight.

Prevention of Infertility

Some types of infertility aren't preventable. But several strategies may increase your chances of pregnancy.

Couples

- Have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Intercourse beginning at least five days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs in the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.

Men

Although most types of infertility aren't preventable in men, these strategies may help:

- Avoid drug and tobacco use and drinking too much alcohol, which may contribute to male infertility.

- Avoid high temperatures found in hot tubs and hot baths, as they can temporarily affect sperm production and motility.

- Avoid exposure to industrial or environmental toxins, which can affect sperm production.

- Limit medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don't stop taking prescription medications without medical advice.

- Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.

Women

For women, a number of strategies may increase the chances of becoming pregnant:

- Quit smoking. Tobacco has many negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.

- Avoid alcohol and street drugs. These substances may impair your ability to conceive and have a healthy pregnancy. Don't drink alcohol or use recreational drugs, such as marijuana, if you're trying to get pregnant.

- Limit caffeine. Women trying to get pregnant may want to limit caffeine intake. Ask your doctor for guidance on the safe use of caffeine.

- Exercise moderately. Regular exercise is important, but exercising so intensely that your periods are infrequent or absent can affect fertility.

- Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility.

How Much Does Fertility Treatment Generally Cost? 

It depends on what you’re being treated for and your insurance coverage. Oftentimes, inexpensive medicine or simple surgery that is covered by insurance, depending on your state, will correct many problems. From there, the costs vary. Here are some average national U.S. costs they shared:

1. Ovulation induction oral medications: $10–$100

2. New patient appointment: $200–$500

3. A single IVF cycle: $15,000–$30,000

4. IVF hormonal medications: $3,000–$5,000

5. Egg freezing cycle: $8000–$15,000

5. Intrauterine insemination (IUI) treatment: $2,500–$4,000

6. Egg, embryo, or sperm storage: $500–$1,000 per year

You might also have some additional costs, including:

- cost of medications

- costs of anesthesia

- preimplantation genetic testing (PGT), if necessary

Doctors Who Specialize in Fertility

There are a variety of doctors who specialize in fertility. The best one for you will depend on your particular medical history and needs.

Reproductive Endocrinologists

Reproductive endocrinologists (sometimes referred to as REs) are what most people think of as fertility specialists. A reproductive endocrinologist is a gynecologist who has additional training in infertility and fertility treatment; they treat both male and female fertility issues.

Reproductive endocrinologists manage, carry out, and prescribe a variety of fertility tests and treatments, including IUI and IVF. When outside specialists are needed in a particular case, the reproductive endocrinologist is usually the primary consultant. They can also help cancer patients with fertility preservation, working with an oncologist to coordinate fertility preservation prior to the start of fertility-threatening cancer treatments.

Andrologists

Andrologists are urologists who have completed additional training in male fertility. Andrologists may evaluate and treat male fertility issues alone, or along with a reproductive endocrinologist. They may look further to find the cause for low or absent sperm counts and—if possible—treat the problem, so the couple can conceive without IVF. An andrologist can also perform a testicular biopsy for use in testicular sperm extraction (TESE). They also treat reproductive infections, erectile dysfunction, testicular torsion, and undescended testes.

Reproductive Surgeons

Another kind of fertility specialist is a reproductive surgeon. While reproductive endocrinologists also perform surgery, reproductive surgeons have even more training in surgical procedures and may treat patients for issues beyond trying to have a baby. Their primary training may be in gynecology or urology.

Reproductive Immunologists

Reproductive immunologists combine the knowledge of immunology and reproductive medicine. A reproductive immunologist may be consulted in cases of recurrent miscarriage, unexplained infertility, or unexplained repeated IVF failure. You might also consult a reproductive immunologist if you have endometriosis or an autoimmune disease, like lupus or rheumatoid arthritis. Reproductive immunologists may be physicians or scientists and usually work with a reproductive endocrinologist to treat infertile couples.

How to Prepare for Your First Fertility Clinic Appointment

What to Bring

Copies of medical records. Every piece of background information that you supply could be a vital piece of the puzzle, so having access to your up-to-date medical records is important. You can streamline this process by authorizing and arranging for each office to fax your records to the fertility clinic ahead of your visit. 

- Your primary care physician

- Your OBGYN

- Any previous fertility evaluations or treatments

A list of questions for your doctor. It is a very good idea to have your questions written down or printed out before you go into the visit. Your fertility team will be asking you a lot of questions, but it is just important that you ask yours. Having a list of questions at hand will ensure that you don’t forget or miss your chance to ask them. See below for a list of suggested questions to get you started.

A notebook to write down any instructions or details. With so much ground to cover in the first visit and the possibility of intense emotions surrounding the event, “information overload” is a common experience. Taking notes during the visit can help you process and remember important details.

Your partner, if you like. It is not necessary to bring your partner to your first visit, but they are both invited and encouraged to attend. This visit is an opportunity for your partner to be included in the process and having them there may be helpful for you and your fertility team. They can provide emotional support and will also be able to answer questions with you, offering your team extra insight into the case. They will also be able to ask questions of their own, which can help them feel supported and clear up any fears or misgivings they may have about fertility treatment.

How to Prepare

Your medical records will have a lot of vital information for your fertility specialist, but they are only part of the picture. Your own recollections and facts are also very important. Take some time to write down and organize the following information ahead of your visit.

1. List any medications, vitamins, herbs, or other supplements you take.

- Don’t be afraid to get detailed here. List everything, no matter how insignificant it may seem.

- Include the amount of each dose and how often you take them.

2. List key medical information.

- Any medical conditions that you or your partner may have.

- Previous evaluations or treatments for infertility.

- Age of first menstruation.

- Details about your cycle. Is it regular? How long is your average cycle? Is the flow especially heavy/light? Do you suffer from PMS or especially painful periods?

3. List details about your attempts to get pregnant.

- How long you have been actively trying to conceive?

- Frequency of intercourse.

- If you have been keeping records of basal body temperature, results of ovulation predictor kits, or fertility charting, this can be very helpful to bring along.

4. Talk to relatives about a family history of infertility.

Check with both sides of the family. Until recently, infertility struggles were often kept very private, so unless you ask directly you may not know if your relatives experienced infertility.

5. Check into your infertility insurance coverage.

- Talk to your HR representative at work and directly to your insurance company about coverage options.

- If you are near an open enrollment window with your insurance, you may be able to switch to a plan with more coverage.

- Even without insurance, there are many ways to finance fertility treatment. You may want to prepare for a consultation with your clinic’s finance specialist.

Tips for Finding The Right Fertility Specialist

It can be hard to know what to ask when you’re meeting with a fertility expert and how to know whether this doctor is a good fit for you and your partner.

Infertility can be scary and complex, so it is important to ask questions, especially if you don’t understand something. Make sure your doctor can explain things in terms you can understand so you feel empowered to make informed and confident decisions.

At the first visit, ask your doctor what potential issues they think may be going on based on your history and what type of testing they recommend to help with making a diagnosis.

Sources:

Cleveland Clinic

Mayo Clinic

Massachusetts General Hospital

Genome Medical

NIH

Healthline

U Health

Very Well Family

SCRC

 

The content herein is provided for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Medical information changes constantly, and therefore the content on this website should not be assumed to be current, complete or exhaustive. Always seek the advice of your doctor before starting or changing treatment. If you think you may have a medical emergency, please call your doctor or 9-1-1 (in the United States) immediately.