Ask the Doctor – General Infertility


What do you think about health care changes and insurance coverage for IVF?

I do believe that infertility is a disease with great treatment success and therefore should be covered by insurance like other illnesses. However, in states where insurance does cover infertility, there are often inappropriate guidelines for usage that can backfire against some patients, for example the 42 year old who just started trying to get pregnant and now must do several treatment cycles of insemination before IVF.

I had my tubes tied but now I want another baby what are my options?

So long as you have your uterus and your ovaries you are in luck! You have two different options: One is to undergo a microsurgical tubal reversal. At RSC we have been doing this for over 20 years with a greater than 80 percent pregnancy rate in patients < 38 years old. If your FSH hormone level is normal and your partner has a normal semen analysis, this would be an excellent option. The surgery is an outpatient procedure with a two to four week recovery.

My husband had a vasectomy, what can we do to have children?

As is often the case, men with vasectomy have good sperm. The problem is that they cannot get from the testicles through the vas deferens to ultimately be ejaculated. There are two options in this situation. Option one is to reverse the vasectomy. A urologist would perform this outpatient procedure. It can be done in our facility. Sperm can be analyzed and cryopreserved on the spot for use in the future if the reversal is not successful. After a three to six month recovery, a semen analysis can be performed to check for healthy sperm. Conception can then occur naturally, or with a little help from inseminations. Option two is to “harvest” the sperm through a simple needle procedure. The sperm (small in quantity) can then be frozen for later use in an IVF cycle. This is the quickest route to achieving a child. It is especially appropriate if the vasectomy was over five years ago or the female partner is over 38.

How do I know what fertility treatment would be appropriate for me?

Your doctor will take a detailed history and perform an ultrasound examination to begin to uncover the potential causes of your infertility. Diagnostic testing will be ordered to further determine any reasons that pregnancy is not occurring. Based on this evaluation, there are many treatment options available. Your doctor will sit down with you and review your specific findings and then review a treatment plan with you. Your treatment plan is always individualized to your particular infertility factors. Some patients benefit from oral medication or injections while other are aided by an insemination procedure. Some patients need in vitro fertilization to help them achieve a pregnancy. Your treatment plan is always created specifically for you to maximize your monthly chances of becoming pregnant.

My cycles are regular and my ovulation kit turns positive every month why am I not getting pregnant?

Monthly ovulation is only one piece of the puzzle in achieving a pregnancy. There are many other factors that come into play. During your evaluation, your doctor will confirm that your fallopian tubes are open because the egg needs to travel into the fallopian tube and the embryo has to travel through the fallopian tube.

Your doctor will also check the sperm to measure the number of sperm, the percentage of swimming sperm, and the shape of the sperm. This information is important for making sure that enough sperm are reaching the egg every month to achieve fertilization.

Your doctor will also make sure that the shape and size of the uterus is normal and that the lining of the uterus is adequate for implantation to occur. The quality of the egg that is ovulated each month is also a predictor of your monthly chance of achieving a pregnancy. Your doctor will most likely recommend an ultrasound and blood testing to assess the quality of the eggs. As you can see, there is so much more than ovulation that goes into making a pregnancy occur.

My doctor told me I have PCOS, how does this affect my fertility?

Polycystic ovary syndrome (PCOS) is a syndrome that commonly affects reproductive age women. It is most often associated with irregular periods and excess male hormone levels. Most women with PCOS do not ovulate every month, making it more difficult for them to achieve a pregnancy. Treatment for women with PCOS focuses on helping ovulation occur with the assistance of oral medications or injections.

Many women with PCOS are overweight, so additional attention is paid to improve a patient’s body mass index (BMI) with diet and exercise guidelines. Decreasing a patient’s weight is also helps improve the safety of a pregnancy for the baby and the mom. If you have irregular periods or have noticed excess hair growth on your face, chest, or abdomen, you should see your doctor to determine if you may have polycystic ovary syndrome.

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Breaking Barriers, Building Families

Since 1983, we have pioneered fertility treatment for every kind of family. We want to help you achieve your dream of having a baby.

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