Frequently Asked Questions and Answers
This page provides general information about infertility and treatment options. However, it is important to have specific questions addressed by a reproductive endocrinologist who can review your medical history and evaluate your condition before recommending a course of action. Laurence Jacobs, M.D., is an experienced infertility specialist serving the Chicago, Illinois area and all surrounding communities.
Healthy couples who are 35 years of age or younger are advised to spend one full year trying to conceive naturally before seeking medical assistance. If, after one year, pregnancy has not occurred, an initial infertility assessment can be performed by an OB-GYN. This may include a hysterosalpingogram to examine the uterus and tubes, a hormonal workup, an ovulation predictor kit, and a semen analysis to evaluate male fertility. Depending on the findings, the physician may recommend seeking an infertility specialist.
Certain factors may increase the likelihood of infertility, however, so couples with any of the following conditions should seek a specialist after six months or less:
For couples trying to conceive naturally, the easiest and most convenient method for predicting ovulation is an over-the-counter kit that detects the increase in lutenizing hormone (LH) that occurs immediately before ovulation. More traditional methods that involve measuring the basal body temperature also work, but commercial LH kits are much simpler to use and easier to interpret.
Another method of predicting ovulation is through an ultrasound examination of the ovaries. This is not an inexpensive technique, however, and is reserved for patients undergoing artificial insemination or another infertility treatment in which timing is of the utmost importance.
There are several ways to calculate a fertility clinic's rate of success. One of the most common is to count the number of clinical pregnancies per IVF cycle performed. Statistics calculated in this manner tend to show very high success rates. However, since the ultimate goal of infertility treatment is not merely pregnancy, but the birth of a healthy baby, it is more accurate to count the number of live births per IVF cycle performed. These rates are generally lower, because pregnancies that end in miscarriage are removed from the equation. However, they provide a more accurate representation of a clinic's level of success.
The statistics of any given fertility clinic are also affected by the clinic's policies regarding patient selection. For example, a clinic that is very selective and only treats patients of a certain age range or those with a relatively good prognosis will have very high rates of success compared to a clinic that is willing to accept those with more complex or serious types of infertility.
IVF clinics that do not treat HMO patient's will always have higher pregnancy success rates. For example, many HMO patients who have a very poor prognosis of less than 5 percent success based on age or other factors will still usually pursue IVF since they are "entitled" to many IVF attempts under the Illinois State Mandate for HMO patients. On the other hand, most "self-pay" patients with such a poor prognosis would not attempt IVF. Therefore clinics such as FCI, who take care of many HMO as well as PPO patients, will always have their pregnancy statistics diminished by the poor prognosis HMO patients who want to try IVF since they are entitled to many IVF attempts.
Statistics can play an important role in your assessment of a fertility clinic, but it is also important to look beyond the numbers and take other factors into consideration. Ask the physician to calculate your individual probability for success, as this is the success rate that ultimately matters most.
There is a law in Illinois known as the "Family Building Act," which passed narrowly in 1992, that demands better insurance coverage for couples undergoing treatment for infertility. However, there are exceptions that allow many companies to avoid offering such coverage. Employers who have less than 25 or more than 250 employees are exempt, as are companies that are self-insured and those that conduct business in Illinois but are based in another state. Consequently, many of our patients still have no insurance coverage for their infertility treatment.
However, the majority of HMOs in the state of Illinois are required to offer some amount of fertility coverage, including up to four IVF cycles for your first child and two cycles thereafter. If you are unsure what kind of coverage your policy offers, contact your company's human resources department.
When a woman is underweight (having a body mass index of less than 20), her hypothalamic and pituitary hormones are suppressed, resulting in a cessation of ovulation. This is why women who suffer from anorexia nervosa and related conditions usually do not menstruate. Depending on the severity and duration of the disease, the interruption of hormone production may be temporary or permanent. In many women, weight gain will cause normal hormone function to resume. If it does not, hormone injections can be administered to trigger ovulation, making pregnancy possible.
Obesity has been shown to have adverse effects on fertility in both men and women. In men, there is a correlation between obesity and high levels of DNA fragmentation in sperm cells. This fragmentation can inhibit the sperm's ability to fertilize the egg or cause miscarriage of the embryo.
