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The Fertility Journey
Basic Infertility Information
Welcome to the Sher Fertility Institute website! This section of the site was created to give visitors access to comprehensive information on the causes, diagnosis and treatment of infertility. If you are just getting started and are looking for general information on infertility, you can browse through the Fertility FAQs below to find the answers you need. Our site also has a wealth of articles on infertility that can be accessed through the menus above.
The information starts with the basics for those who may not even know if they need treatment, and progresses to more complex and technical information for those who are veterans of fertility treatment and IVF. It also includes updates on the latest advances in reproductive medicine from Sher Fertility Institute doctors.
Watch the video above for an introduction to the site by Sher Institute founder and Executive Medical Director Geoffrey Sher, MD.
1. How do I know if I need to see a fertility specialist?
The general rule is that if you have been trying to get pregnant for a year (6 months if you are over 35), you should seek the help of a fertility specialist. Many couples lose precious time by putting this off, and continuing down the same path they have been on. You should also seek the advice of a fertility specialist if you have had more than 2 consecutive miscarriages. This could indicate implantation problems and/or other issues that need to be resolved.
2. How is a Reproductive Endocrinologist different than my regular OB?
A Reproductive Endocrinologist (RE) has specialized training in fertility treatment that goes beyond the scope of what most Ob/Gyns have. To become board certified in the subspecialty of Reproductive Endocrinology and Infertility, a doctor must first be board certified in Obstetrics and Gynecology. REs also have specialized equipment and laboratories that allow them to diagnose and treat fertility problems.
3. What are the most common causes of infertility?
In a general sense, about 40% of fertility problems are due to female fertility issues, 40% are due to male factor infertility, and the remaining 20% are "unexplained" infertility or a combination of male and female infertility. Female fertility problems can be grouped into egg/embryo related problems and implantation problems. Male fertility issues can be grouped generally into sperm quantity and sperm quality categories. More detailed information on various causes of infertility can be found HERE
4. How does age affect fertility?
Age has a negative effect on both egg quality and egg quantity. Most women don't realize that their fertility begins to decline around age 30. By age 35, about 40% of a woman's eggs are chromosomally normal. By age 40, about 15-18% are normal, and by age 45, less than 5% are normal. This is in addition to the declining number of eggs as she ages, so fertility treatment becomes more necessary, but less successful with age. Read more about the "Biological Clock" and its effect on fertility HERE
5. What kinds of tests are needed to diagnose fertility problems?
There are a variety of fertility tests for both the female partner and the male partner. In general, female testing includes assessment of various hormone levels and antibodies, assessment of the pelvic environment for endometriosis, fibroids, blocked/obstructed fallopian tubes, and an assessment of the uterine cavity. For the male, testing focuses on the quality and quantity of sperm present. Read more about diagnosing fertility problems HERE
6. What are treatment options for infertility?
Treatment options depend on the specific fertility issue(s) at hand. Treatment for male factor fertility problems generally focuses on overcoming sperm quantity and quality issues. Specifics can be found HERE. Because female fertility problems can originate from a wider variety of causes, the treatment options are more diverse. They can address issues of egg quality, uterine environment, tubal issues, ovulation problems, hormone levels, immunity, and pelvic environment. The various treatment options for infertility are covered HERE
7. How do I get started?
The first step in any diagnosis or treatment process is to set up a consultation with a SIRM physician. Fill out the consultation request form HERE, or call your nearest SIRM office to schedule an in-person or telephone consultation. Prior to your consultation, we will have you fill out a questionnaire addressing your medical and reproductive history, and ask you to provide any relevant medical records. During your consultation, your doctor will discuss your history in detail, and lay out an individualized plan for systematically addressing your fertility issues. If you proceed to treatment, you will be assigned a clinical coordinator that will walk you through the entire process and answer any questions or concerns that you have along the way.
8. Will your doctors/nurses answer a question if I am not a patient?
There are several ways to reach our doctors with questions – even if you are not a Sher Fertility Institute patient. The first is through our discussion boards at http://forums.haveababy.com. You can register and post your questions for our doctors, who will usually answer them the same day. All of our doctors also have blogs, where you can make comments or ask questions related to any of their blog posts. You can find a list of their blogs HERE.
9. How can I connect with other people dealing with infertility?
One of the best ways to connect with others in the infertility community is through our Facebook page. With nearly 3,000 members, the Sher Fertility Institute Facebook Page http://Facebook.com/haveababy is an excellent place to share your questions and comments, and to read the comments and experiences of others who are going through similar experiences.
