Q: What is infertility?
A: Infertility is when a couple is unable to conceive after one year of unprotected intercourse. It affects approximately 15% of couples, that’s about 5.3 million Americans. Women with certain symptoms such as irregular menses or no menses, and women who are 35 years of age or older should also seek care with a specialist sooner. Approximately 40% of infertility is attributed to the male partner, 50% to the female partner and in 10% of cases, the cause is unknown.

The good news is that most will succeed in achieving parenthood with the appropriate management.

Q: What causes infertility in men?
A: A man’s sperm count can be influenced by numerous factors. Lifestyle, including the excessive use of nicotine, alcohol and marijuana could have a strong impact on semen parameters. Certain medical conditions, such as diabetes, and medications could also impact sperm production. Congenital or anatomic abnormalities either from birth or as a result of surgery (hernia repair), hormonal imbalances, genetic conditions (cystic fibrosis), infections (mumps), testicular damage or trauma have all been known to impact sperm production. Inability to ejaculate normally can also prevent conception and can be caused by many factors including surgery of the prostate gland or urethra, diabetes, high blood pressure, medication or impotence. It should be noted that the cause of many cases of male factor infertility are unknown. The good news is that we are able to achieve successful outcomes in most male factor couples.

Q: What causes infertility in women?
A: Common causes of infertility in women include abnormalities in ovulation, blockage or disease of the fallopian tubes, and ovarian failure or diminished ovarian reserve. Uterine conditions, such as uterine adhesions and fibroids are conditions that rarely cause infertility. Lifestyle factors such as stress, extreme dieting or athletic training can affect a woman’s hormonal axis and hence result in infertility.

Certain medical conditions, such as thyroid gland abnormalities and pituitary gland tumors can also impact the reproductive system and hence resulting in infertility. Other conditions including endometriosis (the abnormal presence of uterine lining cells in other pelvic organs) and pelvic adhesions have been associated with infertility.

Q: How is infertility tested?
A: The first step for a woman is to determine if she is regularly ovulating each month. This can be done by charting changes in morning body temperature, by using an FDA-approved home ovulation test kit (available over the counter), or by a blood test for hormone levels or an ultrasound of the ovaries. Other common female tests to evaluate female infertility include:

• Hormonal Testing: This may include assessment of ovarian reserve, thyroid function and prolactin levels.
  
  
• Hysterosalpingogram: This procedure involves an X-ray to investigate the shape of the uterine cavity and the fallopian tubes after they are injected with dye.
  
  
• Laparoscopy: A miniature light-transmitting tube, also known as laparoscope, exams the tubes and other female organs for disease. Usually under general anesthesia, the tube is inserted into the abdomen through a small incision below the navel.
  
  
• Hysteroscopy: A miniature light-transmitting camera is inserted into the uterine cavity to evaluate for the presence of polyps, adhesions or fibroids, which can interfere with fertility.

Q: How is infertility treated?
A: Treatment of infertility varies for all couples depending on the information gathered from the consultation and the diagnostic testing. Common treatments include ovulation induction, which could be done with clomid, a medication taken orally for five days in the beginning of a woman’s cycle. If appropriate, ovulation induction could also be done with gonadotropins, which are hormonal medications delivered through small injection shots. An intrauterine insemination (IUI) may also be recommended depending on the semen parameters.

If ovulation induction and IUI is not an option due to female and/or male factors or has previously not been effective, the next option for treatment would be in-vitro fertilization (IVF). IVF offers the highest percentage of success rate and every protocol is customized to address the specific needs of the patient.
Conditions that are amendable to surgical correction are approached through surgery. Surgeries that are involved with a woman¡¯s ovaries, fallopian tubes, or uterus are recommended only if there is a good chance of restoring fertility.

Q: What is in vitro fertilization (IVF)?
A: IVF is what is known as a “test tube baby.” It is a technology where medications are given to stimulate the ovaries to produce multiple mature oocytes (eggs). Once the follicles containing these oocytes are at a certain size, the eggs are removed from a woman’s body using a small needle. The eggs are then assessed for maturity and quality and then fertilized with the partner’s sperm in the embryology lab. The resulting embryos are grown for 3 to 5 days and then returned back to the woman’s uterus. A pregnancy test is performed approximately 10 days later.

Q: Is in vitro fertilization expensive?
A: The average cost of an IVF cycle in the United States is $12,400. IVF involves highly trained professionals with sophisticated laboratories and equipment. IVF only account for 0.03% of U.S. health care costs. At Cha Fertility Center, we offer various competitive and flexible payment options to address our patient’s individual situations.

Q: Does in vitro fertilization work?
A: Yes. IVF was introduced in the United States in 1981. Since 1985, through the end of 2006, nearly 500,000 babies have been born in the United States as a result of reported Assisted Reproductive Technology procedures (IVF, GIFT, ZIFT, and combination procedures). IVF currently accounts for more than 99% of ART procedures with GIFT, ZIFT and combination procedures making up the remainder. The average live delivery rate for IVF in 2005 was 31.6% per retrieval.

That’s better than 20% chance in any given month that a reproductively healthy couple has achieving a pregnancy and carrying it to term. In 2002, approximately 1 in 100 babies born in the United States was conceived using ART and that trend still continues today.

Q: What factors increase a man's risk of infertility?
A: The number and quality of a man's sperm can be affected by his overall health and lifestyle. Factors that may affect sperm count and quality include:

• Age
• Tobacco use
• Alcohol
• Drugs
• Environmental toxins, including pesticides & lead
• Medical conditions
• Medications
• Radiation treatment & chemotherapy for cancer

Q: What factors increase a woman's risk of infertility?
A: Many things can affect a woman's ability to have a baby. These include:

• Age
• Tobacco use
• Alcohol
• Stress
• Poor diet
• Athletic training
• Being overweight or underweight
• Sexually transmitted diseases (STDs)
• Health problems that cause hormonal changes

Q: How does aging decrease a woman's chance of having a baby?
A: Aging affects a woman’s ability of achieving pregnancy in the following ways:

• The ability of a woman's ovaries to release eggs ready for fertilization declines with age.
• The quantity and quality of a woman's eggs decline with age.
• As a woman ages she is more likely to have health problems that can interfere with fertility.
• As a women ages, her risk of having a miscarriage increases.