Frequently Asked Questions FAQs

Q: What is Infertility?
A: Infertility is a disease of the reproductive system that impairs one of the body’s most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm’s ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman’s uterus; and sufficient embryo quality. Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman’s hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

Q: What Causes Infertility?
A: No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained. The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality. The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

Q: How is Infertility Diagnosed?
A: Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception. If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.

Q: How is Infertility Treated?
A: Most infertility cases — 85 to 90 percent — are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs.

Q: What is In Vitro Fertilization?
A: In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a “biologically related” child. In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish (“in vitro” is Latin for “in glass”). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women’s uterus, thus bypassing the fallopian tubes. IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatment in the United States.

Q: Does ART damage the ovaries?
A: There is no evidence to suggest that oocyte retrieval damages the ovaries. There is one report that suggests that infertile women who take fertility drugs and do not get pregnant have an increased risk of ovarian cancer. However, the study did not collect information on the type of drugs used, and the control (comparison) population may not have been selected accurately, since infertile women are known to carry an increased risk of ovarian cancer. The fertility drugs used in ART have been in use over 40 years, and other studies have suggested no increased risk. In most cases, the age of menopause does not appear to be altered after ovarian stimulation.

Q: Why is the success rate with ART so low?
A: Studies of human reproduction indicate that for a couple with proven fertility, the likelihood of conception is only 20% per month. ART affords couples with infertility factors similar chances for conception.

Q: Is there an increased chance of birth defects if I become pregnant through ART?
A: No. The risk of congenital anomalies in children conceived through ART appears to be the same as the risk in the general population. Chromosome abnormalities, such as Down’s syndrome also occur at a rate similar to the general population.

Q: Can we have intercourse while attempting ART?
A: Yes. We recommend that the man abstain from ejaculating for at least 48 hours preceding egg retrieval. This precaution assures that the semen sample for ART is of optimal quality. Near the time of egg retrieval, the ovaries can be enlarged and tender, which can make intercourse uncomfortable.

Q: What if I ovulate before the retrieval?
A: Virtually all cases of premature ovulation are now prevented by the use of GnRH analogs (Lupron®, Synarel®, Cetrotide® or Antagon®). In rare cases in which GnRH analogs are not used, we perform an ultrasound prior to retrieval to make sure the follicles are intact. In the uncommon case of ovulation, we will not perform retrieval because the quality of the remaining oocytes is adversely affected.

Q: How much activity is recommended after ET?
A: We recommend a fairly quiet 24 hours after ET. Thereafter, most patients resume their normal routines. Strenuous exercises, running, etc. should be avoided until a pregnancy test has been performed.

Q: After embryo transfer, how long must we wait until we have intercourse without risk to the embryo?
A: No one knows for sure. We recommend abstinence for a minimum of 72 hours after transfer.