Becoming a SIRM Patient
Thank you for choosing Sher Fertility Institute! If you are ready to lay out a plan for taking charge of your fertility, you have come to the right place! Here, you will find information on setting up your initial consultation, direction on what types of testing and treatment may be recommended, and the process for putting your fertility treatment in motion. If you are coming to SIRM from another fertility clinic, you'll find information on having your records and/or your embryos transferred from your current clinic to SIRM. You will also find information about the costs of treatment and the IVF plans available at SIRM. Browse the fertility treatment FAQs below, or select from the menus at the top of the page to begin your journey with SIRM.
1. How do I become a Sher Fertility Institute patient?
Your first step is to schedule a consultation with a SIRM physician. You can do that by filling out a consultation request form found HERE or by calling one of our offices directly (you can find a list of all SIRM offices HERE. Prior to your consultation, you will be asked to fill out a new patient questionnaire with details of your prior medical and reproductive history. The questionnaire can be found HERE. You may need to have your medical records transferred from your current physician, which is outlined in the question below./div>
2. How do I make an appointment to speak with a doctor?
3. How do I know what kind of treatment I need?
Your first step toward understanding your best course of treatment is to set up a consultation with a Sher Fertility doctor. They will talk with you about your medical and reproductive history, go over your medical records, and develop an individualized plan for testing and/or treatment
4. What kind of testing should I have?
This depends on what tests you have already done, how recently they were completed, and the recommendations of your Sher Fertility doctor. Your first step is to set up a consultation with a Sher Fertility doctor. They will talk with you about your medical and reproductive history, go over your medical records, and make recommendations for any necessary male and/or female testing. An overview of diagnostic fertility testing is available HERE
5. How can I get my medical records transferred from my current doctor?
Contact your current doctor's office and request a records transfer. They generally require you to sign a release authorizing the transfer.
6. How do I get my embryos transferred from my current clinic?
This can be tricky, as most clinics will not ship embryos because of the liability. Often, you can arrange to pick up your embryos at your clinic after signing a release, and ship them yourself. We recommend that you research specialty shipping services with expertise in embryo shipping, as there are certain regulations that have to be adhered to and specialized shipping containers that maintain the proper temperatures.
7. Do you have discounted IVF plans?
We have a variety of plans including multi-cycle package plans, lower stimulation IVF plans for couples that fit certain profiles, and discounted IVF packages for military families, "First Responders", teachers, and couples on incomes under $55,000. You can find more info on our package plans HERE
8. Do you offer financing?
We don't directly finance IVF treatment, but we can refer you to other companies that offer financing. You'll find a list of them HERE
9. I would like to donate my eggs. What is the process?
We don't operate our own egg donation services. All these services are coordinated by outside donor agencies. To donate your eggs, most agencies require that you fill out a detailed medical and personal history, go through medical screening, and register with them. Once you are registered, your photo and profile are stored in a donor database until an IVF patient selects you as their donor. At this point, you will begin a regimen of injectable medications that cause your ovaries to produce multiple eggs. The eggs are then extracted under general anesthesia using a needle, and fertilized in a laboratory. 1 or 2 of the resulting embryos are then transferred to the recipient's uterus, where, if all goes well, they will implant and grow into a pregnancy.
10. How old is too old for IVF?
There are no absolutes, but as a woman gets older, the number of eggs she produces drops off sharply. In addition, her egg quality (chromosomal makeup) declines, such that by age 35, only about 40% of a woman's eggs are chromosomally normal, by age 40, about 15-18%, and by age 45, less than 5% are normal. This reduces the chance of IVF success to the point that it isn't recommended (with the woman's own eggs) past age 43-45. However, with good quality donor eggs, a woman can carry a baby into her 50's or later.
11. How do I know if I need an egg donor?
This question can only be answered by your doctor based on a variety of testing. In general, the quantity and quality of your eggs will determine whether you'll need a donor. There are a number of factors that affect both, but age is the most universal determinant.
Current SIRM Patients
If you are a current SIRM patient, or are beginning fertility treatment with us soon, this section provides the information you will need to navigate your treatment as efficiently and conveniently as possible. Here, you will find information on IVF treatment calendars and scheduling, administering your fertility medications, reaching your doctor and/or nurses, ways to optimize your treatment, and an overview of various testing procedures that you may opt for prior to your treatment. Browse the FAQs listed below to get started.
