Fertility & Infertility FAQs
How can I tell if I am a candidate for IVF?
IVF is most successful in women whose fertility issues are caused by:
- Blocked or absent fallopian tubes
- Endometriosis
- Polycystic ovarian syndrome (PCOS)
- Low egg count or quality
IVF is also a good option for couples where the cause of infertility is unknown, or the man has fertility issues (which can be overcome since fertilization occurs in the lab).
What is IVF?
IVF stands for in vitro fertilization and is a series of procedures to help a woman become pregnant. A cycle of IVF takes about 2 weeks, and involves several steps. First, drugs are used to boost the woman’s egg production. Then, the eggs are retrieved (harvested) from the uterus and fertilized by sperm in a lab, before they are placed back into the uterus. IVF can be performed with a partner’s or donor’s eggs and/or sperm.
How expensive is IVF?
Does IVF hurt?
The egg retrieval part of IVF is usually performed under light sedation. Women may not be fully asleep, but should not be in pain. Immediately before the procedure, patients speak with an anesthesiologist to talk through any fears, how well the patient typically handles anesthesia, overall pain tolerance, etc. The anesthesiologist will also want to take into account how crampy or sore the patient may already be feeling because of the fertility drugs. During the procedure, patients should inform the doctor if they experience any discomfort so the anesthesiologist can make adjustments.
Am I too old for IVF?
Most fertility clinics have two age limits for having IVF, one for using the woman’s own eggs (typically 42-45) and one for using donor eggs (typically 50). But these are just general guidelines. Whether a woman is a good candidate for IVF depends on a lot of factors, only one of which is age.
How long does IVF take?
IVF is a series of medications and procedures that take place over 3-4 weeks. Women using their own eggs take medications to stimulate multiple egg production for a week or more, then take another medication to help the eggs mature. A day or two later, the egg retrieval procedure is performed and the sperm and eggs are brought together in the lab for fertilization. If all goes well, the embryos are transferred into the woman’s womb within 48 hours and a blood test the following week can detect whether pregnancy was achieved. The whole process is precisely timed.
How long should I wait before consulting a fertility doctor?
Infertility is defined as having frequent, unprotected sex for at least a year (if you are under 35) or at least 6 months (if you are 35 or older), without becoming pregnant. But that’s a general rule only. Women who have known issues that impact fertility, like endometriosis or PCOS, probably don’t need to try as long before seeing a specialist.
What is IUI?
IUI stands for intrauterine insemination and is a procedure to place sperm inside a woman’s uterus. Because it boosts the number of sperm that make it to the fallopian tubes, it increases the likelihood of fertilization. It can be done with or without fertility drugs. IUI is less successful than IVF, but also far less expensive.
Can I get pregnant the first time using fertility treatments?
What is ART?
ART stands for assisted reproductive technology. It’s a term that groups all the medications, procedures, and protocols that are used to help people with fertility issues achieve pregnancy. In vitro fertilization (IVF) and intrauterine insemination (IUI) are both types of ART.
How many tries does it usually take to get pregnant using fertility treatments?
The success rates of fertility treatments vary by the type of procedure, the age of the woman, whether fresh or frozen eggs are being used, and more. Clinics should be able to provide potential patients with their average success rates for procedures or situations that most closely matches theirs. But even that will not provide any guarantees. The best approach is to ask a lot of questions—including going to multiple fertility clinics if needed.
Do all fertility treatments mean getting injections?
For most women, yes. Hyperstimulation drugs help more than one egg to mature per cycle. There are milder stimulators in pill form (such as Clomid and Femara) that may be used with intrauterine insemination (IUI). But these tend to stimulate fewer eggs per cycle than injectables (gonadotropins). Since the egg retrieval is the most expensive part of in vitro fertilization (IVF), the goal is to harvest as many eggs as possible—which means using injectables. But even if IUI is performed with pills, an injection is also needed to precisely trigger ovulation and allow for better timing of the insemination.
Can I give myself fertility treatment injections?
Are there any tips to making fertility treatment injections easier?
