Fertility Treatment 101

1. What are common causes of infertility?

   Today, 1 in 6 U.S. couples experiences fertility problems at some point in their lives. Six common causes of infertility include: (CCRM Fertility)

   • Age
   • Ovulation Disorders (e.g. PCOS)
   • Tubal Factors (e.g. endometriosis)
   • Uterine fibroids
   • History of STIs
   • Male Factor Infertility (e.g. varicocele, ejaculations disorders)

2. When should I see a fertility specialist?

   Those under 35 with regular cycles who haven’t become pregnant after 1 year, or those 35+ with regular cycles who haven’t become pregnant after 6 months, should meet with a reproductive endocrinologist. Women who aren’t ovulating, haven’t experienced regular menstrual cycles and/or those who have had multiple pregnancy losses should seek fertility care as soon as possible. (CCRM Fertility)

3. What questions should I ask my fertility doctor?
   • Based on our history and previous testing, what issues do you think we have? What additional testing would you recommend to help with diagnosis?
   • How does age affect my fertility and chances for a healthy pregnancy? Do I have any lifestyle or medical issues that should be evaluated to increase my chances for a healthy pregnancy?
   • How long will it take to get my workup/tests completed and start some form of treatment?
   • Who is the best person to contact with questions about next steps or treatment?
   • What is our diagnosis?
   • Which treatment options do you recommend?
   • How long should we try this treatment and what other options are available if that treatment doesn’t work?
   • What does this treatment entail and what are the potential side effects?
   • When can we start treatment and what preparations need to be made? (CCRM Fertility)

4. What fertility treatment is right for me?

   Treatment at CCRM Fertility is highly individualized based on patients’ specific needs. A personalized plan will be developed alongside a CCRM Fertility doctor who will consider a variety of factors, including age, partner’s age, cause of infertility, prior history of miscarriages, prior fertility treatments, and fertility treatment goals. (CCRM Fertility)

5. What should I do to prepare my body for fertility treatments?

   Eat a healthy, well-balanced diet. Start taking prenatal vitamins. Maintain a healthy weight. Stop smoking, drinking alcohol and taking recreational drugs. Reduce or eliminate caffeine altogether. Decrease stress. Don’t be afraid to ask for help. Reach out to a psychological counselor for support, if needed. (CCRM Fertility)

6. What is intrauterine insemination (IUI)?

   IUI involves preparing sperm in a special solution and placing a small concentration of rapidly moving sperm directly into the uterus via a catheter when a woman is most fertile. (CCRM Fertility)

7. What is in vitro fertilization (IVF)?

   During IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a petri dish. The eggs are examined by an embryologist to see if fertilization has occurred. On day 5-7, the blastocyst embryo is then transferred to the woman’s uterus. (CCRM Fertility)

8. Is IVF painful?

   IVF involves taking injectable medications, which may cause some discomfort. Icing the area for a few minutes prior to injection can be helpful to minimize pain. As the ovaries respond to the medications to grow multiple follicles, some discomfort and bloating may be felt.

   Patients are sedated during the egg retrieval, so the procedure isn’t painful. However, it is not uncommon to have some soreness, and intermittent abdominal bloating and cramping for about a week after the egg retrieval. The embryo transfer, similar to a pap smear, is virtually pain-free in most cases. (CCRM Fertility)

9. Is IVF expensive?

   IVF costs vary depending on the clinic and if additional procedures are needed, such as intracytoplasmic sperm injection (ICSI) or pre-implantation genetic testing of embryos. The average cost for an IVF cycle at CCRM Fertility using frozen eggs is $12,880, with additional fees for anesthesia, testing, medications, and storage.

   Before starting treatment, you should contact your employer to learn about your fertility health benefits. Fertility testing necessary to begin IVF is often covered, but IVF treatment may not be covered. CCRM Fertility works with many financing partners and offers IVF Refund and Multi-Cycle programs to help make the process more affordable. (CCRM Fertility)

10. How successful Is IVF?

    IVF success depends on many factors, including age and potential health conditions that may impact the reproductive system. (CCRM Fertility)

COVID-19

11. Does the COVID-19 vaccine affect fertility?

There is currently no evidence that vaccine ingredients or antibodies made following COVID-19 vaccination would cause any problems with becoming pregnant now or in the future.(CDC)

12. Will I have trouble getting pregnant after receiving the COVID-19 vaccine?

    Many people have become pregnant after receiving a COVID-19 vaccine, including some who got vaccinated during COVID-19 vaccine clinical trials. (CDC)

13. Can the COVID-19 vaccine cause a miscarriage?

Scientists have not found an increased risk for miscarriage among people who received an mRNA COVID-19 vaccine just before and during early pregnancy (before 20 weeks of pregnancy). (CDC)