1. How can I reach my clinical coordinator?
Your SIRM office should provide you with a phone number and an email address that will allow you to reach your coordinator - or the after hours answering service, which have someone get in touch with you. You can find the phone numbers for the SIRM offices HERE
2. What are the steps and timing of an IVF cycle?
You can access a full overview of the IVF process by clicking HERE. When you schedule your IVF procedure, you will be given a calendar by your clinical coordinator that will highlight all of the key components of your cycle, including medications, appointments, ultrasounds, tentative egg retrieval, embryo transfer and pregnancy test dates.
3. What if I need to reach the doctor after hours?
Call your SIRM office, and request that the answering service have the doctor contact you. If you are in cycle, you may be given a special phone number that rings directly to a clinical coordinator who can help you.
4. Should I have genetic testing/PGD done on my embryos?
This depends on a number of factors including your age, medical history, and other risk factors. As a rule, genetic testing can improve pregnancy rates by identifying those embryos that are most likely to make a baby. The additional cost may negate the advantages for some couples. Another reason for having genetic testing done is for Gender Selection. IVF with PGD is really the only accurate method of gender selection available.
5. Do I need immune testing?
Your SIRM physician may recommend immune testing based on your reproductive and medical history – particularly if you have a history of recurrent miscarriage. This is something that can be discussed in your consultation. You can read more about immunologic factors and testing HERE
6. Does acupuncture improve IVF success rates?
There are varying opinions on the effectiveness of acupuncture at aiding successful IVF. Certain studies indicate that there are benefits, and many patients find that it gives them additional confidence and peace of mind. In the end, it is a personal decision.
7. Who can I ask a question about medications?
If it is an urgent question regarding your current cycle, please contact your clinical coordinator by phone or email. If it is after hours, please call your SIRM office and ask the answering service to have a nurse get in contact with you. If it is a more general question about administering your medications, you can view our instructional videos HERE. Finally, if it is a question about a specific type of medication, you can post it on our discussion boards and usually receive a response within a few hours.
8. How do I prepare and administer my medication injections?
We have produced a series of detailed videos on preparing and administering your injections that can be viewed HERE
9. How do I have my records transferred to another doctor?
Please contact the SIRM office where your records are kept and they will direct you on the process for having your records released.
10. How do I have my embryos transferred to another clinic?
Please call the SIRM clinic where your embryos are stored to find out their specific protocols on transferring your embryos.
11. Is my beta hCG strong? What do the numbers indicate?
The most important indicator in beta hCG tests is whether the number doubles every 48 hours. In some cases where a beta number doubles initially, then decreases its rate, it may indicate that a twin pregnancy has reduced to a singleton. When this is the case, it may slow initially, but should then begin to double again every 48 hours. Some betas may start off as low as 3 or 4, then progress to a healthy pregnancy, so there is really not a specific threshold number that indicates a viable pregnancy. Every case is different. Dr. Sher has written a helpful article about the beta hCG test that can be found HERE
12. Do you have discounted rates with local hotels?
Yes, since many of our patients travel from out of town to our offices, we have arranged special rates with local hotels for patients being treated at our clinics. Contact your SIRM office for a list of hotels in your area.
13. If I am traveling to your center from out of town, how long will I need to be gone?
In general, from the time of your first monitoring appointment (generally on cycle-day 9), you'll need to be near our offices for 10-14 days. This will depend on the timing of your egg retrieval and embryo transfer.
14. I am traveling from out of town to SIRM for IVF. Can I do some of my monitoring and/or testing at my local doctor's office?
Yes, all pre-cycle testing can be done with your own local physician. It depends on your situation and your own SIRM physician's choice, but often the SIRM physician prefers to do their own in-cycle monitoring for quality control reasons.
15. I have frozen embryos that I am not planning to use. What are my options?
You have several basic options:
1. Continue to store them. Current freezing technology allows frozen embryos to remain viable almost indefinitely.2. Donate them to another couple for use in IVF. This is commonly known as "Embryo Adoption" and there are a number of agencies that specialize in facilitating these exchanges. An internet search for Embryo Adoption will turn up a wealth of information and resources on the subject.
3. Donate them for research. IVF clinics don't accept donations of embryos for research, but other research organizations do. They are used in stem cell and other types of research. There are extensive amounts of paperwork and consents to fill out when donating embryos for research. Also, if donor sperm or eggs were used in the creation of the embryos, the donor(s) must sign a consent form as well. Only an estimated 1% of frozen embryos are donated for research.
4. Have them discarded/destroyed by your clinic. This requires consent from all parties involved as well.
Ultimately, the decision is highly personal and should be undertaken with careful forethought.
Dr. Sher has written a blog post on the topic of leftover embryos and deciding what should be done with them. It can be found HERE.