1. What does a fertility specialist do?
A fertility specialist is an OB-GYN with expertise in reproductive endocrinology and infertility. Fertility specialists support people through all aspects of reproductive care. This includes infertility treatments, genetic diseases that can affect future children, fertility preservation, and uterine problems. They also help with ovulation issues like amenorrhea, polycystic ovarian syndrome, and endometriosis.
2. How long should I try to conceive before seeing a fertility doctor?
This depends on how concerned you are and what information you’re looking for. Many women will seek to undergo a fertility assessment before they try to conceive, or if they’re trying to plan their reproductive future.
If you’ve been unsuccessfully trying to conceive, see a fertility specialist after 12 months if you’re under age 35. If you’re age 35 or older, see one after six months.
3. What’s the first step a fertility specialist will take if someone can’t conceive?
Typically, a fertility specialist will begin by assessing your complete medical history. They’ll also want to review any prior fertility testing or treatment that you’ve received.
As an initial step, you’ll also establish what your goals are for seeking fertility care. For example, some people wish to be as proactive as possible, while others hope to avoid medical intervention. Other goals may include genetic testing on embryos or fertility preservation.
4. What tests might a fertility doctor order, and what do they mean?
A fertility doctor will often do a full testing panel to learn the cause of the infertility and assess your reproductive potential. Your doctor may conduct hormone tests on the third day of your menstrual cycle. These include follicle-stimulating hormone, luteinizing hormone, and anti-Mullerian hormone tests. The results will determine the capacity of eggs in your ovaries. A transvaginal ultrasound can also count the small antral follicles in the ovaries. Combined, these tests can predict whether your egg reserve is good, fair, or diminished.
Your specialist may also perform endocrine screening for thyroid disease or prolactin abnormalities. These conditions can affect reproductive function. To assess the fallopian tubes and the uterus, your doctor may order a special type of X-ray test called a hysterosalpingogram. This test determines if your fallopian tubes are open and healthy. It’ll also show problems with your uterus, like polyps, fibroids, scar tissue, or a septum (wall) that could affect implantation or growth of an embryo.
Other studies to examine the uterus include a saline-infused sonography, office hysteroscopy, or endometrial biopsy. A semen analysis may be conducted to determine if the count, motility, and appearance of sperm are normal. Preconception screenings are also available to test for transmissible diseases and genetic abnormalities.
5. What lifestyle factors affect my fertility, and is there anything I can do to increase my chances of becoming pregnant?
Many lifestyle factors affect fertility. Healthy living can enhance conception, improve fertility treatment success, and maintain a pregnancy. This includes consuming a well-balanced diet and avoiding processed foods. There is data showing that weight loss leads to better fertility treatment outcomes. For women with gluten sensitivity or lactose sensitivity, avoidance can be helpful.
Take prenatal vitamins, limit caffeine, and avoid smoking, recreational drugs, and alcohol. You may also benefit from a vitamin D supplement. This is because vitamin D deficiency may have poorer in vitro fertilization (IVF) outcomes or lead to miscarriage.
Moderate exercise is also great for general health and stress reduction. Yoga, meditation and mindfulness, and counseling and support can also be beneficial.
6. What are my treatment options if I can’t conceive?
There are many options for infertility treatment. Your doctor may prescribe ovulation stimulation medications such as clomiphene citrate and letrozole. Other treatments include follicle growth monitoring with blood work and ultrasounds, ovulation triggering with hCG (human chorionic gonadotropin), and intrauterine insemination. More involved treatments include IVF, intracytoplasmic sperm injection, and preimplantation genetic testing of embryos.
The option that you and your doctor choose depends on the duration and cause of infertility and the objectives of treatment. Your fertility specialist will help you determine which approach is best for you to ensure the best outcome possible.
7. How successful are fertility treatments?
Fertility treatments are successful, but outcomes depend on many factors. The two most important factors are a woman’s age and the cause of infertility.
Naturally, more interventional therapies have higher success rates. Ovulation stimulation with intrauterine insemination treatments can have success rates of 5 to 10 percent per cycle in unexplained infertility. This can go up to 18 percent in individuals with ovulation disorders or when donor sperm is being used and there aren’t any underlying female issues. Typically, IVF can have live birth rates of 45 to 60 percent. This can increase to live birth rates of up to 70 percent if high quality embryos are transferred.
8. Can a fertility specialist help me find emotional support?
Yes, a fertility specialist and their team can offer emotional support. Your fertility center may have supports on-site, like a mind-body program or support groups. They can also refer you to counselors, support groups, wellness and mindfulness coaches, and acupuncturists.
9. Is there help available to finance fertility treatments?
Fertility treatments can be expensive, and financing them can be complex and challenging. A fertility specialist will typically have you work closely with their financial coordinator. This person can help you learn about insurance coverage and potential out-of-pocket costs.
You can also discuss treatment strategies with your doctor that may lower costs. Your pharmacy may also have programs that offer fertility drugs at reduced rates, as well as various third-party programs. Discuss these options with your doctor if the cost of treatment is something that concerns you.
Dr. Alison Zimon is the co-founder and co-medical director of CCRM Boston. She is board-certified in reproductive endocrinology and infertility, and in obstetrics and gynecology. In addition to her role at CCRM Boston, Dr. Zimon is a clinical instructor in the Department of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School and is a staff physician in OB/GYN at Beth Israel Deaconess Medical Center and Newton Wellesley Hospital in Massachusetts.