In women, high body mass index (BMI) can disrupt normal hormone function, interfering with ovulation. Obesity is also a symptom of both polycystic ovarian syndrome (PCOS), an endocrine disorder that causes infertility, and hypothyroidism. Obese women who do become pregnant also have a higher risk of complications during pregnancy or delivery, such as preeclampsia, caesarean section, diabetes mellitus, and serious birth defects.
Fortunately, these effects are reversible through a combination of weight loss and fertility therapy. See our page on Fitness for Fertility to learn about Dr. Laurence Jacobs' program for helping patients improve their fertility through a healthy lifestyle.
Polycystic ovarian syndrome, or PCOS, is a hormonal disorder that can cause infertility. During normal ovarian function, a small number of follicles begin to develop each month, with one quickly becoming dominant. The dominant follicle will ultimately release a mature egg and the others will deteriorate. In polycystic ovaries, many follicles develop, but none of them become dominant and none of them produce eggs.
The symptoms of PCOS are variable and there is no single test to diagnose it. Although an ultrasound examination can detect polycystic ovaries, not everyone with PCOS will necessarily have this particular symptom. Other common signs are infertility, weight gain, irregular or absent menstruation, infrequent or ceased ovulation, and signs of androgen overproduction such as excess hair growth and severe acne.
In order to diagnosis PCOS, the woman must meet two out of the three following criteria:
1. History of irregular or absent periods
2. Hirsutism (excessive hair growth) or increased blood levels of male hormones (androgens)
3. Ultrasound evidence of polycystic ovaries
Polycystic ovarian syndrome is also very closely linked to diabetes. Fertility therapy involving the use of metformin, an insulin-sensitizing medication, and lifestyle changes to achieve weight loss have been very successful in restoring fertility to women with PCOS.
When women with PCOS are able to correct the insulin resistance with proper diet, exercise, and/or insulin-sensitizing drugs, such as metformin (Glucophage), normal ovarian function (ovulation and normal female hormone production) often returns. Use of metformin, regular exercise and/or weight loss of 5-10% of body weight can each independently lead to spontaneous pregnancies as well as dramatically improve pregnancy rates with all fertility treatments.
Read Dr. Jacobs' article about PCOS strategies (PDF)
Endometriosis is a condition often associated with infertility in which sections of the uterine lining, or endometrium, exist outside of the uterus. These sections of endometrial tissue attach to the outside of the ovaries, fallopian tubes, uterus, and other pelvic organs and continue to respond to the woman's hormonal cycle by thickening and shedding each month. This causes inflammation, typically resulting in severe menstrual cramping and adhesions (scar tissue).
The only way to positively diagnose endometriosis is through laparoscopy, which involves the insertion of a minute camera through a small incision to view the internal structures of the abdomen. However, if the symptoms are mild and an ultrasound examination does not reveal any physical abnormalities of the ovaries or tubes, laparoscopy may not be necessary.
Although many women with endometriosis have trouble becoming pregnant, the reason is not always clear. In severe cases, endometrial tissue can grow into the ovaries and form cysts or prevent the fallopian tubes from collecting the egg once it is released. In milder cases, however, the reasons for infertility are not understood.
In some cases, fertility treatments, such as ovulation induction medication or intrauterine insemination, can help those with endometriosis to conceive. For those with severe endometriosis, in which the symptoms extend beyond infertility, surgical treatment of the endometrial lesions can provide relief.
Premature ovarian failure (POF) is essentially the onset of menopause before the age of 40. Ovulation and menstruation cease and estrogen levels diminish, resulting in menopausal symptoms, including infertility. The condition may be permanent, temporary, or intermittent and treatment must be determined on a case-by-case basis. While some women with premature ovarian failure can benefit from infertility treatment with medications, others may need to use a donor egg in order to become pregnant.
Some of the physical and emotional changes due to low estrogen may include irregular periods or no periods, hot flashes, irritability, sleep disruption, decreased sex drive, depression, and drying of the vagina. Due to the lack of estrogen at a relatively early age, women with POF are at increased risk for osteoporosis and heart disease. There has been recent controversy about the relationship of hormone replacement therapy (HRT) and heart disease and strokes. Several studies have shown that HRT in normally postmenopausal women (menopause starting at age 50+) may increase their risk of heart attacks and strokes. However, data may not apply to younger women with POF. Presently, many doctors who specialize in POF (reproductive endocrinologists) are recommending that young women with POF continue with their HRT.