Pinching the skin at the injection site, pushing the medicine in slowly, and rubbing the site when it is done can all help make fertility injections easier. For belly injections, it may help to shift the location around each time to keep the same area of skin from becoming irritated. Icing the area before the injection may also help. For muscular injections, heating the muscle before and after can help with discomfort. Women should keep their bodies as loose and relaxed as possible and focus on the end goal to make things go more easily. Patients can ask their fertility clinic or doctor’s office for tutorials or tips as needed.
What if I don't live with someone who can give me fertility treatment injections?
Women can give themselves every injection they will need throughout the fertility process. But living alone doesn’t have to mean doing it alone. Family and friends are often willing to lend a hand. The fertility clinic may also offer solutions, when needed.
What tests will I need to evaluate my fertility?
For women, the first step is blood testing. Be prepared that the lab will likely take many more vials of blood than is typically used for a blood test—as many as 15 or more. Some or all of these blood tests may be repeated or timed to occur at specific points in the menstrual cycle. Of course, a full medical history and gynecological exam will also be performed. Any additional tests needed will depend on the patient.
What is fertility testing like for men?
For most men, sperm analysis will be the extent of their fertility testing. Sometimes urine testing will also be done. A medical history and physical exam will also be performed. All are relatively easy for the patient, which is one reason that male fertility testing is recommended for all couples having trouble conceiving. About 50% of all fertility issues are believed to be caused by male infertility.
What fertility imaging tests are performed for women?
There are four main imaging procedures that women with fertility concerns may have:
- Hysterosalpingogram (HSG). A dye is injected through the uterus and fallopian tubes while taking an x-ray, allowing doctors to see problems
- A scope is inserted into the uterus so that doctors can see any scarring, growths, or other issues
- Endometrial biopsy. A small amount of tissue is scraped from the lining of the uterus (endometrium) just before the start of a menstrual cycle to determine if the tissue is the right thickness for pregnancy
- Small incisions are made in the abdomen to look for and treat endometriosis, growths, or scarring
What happens during the IUI procedure?
IUI (intrauterine insemination) is a simple procedure performed at the fertility clinic. The sperm is prepared first—thawed if it was frozen and “washed” (separated from semen). The woman lies down on the table, similar to the position for a gynecological exam. A small, thin tube called a catheter is inserted through the cervix into the uterus. The sperm is pushed through the tube into the uterus and the catheter is removed. The whole procedure might feel similar to a Pap smear, and there is no anesthesia needed. After, the woman may be asked to lie still for a few minutes before rising and resuming normal activity.
What happens during IVF egg retrieval?
Egg retrieval is precisely timed after the final injection and before the woman naturally ovulates. It takes place in a doctor’s office or fertility clinic. After discussing what will happen with both the doctor and anesthesiologist, the patient is given a sedative and is unconscious for the procedure. Using an ultrasound to see, doctors guide a thin needle through the vagina and into the follicles on the ovaries to retrieve the eggs. Less commonly, eggs may be retrieved through a laparoscopy surgery (a small incision near the belly button). After the procedure, women sometimes experience cramping and pressure, or a feeling of fullness. The retrieved eggs are incubated and analyzed in the lab where mature eggs will be fertilized.
What happens during IVF embryo transfer?
The embryo transfer takes place in the doctor’s office or fertility clinic anywhere between two and six days after the egg retrieval. Patients may be given a mild sedative or remain fully awake. While there is generally no pain, some mild cramping may occur. The doctor inserts a long tube, called a catheter, through the vagina and cervix into the uterus. The embryos suspended in fluid are pushed through the catheter into the uterus. Women may be asked to lie still for a while after the procedure before resuming normal activities.
What is mini IVF?
Mini IVF is a term sometimes used to refer to an IVF cycle that uses lower dose medicines to stimulate the production of eggs. It has the same parts as conventional IVF – the egg retrieval, in-lab fertilization, and embryo transfer. But, because lower doses of medications are used, fewer eggs are retrieved and transferred each cycle. The benefits are lower costs per cycle (mainly due to less medication), and lower risk of ovarian hyperstimulation syndrome (OHSS). The down-side is that success rates are typically lower, and because few eggs are retrieved each cycle, the egg retrieval procedure needs to be repeated more often for multiple attempts.