14. What are the risks of COVID-19 for pregnant women?

People with COVID-19 during pregnancy are more likely to experience complications that can affect their pregnancy and developing baby compared to people without COVID-19 during pregnancy. For example, COVID-19 during pregnancy increases the risk of delivering a preterm(earlier than 37 weeks) or stillborn infant. People with COVID-19 during pregnancy may also be more likely to have other pregnancy complications. (CDC)

15. Does COVID-19 (or the vaccine/booster) cause changes in women’s menstrual cycle?

It’s not yet clear if either COVID-19 or the COVID-19 vaccine causes changes in menstruation. A recent study of 4,000 people suggests that the vaccine is linked with a less than one-day change in menstrual cycle length for each dose. Keep in mind that multiple factors can affect menstrual cycles, including infections, stress, sleep problems and changes in diet or exercise. (Mayo Clinic)

LGBTQ+/Inclusivity

16. What are fertility treatment options for a lesbian/same-sex female couple?

    The two primary treatment options are intrauterine insemination (IUI) and IVF.

    IUI, also known as artificial insemination, requires using donor sperm from an anonymous or known donor. IUI involves injecting sperm directly into a uterus.

    IVF also uses donated sperm. The process involves ovarian stimulation to produce multiple eggs, egg retrieval, fertilization of the egg with the donor sperm in the lab and transferring an embryo into the uterus. (CCRM Fertility)

17. What is the fertility treatment process like for lesbian couples?

    After the couple decides which partner will carry the pregnancy, the person chosen will complete a fertility work-up. This includes blood work on the third day of her period to test hormone levels and an HSG (hysterosalpingography) to determine the health of the uterus and fallopian tubes. If the prognosis is good, the couple will select a sperm donor to start the process.

    If IVF is needed, a more complex treatment protocol involving medications to stimulate the ovaries will occur. If a partner whose eggs are being used, but will not carry the pregnancy, will also undergo a surgical egg retrieval procedure. The eggs will be inseminated with the donor sperm and once mature, the embryos will be placed in the uterus of the woman who will carry and give birth. (CCRM Fertility)

18. What are fertility treatment options for a gay/same-sex male couple?

    Gay men planning to build a family through fertility treatments will meet their physician to discuss the details of using an egg donor and gestational carrier/surrogate to achieve pregnancy via in vitro fertilization (IVF). (CCRM Fertility)

19. What is the treatment process like for gay couples?

    The partner whose sperm is used during the IVF process, will undergo a fertility work-up, including bloodwork and fertility testing. Per CCRM Fertility policies developed in accordance with FDA and ASRM requirements, known sperm donors and gay male couples are required to quarantine sperm. Persons undergoing quarantine must undergo medical, psychological and genetic testing prior to collecting and freezing sperm. Some of these tests are completed again after the quarantine period to reduce risk of infectious disease transmission. After the quarantine, the sperm are thawed and used to fertilize donated eggs. The embryo is then transferred to the person carrying the pregnancy, which is known as the surrogate. (CCRM Fertility)

20. What is the process for using an egg donor?

    Egg donors may be an individual known to the couple or an anonymous person who has been vetted and screened. The age of the egg donor is one of the most important factors affecting the outcome of IVF. Because fertility declines with age, the donor should ideally be between 19-33 years old. Once selected, the donor will undergo an intensive screening process that includes medical, psychological, genetic and infectious disease tests, and meet with an independent reproductive attorney. (CCRM Fertility)

    All individuals/couples using an egg donor, regardless of sexual orientation or gender identity, are required to meet with the CCRM Fertility mental health team before starting treatment. This meeting is focused on how to best support you and your future child around the issues of third-party conception. It is not an evaluation of any kind. (CCRM Fertility)

21. What should transgender individuals wishing to preserve fertility or conceive consider?

    Transgender men wishing to maintain future fertility potential should discuss fertility preservation options (such as egg and embryo freezing) with a reproductive endocrinologist prior to starting hormone therapy and/or undergoing gender-affirming surgery.

    Transgender women who may want to conceive children in the future should consider sperm freezing prior to starting any hormone therapy and/ or gender-affirming surgery. (CCRM Fertility)

Fertility and the BIPOC (Black, Indigenous & People of Color) Community

22. Are black women more likely to experience infertility?

    In the general population, infertility impacts 1 in 6. Black women, on the other hand, experience infertility at even higher rates than their white counterparts, even when taking into account socioeconomics or risk factors such as fibroids. (American Journal of Ob-Gyn)

23. What other factors affect why BIPOC women and other women of color experience higher rates of infertility?

    Cultural practices and differences could also affect why Black women and other women of color experience higher rates of infertility. A 2015 study found that Black women avoid discussing infertility with their closest family members and friends. They even experience discomfort talking with their doctors, which could lead to delays in treatment, ultimately resulting in increased difficulty of conceiving. (American Journal of Ob-Gyn)