The Premature Ovarian Failure Support Group (POFSG) started in Washington DC in 1995 and has expanded its resources of material and information. We recommend you visit their website at www.pofsupport.org for more information. POFSG is a tremendous resource that will give the knowledge to help you deal with POF and make sound decisions.
Read Dr. Jacobs' article about POF (Premature Ovarian Failure) (PDF)
Hypothyroidism, or under active thyroid, is a condition that often goes undiagnosed and can interfere with a woman's ability to conceive. When the thyroid stops producing adequate amounts of certain hormones, the body responds by producing more thyroid stimulating hormone, or TSH. The excess TSH in the system suppresses the production of follicle stimulating hormone, or FSH, which is responsible for triggering ovulation.
Common symptoms of hypothyroidism are fatigue, constipation, unexplained weight gain, dry skin, muscle weakness and soreness, and intolerance to cold. Once diagnosed, the condition can be treated with medication.
Ectopic pregnancy, when an embryo implants somewhere other than the inside of the uterus (most commonly in the fallopian tube), is a potentially serious condition that is sometimes associated with infertility. Due to improved methods of early detection and effective treatment techniques, the risk of death from ectopic pregnancy has been reduced by nearly 90 percent from 20 years ago.
Ectopic pregnancy is associated with various symptoms: early known pregnancy or delayed menses associated with lower abdominal or pelvic pain, irregular vaginal bleeding or spotting. Ruptured ectopic pregnancies are less commonly seen today, primarily because modern diagnostic tests are more sensitive and allow for an earlier diagnosis. A greater knowledge of early symptoms and awareness of risk factors help to raise clinical suspicion for ectopic pregnancy and allows for earlier diagnosis. For most women, the combination of one or more serum hCG blood tests in conjunction with vaginal ultrasound(s) can often establish the early diagnosis of ectopic pregnancy. The early diagnosis of ectopic pregnancy allows for early intervention and treatment options that may help minimize tubal damage.
Risk factors associated with ectopic pregnancy include infections (such as pelvic inflammatory disease, gonorrhea, or chlamydia), previous tubal sterilization or other surgery, certain types of infertility and infertility treatment, and previous ectopic pregnancy.
Treatment may involve an injection of medication (Methotrexate) to cease growth of the tissue or laparoscopic surgery to remove it from the tube. Because surgery can potentially damage the tube, resulting in even higher risk of future ectopic pregnancy or infertility, it is usually only performed if medication cannot be used or is unsuccessful.
Read Dr. Jacobs' article about ectopic pregnancy (PDF)
By definition, infertility is an inability to become pregnant within a year of unprotected intercourse. Recurrent miscarriage, when a woman is able to become pregnant, but unable to carry a pregnancy to term, is in a category of its own. There are several problems that can cause or contribute to recurrent pregnancy loss and many of them can be addressed with some kind of medical procedure. Learn more by visiting our Recurrent Miscarriage page.
Preimplantation genetic diagnosis / screening (PGD / PGS) is a genetic testing procedure that can be performed in combination with in vitro fertilization. Candidates for PGD are couples who know they carry a serious genetic condition, women 40 and older, or those with a history of recurrent pregnancy loss or severe male factor infertility. Learn more about PGD on our Micromanipulation / Genetics page.
Egg vitrification (freezing) offers patients facing potential infertility, due to cancer treatment or other medical problems, or advancing maternal age, a way to preserve their eggs so they can become pregnant in the future. Until recently, a successful and reliable method for freezing and storing eggs has been elusive. Traditional freezing methods have a tendency to cause damage to the eggs due to the formation of ice crystals. Vitrification, however, is a freezing technique that is so rapid that ice crystals never have a chance to form. The eggs are collected as they would be for in vitro fertilization, combined with a special solution, and quickly frozen. They are then stored in liquid nitrogen until they are ready to be thawed and fertilized.
