Q. When should I consider seeing a Reproductive Endocrinologist Infertility (REI) specialist?
A. The American Board of Obstetrics and Gynecology recommend that patients under age thirty five try to conceive for one year before pursuing infertility treatment. Patients between the ages of thirty five and thirty nine should try to conceive for six months and women age forty and over should wait no more than three months.
There are a few exceptions to these recommendations. Patients who have irregular menstrual periods (cycles that are thirty five days or longer between periods) or have had previous pelvic infections such as PID should seek advice from their Gynecologist for an earlier referral.
Q. Why should I see a board certified Reproductive Endocrinologist Infertility specialist?
A. Board certified Reproductive Endocrinologist Infertility (REI) specialists have completed: 1) Fours years of medical school, 2) Four year residency training in the OB/GYN specialty, 3) Two to three years of fellowship training in the Reproductive Endocrinology Infertility specialty, and 4) Passed the national Reproductive Endocrinologist Infertility written and oral test along with the OB/GYN specialty written and oral given by the American Board of Obstetrics and Gynecology.
The additional two to three years of training beyond the OB/GYN specialty focuses on assisted reproductive techniques, advanced microsurgery of the pelvic organs, disorders of the anatomy which may affect fertility, and disorders of the sperm. This additional training beyond the OB/GYN specialty is invaluable and will increase your probability of conception.
Some insurance plans will only reimburse fees for infertility services if the doctor is a Reproductive Endocrinologist and Infertility specialist. The American Board of Obstetrics and Gynecology recommends patients seeking advanced infertility treatments see a board certified REI.
Q. How much does infertility treatment cost?
A. The cost involved with creating a successful pregnancy depends upon the nature of the disorder causing the infertility, the age of the female partner, and if a male factor is involved. Costs can range from a small co-pay for those who have insurance coverage for treatment. For patients who do not have insurance coverage for IVF treatment, we offer discounted package prices. Our practice has been able to greatly reduce the total cost for those patients needing the most advanced treatments such as IVF by having our own egg retrieval suite on site thus eliminating a separate facility fee to a hospital. Our egg retrieval suite is equipped with state-of-the-art equipment and all anesthesia is given by licensed Anesthesiologists who practice within the Memorial Hermann Hospital system.
* Fees are subject to change without notice but not during a treatment cycle.
Q. Will infertility therapy be covered by my insurance plan?
A. Most insurance plans cover the initial consult with a Reproductive Endocrinologist Infertility (REI) specialist and the diagnostic portion (the testing) of finding out why you are not able to get pregnant. The infertility treatment itself may be covered in part or completely. Although the trend is toward more insurance plans covering infertility, there are still plans that offer no coverage.
Our staff is highly trained in handling insurance coverage verification and claim filing. We will make every effort to obtain payment from your insurance plan when possible.
Q. How successful are infertility treatments?
A. Improvements in medication, microsurgery, and in assisted reproductive technologies (ART) make pregnancy possible for the majority of the couples pursuing treatment. Over two thirds of infertile couples will be able to make their dreams of having a child come true. In particular, success rates have dramatically improved for couples who require ART. The pregnancy rate for an ART cycle approaches the monthly fertility rate for most couples. After an initial consultation and a review of diagnostic tests we can better determine your probability as success rates vary from patient to patient and from situation to situation.
Q. What are my chances of having twins, triplets or higher multiple births?
A. Most cases of successful treatments with either ovulation induction with IUI or IVF will result in a single birth. The national averages are approximately 25% twin rate and 5% triplets or more. Currently our twin rate is less than 10% and our triplet rate is less than 1% and currently no higher order of multiples (quadruplets, quintuplets).
Q. Is it safe for me to have a baby in my late 30’s or early 40’s?
A. Many women well into their 40’s will have healthy children. The risk for birth defects such as Down Syndrome do increase as you age, as do the risks of developing complications during pregnancy such as Gestational Diabetes (Diabetes during pregnancy) or Hypertension (high blood pressure). Early genetic screening can be used to detect certain defects like Down syndrome. Maintaining a healthy diet and exercise pattern will help reduce the possible health complications. Your physician can help you evaluate your individual risks based on your age and overall health.
Q. How long should I remain on Clomid/Serophene/Clomiphene Citrate therapy?
A. The majority of patients who respond to Clomiphene Citrate do so during the first month of therapy. Three ovulatory courses constitute an adequate therapeutic trial. If pregnancy has not been achieved after three ovulatory responses, further treatment is not recommended. Other treatment options should be considered.
Emotional Impact of Infertility and Treatment
The diagnosis of infertility and the treatment required to successfully achieve pregnancy may be one of the most stressful times a couple faces in their marriage.
Couples find themselves struggling with feelings they never experienced before. Feelings of loss of control of their life and schedule, emotional ups and downs each cycle of treatment can bring that begin with hope and end with disappointment. Financial issues can be a significant source of stress. Borrowing money or using savings for something that is not absolute can be difficult for some partners while others feel any cost to obtain their dream is acceptable. Many couples experience feelings of guilt, shame or embarrassment, blaming themselves for things beyond their control. Time spent during treatment cycles can impact some careers by adding pressure. The treatment itself can affect intimacy in the relationship. Coping in a fertile world where it seems everyone else but you can conceive may bring feelings of injustice.
Men and women often cope with stress in different ways. Women tend to be emotional caretakers, experiencing not only their own emotions but wanting to protect their husband's feelings too. This can be overwhelming after awhile. Men often are more instructional, tending to make decisions and act without emotion, often immersing themselves in their work or hobbies where they can better control outcomes. Without good communication skills eventually these differences can create problems within the marriage.
Psychological counseling with a counselor who has experience in infertility can be beneficial. Sharing with a third party who has experience and knowledge of the difficulties of infertility and treatment may help couples better understand each other's reactions. Support groups like Resolve and American Infertility Association where others who have experienced infertility share and offer support at regular meetings can be helpful. Reading from the suggested list of books below is another option.
1. Choosing Assisted Reproduction: Social, Emotional & Ethical Considerations, Susan Cooper, Ellen Sarasohn Glazer
2. Experiencing Infertility: An Essential Resource, Debby Peoples, Harriette Rovner Ferguson
3. Experiencing Infertility: Stories to Inform and Inspire, Ellen Sarasohn Glazer
4. Fierce Longing: Women and Infertility, Ruth H. Judy
5. For Want of a Child: A Psychologist and His Wife Explore the Emotional Effects and Challenges of Infertility, James McGuirk, Mary Elizabeth McGuirk
8. The Infertility Survival Guide: Everything You Need to Know to Cope with the Challenges while Maintaining Your Sanity, Dignity, and Relationships, Judith C. Daniluk, Margo Fluker Judith C. Daniluk
9. The Long Awaited Stork: A Guide to Parenting after Infertility, Ellen Sarasohn Glazer and Alan Rinzler
10. Longing for a Child: Coping with Infertility, Bobbie Reed
11. Pennies from Heaven: 101 Meditations for Couples Trying to Get Pregnant, Frances Stone, Philip Stone
12. Stolen Joy: Healing after Infertility and Infant Loss, Anne Barney
13. Sweet Grapes: How to Stop Being Infertile and Start Living Again, Jean W. Carter, Michael Carter
14. Taking Charge of Infertility, Patricia Irwin Johnston
16. This Too Shall Pass: A Handbook for the Emotions of Infertility, Lori Durante Rardin