24. Are Black women at a higher risk for fibroids?

A study found that by age 50, almost two-thirds of all women will develop uterine fibroids. Black women are not only three times more likely to experience fibroids, but they also have an increased chance of having larger and multiple tumors with more severe symptoms, and are more likely to develop them earlier in life compared to women of other races. (NIH)

25. How does race/ethnicity impact attitudes on infertility?

A study found that the social stigma of infertility was “very concerning” to 49% of fertility patients, and Black and Chinese women were more concerned about social stigma related to infertility than White women. (Fertility and Sterility)

26. Does race/ethnicity impact when a couple seeks fertility treatment?

    East Asian women and couples wait longer than their (Caucasian) peers before they consult a doctor about infertility. They are also much less likely to seek early intervention when they’re having problems getting pregnant. (Fertility and Sterility)

    East Asian (including Chinese, Korean, Japanese and Vietnamese) women have been demonstrated to have a longer duration of infertility by the time they reach consultation compared to white women, which may influence their chance for success with ART (Assisted Reproductive Technology). (Fertility IQ)

27. Does race/ethnicity impact access to fertility care?

    In a survey of 743 women: Black and Hispanic women were significantly more likely to report difficulties finding a doctor they could trust and afford fertility treatment from.

    Also, Black and Chinese-American women were significantly more likely to report social stigma as a barrier to seeking infertility care. (Fertility and Sterility)

Family Planning Options

28. Can birth control cause infertility?

    While birth control can prevent pregnancy while you’re on it, most forms of birth control don’t harm your future fertility. Women who’ve experienced irregular periods before starting birth control may see that irregularity return once birth control is stopped. (CCRM Fertility)

29. Should I consider fertility testing before trying to conceive?

    Comprehensive fertility testing helps fertility doctors evaluate one’s fertility health and develop a personalized treatment plan. (CCRM Fertility)

    If a woman is over 35, she should consider fertility testing after six months of trying to get pregnant. Since infertility affects men and women equally, so both partners should have their fertility tested. Taking a test earlier offers the chance to tackle roadblocks right off the bat. Further, if the results show signs of possible fertility issues, the doctor may recommend freezing a woman’s eggs while she’s still at a younger age. (American Society of Reproductive Medicine)

30. Why should I consider freezing my eggs?

    When it comes to fertility, age matters. As women age, their eggs diminish in quantity and quality, making it more difficult to conceive or maintain a pregnancy. This change occurs at different rates in different women, but does occur in all women no matter how healthy they may be otherwise. By the time a woman reaches her late 30s, about half of her eggs will be chromosomally abnormal (too few or too many chromosomes). These abnormalities often lead to failed implantation or miscarriage. Unfortunately, by the time she reaches her 40s, there’s just a 5% chance of becoming pregnant each month. For women not yet ready to conceive but wish to preserve fertility for the future, freezing their eggs in their 20s and 30s allows them to take advantage of their body’s fertility at a time when their eggs are at their healthiest. (CCRM Fertility)

31. Why should I consider freezing my sperm?

    Unlike women who are born with all their eggs, men continuously produce new sperm throughout adulthood. But like their female counterparts, men do have biological clocks. Studies show that men who are over 45 are at risk of new genetic mutations and other abnormalities in their sperm, which greatly increases the risk of genetic disorders and childhood health risks. To maximize the chance of having a healthy baby, CCRM Fertility recommends men younger than 50 who plan to have children in the future freeze their sperm. (CCRM Fertility)

Male Infertility

32. How common is male fertility?

    Infertility is often thought of as a woman’s issue, but it actually impacts men and women equally. About 10% of all males in the U.S. who are attempting to conceive experience infertility (CCRM Fertility) 

33. What causes male infertility?

    One of the main causes of male infertility are problems related to the testicles, such as varicocele. There are numerous additional factors that may affect male infertility, including hormone imbalances, blockages in the male reproductive organs, medications, surgeries and genetic disorders. (CCRM Fertility)

34. How is male fertility tested?

    Assessing male fertility involves providing a semen analysis. The sperm is then evaluated for a variety of things, including sperm count, the shape of the sperm and how well they move. (CCRM Fertility)

35. How is male infertility treated?
    • There are a variety of treatments available for men who are struggling to conceive. The course of treatment depends on the cause of low sperm count. It can sometimes be treated through IVF or IUI, depending on the severity of the reproductive issues. Intracytoplasmic Sperm Injection (ICSI) is the most advanced and revolutionary treatments. The process involves extracting a man’s sperm and then injecting directly into the egg using a specialized microscope. There are also other options, such as sperm retrieval or using donor sperm. Patients should work closely with their fertility specialist to choose the best option to fit their fertility needs. (CCRM Fertility)

Learn more about your fertility options at ccrmivf.com.