What is genetic counseling?
Genetic counseling is the process of helping potential mothers and fathers understand the variety of genetic testing available so that they can make informed decisions. For couples using in vitro fertilization (IVF), this may include testing multiple embryos for genetic conditions before deciding which embryos to implant – a process called pre-implantation genetic diagnosis (PGD). Genetic counseling can also be valuable to help parents understand the results and implications of genetic tests performed during pregnancy or after birth.
Do I need genetic counseling?
There are benefits to letting people know. It can lead to added support—which can really help as people go through fertility tests and treatments. People who share their fertility experiences might also be helping someone else by educating those around them about infertility. The downside is that there are more people to update along the way, which can feel like added pressure to some people. Ultimately, the decision to share is a personal one.
How much should I tell friends and family about my fertility treatments?
How much to share (or whether to share at all) is really up to each person. Some women share treatments, but keep the cause of their fertility issues private (especially if it involves their partner’s privacy, too). Another consideration is to only open up to people who are sensitive enough to put the patient’s needs before their own curiosity. People dealing with fertility issues may even be surprised to find others in their own circle are going through (or have been through) something similar.
Why is getting pregnant so hard?
Even when everything is functioning normally, a couple ages 29-33 has only a 20-25% chance of conceiving in any given month. This decreases with age and as many as 1 in 8 women have trouble getting pregnant or sustaining a pregnancy. Age, smoking, excessive alcohol, stress, and weight changes all decrease a woman’s chance of conceiving, as can conditions such as PCOS, endometriosis, or problems with the structure or function of the female reproductive system.
How do I know when it's time to give up on fertility treatments?
Many people embarking on fertility treatments find it useful to set financial and time limits before starting. The rush of hope with each treatment cycle can become addictive and the impulse to try “just one more cycle” can be compelling—leading couples to continue longer than recommended, even by their own fertility specialists. Signs it might be time to stop treatment include:
- Treatment is causing painful or disruptive symptoms
- Continuing would put couple deep into debt
- There are signs of depression (e.g., loss of interest in activities, fatigue, self-loathing, anxiety, sleeplessness)
- It is interfering with jobs or relationships
What changes will going through fertility treatments mean for our relationship?
Fertility treatments can be intensely stressful for couples, but that doesn’t mean it has to hurt relationships—especially if both partners support each other throughout the process. Two strategies that may help are to avoid blame (or words that might sound like placing blame) and protecting the relationship. That means taking time for each other, even a break from trying, if needed. Give each other the space and understanding to deal with situations in their own way, but keep talking. Couple therapy can also help.
What changes will going through fertility treatments mean for my lifestyle?
Big lifestyle changes should happen whether women are trying to get pregnant naturally or with fertility treatments: Avoid smoking and drinking, eat a healthy diet, limit caffeine, and get enough sleep. For those going through infertility treatments, you will probably need to stick close to home for a while. There will be a lot of doctor appointments and bloodwork, and fertility treatments are precisely timed. Sneaking away for a long weekend may be possible, but most people shouldn’t go very far or plan too far in advance.
What is secondary infertility?
When fertility issues arise in people who already have one (or more) children, it is referred to as secondary infertility. It’s more common than many think, since parents are older when they try to grow their families and age is a factor in infertility.
Should I tell my other children about my fertility treatments?
It can be tempting for parents trying to grow their family to keep their fertility treatments secret from other children. But that is not always best. Kids pick up on emotions really quickly, and trying to conceive is an emotional time—even without the addition of fertility drugs. If children don’t know what is happening, they may misinterpret those emotions as being about them. Every child, and family, is different, but consider having age appropriate conversations to help children understand.
How do I explain fertility treatments to my other children?