For more information, visit our Cryopreservation page
Read Dr. Jacobs' article about egg vitrification (PDF)
While acupuncture will not treat the medical sources of infertility, it has been shown to have many beneficial effects as a complementary treatment. An acupuncture program specifically designed for couples suffering from infertility can help to relieve tension, diminish stress, increase blood flow to the pelvic region, and improve hormone production and response.
When couples are trying to conceive, they are often plagued by significant stress, both emotional and financial, but acupuncture may help alleviate some of this stress. The treatments help release beta endorphins from the brain which can then induce a calming effect. Many of our patients claim that acupuncture helps them to be more relaxed during fertility therapy. Patients often need to undergo several attempts at IUI and/or IVF in order to get pregnant, so any form of stress reduction (yoga, meditation or acupuncture) can often help the women persist in their fertility treatments, thereby improving their chances for a successful outcome.
The only thing to be aware of is that the herbs used in combination with traditional acupuncture may have adverse effects on a developing embryo, so it is recommended that this type of acupuncture be performed before, but not during, active infertility treatment. At Fertility Centers of Illinois, acupuncture programs designed specifically for couples undergoing fertility treatment are offered by practitioners from Pulling Down the Moon (www.pullingdownthemoon.com) and other practitioners. Visit our Complimentary Treatments page to learn more.
Traditional Chinese Medicine integrated with Western Reproductive Medicine may be a good choice for many patients. At Fertility Centers of Illinois (FCI), we have had success integrating Eastern and Western medicine in order to help alleviate stress and potentially optimize our patient's fertility treatments. We have also had a very positive experience with Pulling Down the Moon, specializing in yoga, acupuncture, and meditation. Don't just pick any name from a phonebook; you want a well trained acupuncturist, experienced in infertility. For a list of certified licensed acupuncturists experienced in treating infertility, visit www.nccaon.org or call our office at 847-215-8899. Dr. Jacobs can summarize his opinion about acupuncture as an adjunct to fertility treatments in 9 simple words: "Acupuncture may help; it can't hurt; you'll feel better"
Tubal anastomosis, the reversal of a tubal ligation, is a delicate procedure and success depends on a number of factors. The age of the woman and the method used in the initial operation are the primary factors that will determine candidacy. For women under the age of 35 with the majority of their tubes still intact, reversal may be a very good option.
If the woman is over the age of 35, if large sections of the tubes have been removed, or if male infertility is a factor, in vitro fertilization is generally recommended instead.
Read Dr. Jacobs' article about tubal disease and Infertility (PDF)
Because women undergoing IVF treatment do not usually produce the necessary amount of progesterone after egg retrieval to adequately thicken the uterine lining and prepare the body to support the embryo, supplementary progesterone is commonly given. Without it, the chances of successful implantation and pregnancy are significantly diminished because the cells that would normally produce the progesterone after ovulation tend to be removed during the egg retrieval procedure.
Most of us who specialize in infertility and hormonal therapy will use only natural progesterone for patients actively trying to conceive. The most commonly used natural progesterone preparations include:
Concerns about the safety of progesterone stem from a perceived correlation between synthetic progestins and a slight increase in birth defects. There is no need to worry about taking progesterone, however, because the supplements given to women undergoing infertility treatment are from natural sources and have never been associated with adverse effects.
Read Dr. Jacobs' article about progesterone supplements (PDF)
Although vigorous exercise has many physical and mental health benefits, it is probably best to avoid any unnecessary strain on the body during certain stages of infertility treatment. This does not mean that exercise should be avoided altogether. Mild forms of exercise, such as walking, can provide many of the physical benefits of more strenuous exercise without taxing the body or risking the success of treatment.
Therefore, it is logical to decrease the intensity and duration of your workout simply because we do not know for sure if vigorous exercise is okay during fertility therapy.
Alice D. Domar, Ph.D. is the director of the Mind/Body Center for Women's Health at Boston IVF. In one of her books, she suggests "mindful walking." Being mindful means being in the moment and focusing on all five of your senses - seeing, hearing, smelling, feeling, and tasting. Walking mindfully is exercise and relaxation all in one. Mild exercise will decrease your level of stress and it's highly recommended during fertility therapies.
If you have additional questions about these or other infertility topics, contact our Chicago, Illinois-area practice to schedule a consultation with Laurence Jacobs, M.D.