If you’ve been trying to conceive for more than a year, you may be experiencing infertility.
Most medical professionals define infertility as the inability to get pregnant after 1 year or longer of sex without birth control.
If you’re over 35 years old, many healthcare professionals consider it infertility if you’ve not conceived after 6 months of trying.
Infertility is more common than many people think. In fact, it’s estimated to affect
According to the
Infertility can also affect someone who has given birth to a baby before. The
Infertility affects men as well. The National Institutes of Health — which also divides their data into two groups, women and men — reports that about
Despite how common fertility issues can be, though, there is still a lot of confusion around what fertility treatment might involve.
So, we interviewed Dr. Samuel Brown, surgeon, founder, and medical director of the Florida-based Brown Fertility treatment center, and Dr. Jenna Turocy of Columbia University Fertility Center, to help demystify infertility and how it is treated.
If you haven’t been able to conceive for a year or more, make an appointment with a fertility consultant.
During this appointment, “the first step is to make a new patient consultation to discuss your specific circumstances,” Brown says. “Then, they may have various tests to rule out the cause for infertility, one by one.”
These tests may include:
- ovulation detection
- evaluation of your fallopian tubes
- evaluation of your cervix
- evaluation of your uterus
- semen analysis (if necessary)
“Once testing is complete, your appropriate treatment plan can be started immediately,” Brown says.
What’s the best way to find a fertility specialist?
“I recommend patients speak with their OB-GYN or primary care doctor to see if they have recommendations,” says Turocy. They can help refer you to a trusted reproductive endocrinologist.
In addition, there are databases of fertility doctors and clinics. For example, The Society for Assisted Reproductive Technology (SART) compiles over 430 IVF centers, and FertilityIQ has profiles for both fertility doctors and clinics as well as patient reviews.
Brown says that in general, the fertility concerns he sees and treats are caused by:
- Age. Age begins to be a concern over the age of 35 for women trying to conceive.
- Male factor infertility. Male factor infertility can have a range of causes, including hormonal imbalances, poor semen quality, diabetes, certain medication, blocked ducts in the testes, varicocele, or previous sexually transmitted infections (STIs).
- Endometriosis. Fertility issues are a significant complication of endometriosis.
- Ovulation problems or dysfunction. Polycystic ovary syndrome (PCOS) is the most common cause of ovulation problems.
Many of his clients have had a history of miscarriages, and for some, the cause of their fertility concerns remains unexplained.
“About 30 percent of the time, there’s no obvious reason for infertility,” Brown says. “Sperm analysis looks good, ovulation is happening, and couples are looking for an explanation.”
It depends on what your doctor believes is behind your fertility concerns.
“Fertility treatment encompasses a wide range of options,” says Turocy, “from the less invasive options, such as timed intercourse where we help determine the best time for a couple to have intercourse at home, to more invasive options, like in vitro fertilization where an egg and sperm are combined outside the body in the laboratory.”
For example, some conditions, such as PCOS, can be managed with medications such as metformin and clomiphene, while others, he says, can be treated with simple surgeries.
“For families experiencing unexplained infertility, medications, intrauterine insemination, and in vitro fertilization can help you conceive,” says Brown. ”[And] for male infertility, we’ll oftentimes approach it with intrauterine insemination or IVF with ICSI (where a single sperm is injected right into the egg).”
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,” Brown says.
From there, the costs vary, say both Turocy and Brown. Here are some average national U.S. costs they shared:
- Ovulation induction oral medications: $10–$100
- New patient appointment: $200–$500
- A single IVF cycle: $15,000–$30,000
- IVF hormonal medications: $3,000–$5,000
- Egg freezing cycle: $8000–$15,000
- Intrauterine insemination (IUI) treatment: $2,500–$4,000
- 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
Does insurance cover fertility treatment?
It depends on where you live.
“In the United States, only
So, he continues, “The cost of reproductive medical treatments, and specifically lack of insurance coverage for infertility medical treatments, is a major barrier to family building.”
“It’s only been 40 years since IVF came to the U.S., and now the issue isn’t accessibility — it’s affordability,” Brown says.
Their outlook is hopeful, says Brown.
“Never lose hope [because] most infertility cases — 85 to 90 percent — are treated with conventional medical therapies, such as medication or surgery,” he says.
“In vitro fertilization and similar treatments account for less than 3 percent of infertility services and aren’t necessary for everyone,” Brown adds.
If you do need IVF, your chances of conception depend on a few factors, including your age and egg quality.
“Broadly speaking, women under the age of 35 are typically the best prognosis patients,” says Turocy, “but even women in their mid-to-late 40s may achieve success using donated eggs.”
For example, according to the
“I encourage all women having difficulty conceiving or wishing to preserve their fertility for the future to speak with a fertility specialist who can help them understand their individualized chance of success,” says Turocy.
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.
Turocy offers some advice:
“Infertility can be scary and complex, so it is important to ask questions, especially if you don’t understand something,” she says. “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,“ Turocy adds.
Examples of questions to ask:
- What’s the best way to contact you if I have questions at home?
- What are your clinic’s success rates for couples in a similar situation?
- Do you have in-house preservation for fertilized eggs or sperm? If so, do you have 24-hour monitoring or a generator to preserve samples in case of a power failure?
- Is there someone at the clinic I can talk with about the costs or my insurance coverage?
Regarding one thing people need to know about fertility concerns, Brown says, “When it comes to fertility, especially related to age, it’s all about preservation.”
That’s why fertility preservation, such as egg and embryo freezing, can be a good idea, especially for women who know they are not going to get pregnant before 38, he says.
“I would strongly encourage them to consider freezing their eggs,” Brown says. “Having a detailed discussion on any plans to conceive is crucial, and it’s never too early to start having that conversation.”
Infertility can be scary and stressful — but the good news is, there are doctors and clinics available to help you go over your options and discuss possible treatments that might work for you.
IVF is a powerful tool that may be very effective for some couples but may not be necessary for everyone.