When talking to children about fertility treatments, it’s important to keep it age-appropriate. For younger children who don’t know how babies are made yet, parents can just say they are trying to grow their family and taking some medicine to help (or another treatment type). Older kids can handle more detail, but it’s best to start out with a short statement and then let them respond with questions. Answer simply and honestly. Don’t ask kids to keep it a secret. Young ones won’t be able to and for older ones, the stress of keeping secrets can be significant. Reassure kids at every turn that they are loved and try to shield them as much as possible from the ups and downs of fertility treatments.
When should I tell my child that they were conceived through fertility treatments?
In age appropriate ways, parents can talk to their children about the fertility treatments used in their conception as young as 2. But most children won’t be able to understand much until they are older. The recommended goal is for kids to grow up “always knowing” which means by 4 or 5 for most children. Starting this young tends to make the conversation much easier for kids and parents throughout their lives. When telling older children and adults, a great deal depends on the unique situation and relationships. Family counseling may be helpful.
What should I tell my child who was conceived through fertility treatments?
Keeping the details age appropriate, parents should start with a basic statement of the facts and let kids follow up with questions. One starter might be “Some families need extra help having babies. We got help from a doctor and that’s how we had you.” This will likely be repeated over time and as kids age, they will ask more detailed questions. Parents should answer honestly and clearly, while reinforcing how wanted and loved the child is. Adding in “there are all different kinds of families” can also help, especially in situations where donor sperm or eggs were used.
Are there any restrictions while undergoing IVF?
Could I still be pregnant if my home pregnancy test was negative?
Yes. Home pregnancy tests detect the amount of a hormone called HCG that increases rapidly with pregnancy. While they claim to be 99 percent accurate, false negatives do happen (much more commonly than false positives). The tests are most accurate if they are taken at least 7 days after a missed period. The earlier they are taken, the less accurate they are. Also, it’s important to give the test the full time listed on the package instructions before reading the result. Taking the test first thing in the morning, when urine is most concentrated, will also improve accuracy.
What is my fertility window?
It is important to review all medications and supplements with your fertility doctor to determine if any need to be paused or changed. This review should include any medications that are sometimes used for pain relief, allergies, or other common concerns. Aside from this, most fertility clinics will advise patients to:
- Stop smoking—for at least 3 months before beginning an IVF cycle
- Stop drinking—from the beginning of IVF treatment until the pregnancy test (or birth of the child if IVF is successful)
- Stop vigorous exercise (e.g., aerobics, weightlifting, and running)—from the start of ovarian stimulation until the pregnancy test
- Limit caffeine—only 1 or 2 caffeinated beverages a day
- Avoid having sex—from 2 days prior to egg retrieval until the pregnancy test
Are there side effects associated with IVF?
The most common side effects after IVF include mild bloating and cramping, breast tenderness, and/or constipation. Women may also pass a small amount of clear or blood-tinged fluid. There are also side effects of the medication used during fertility treatments, which may include headaches, mood swings, abdominal pain and bloating, and/or hot flashes. Symptoms of concern that should be immediately reported to a doctor, include:
- Heavy vaginal bleeding
- Blood in urine
- Severe stomach or pelvic pain and/or bloating
- Fever over 100.5°F (38°C)
- Nausea or vomiting
- Shortness of breath
- Decreased urinary frequency
- Gaining 10 lbs. or more in a 3 to 5-day period
What is the likelihood I'll have twins or multiples with fertility treatments?
A woman’s chance of pregnancy with multiples (e.g., twins, triplets) increases with the fertility drugs used to stimulate more than one egg to mature in a cycle (superovulation). The two most common medications are Clomid (clomiphene citrate) and a class of drugs called gonadotropins. According to the American Society for Reproductive Medicine, between 5% and 12% of pregnancies conceived with Clomid are twins and less than 1% triplets. Gonadotropins are much stronger, with about 30% of pregnancies resulting in multiples (and up to 5% total triplets or greater). For this reason, gonadotropins are typically only recommended in conjunction with in vitro fertilization (IVF)—where women and their doctors can decide together how to best limit that chance. For instance, transferring only one egg per cycle drastically reduces the risk of multiples with IVF.