fertility
Your Path to Single Motherhood
Your Checklist To Fertility
Five things to know if you’re thinking about fertility treatments.
6 min read
As a fertility doctor who’s been practicing for more than 30 years, I’ve helped tens of thousands of parents realize their dream of having a child. In that time, a lot has changed—mostly all for the better. Thanks to new and improved techniques, fertility treatment success rates have continued to climb. With that success, access to fertility treatments in New York state has also grown. The state even introduced a new mandate requiring some insurance providers to cover these treatments.
If you’re considering seeing a fertility specialist, here are the five key questions you need to think about.
1. Are you & your partner both on the same page?
When I first started practicing back in the '90s, a couple would come in to see me after trying to get pregnant for about six months to a year, and were usually in agreement about being ready for a baby. Today, it’s quite different. A lot of times, one partner isn’t as committed to pursuing fertility treatments at that particular moment as the other. While one individual may be ready to start, the other may want to wait until they’ve finished law school or their career is more established.
However, just because a couple might not be in agreement on timing doesn’t mean that there aren’t options to explore with a fertility expert. If you (or your partner) aren’t quite ready to have a baby, it may be worthwhile to consider options for preserving fertility, including freezing sperm, eggs, or embryos for the future.
2. What does your insurance coverage look like?
Fertility treatments can be expensive, costing upward of $10,000, and—depending on the type of health insurance you have—coverage can vary. However, thanks to a new mandate in New York state that took effect recently, many couples who previously did not have insurance coverage for fertility treatments now do.
If a woman is infertile, the mandate requires large group health insurance plans (meaning companies with 100 or more employees) to cover three cycles of in vitro fertilization (IVF), which involves removing eggs from a woman’s body, fertilizing them in a petri dish, and then transferring one or more embryos to a woman’s uterus. The mandate also requires insurance companies to cover any fertility preservation cycles that are considered medically necessary.
Under the new mandate, infertility is defined as “failure to get pregnant after 12 months of regular, unprotected sex or donor insemination, or after six months for women 35 and older.” If you’re not sure if your insurance plan qualifies, check with your employee benefits department.
3. What tests have you had?
Once a couple has made an appointment with me, they’ve often already had some fertility testing done by either a gynecologist, or in the case of men, a urologist. These tests look for fertility problems that fall into these four general categories:
- A woman isn’t ovulating, or releasing eggs
- A man’s sperm count is low or he has low sperm motility, meaning the sperm aren’t moving quickly enough to fertilize an egg
- A woman’s fallopian tubes aren’t working well, usually because an infection or scarring from abdominal or pelvic surgery has caused a blockage
- A woman’s advancing age means she has a dwindling egg supply or the eggs she has don’t fertilize properly
This last issue is probably the one we see most often, since so many modern women delay having children until their mid- to late-30s and beyond. Blood tests can determine if a woman is ovulating normally, and we can also look at the health of a woman’s ovaries relative to her age. Some women may already be out of their fertility window at age 40, while others may not be. We can also examine a woman’s ovaries through sonogram to predict how many good eggs remain viable for pregnancy.
To check to see if a woman’s fallopian tubes are open, an X-ray called a hysterosalpingography (HSG) is used. And, if a urologist hasn’t already done a semen analysis to check a man’s sperm count and motility, a fertility doctor can order that test, too.
4. What are your treatment options?
There are several different treatment options for infertility, and not all couples will need to resort to IVF in order to become pregnant. In many cases, we start by prescribing fertility drugs (either in pill or injectable form) that stimulate a woman’s ovaries to make more eggs. We’ll often combine that treatment with insemination, which means we’re putting the sperm directly into the uterus so that it’s closer to its target, the egg.
If there’s a problem with the fallopian tubes, surgery can sometimes open up the blockage, but in many cases, IVF is necessary.
The age of the woman also influences our treatment recommendations. If a woman is in her early 40s, and is set on using her own eggs rather than those from a younger donor, we may recommend that she move straight to IVF, which has better success rates. For these women, intrauterine insemination (IUI) and other fertility treatments have historically not been as successful as IVF when the goal is to achieve a positive pregnancy using their own eggs.
If the couple has male factor infertility, which accounts for roughly 30% to 40% of cases, then IVF is usually recommended. Even if a man’s sperm count is very low or there’s little to no motility, we can use special techniques to ensure that fertilization occurs.
When you’re considering all of your treatment options, make sure you ask about the clinic’s success rates. Some fertility clinics have better statistics than others, so it’s worth it to do your homework.
5. What’s your threshold?
Finally, every couple needs to decide how far they are willing to go with fertility treatments in order to have a baby. That’s one of the things I always ask at that first consultation. Some people are only comfortable using medications and insemination to increase the odds that they can get pregnant, but they draw the line at making embryos out of the body with IVF. For others, the threshold is using donor eggs. In my practice, only about 25% of the patients I see are willing to use a donor egg to conceive a child. And while years ago, stigmas attached to having a low sperm count led many men to refuse to do IVF, today most have no problem with the treatment.
Couples also need to be clear on how much they’re willing to spend, especially if they don’t have an insurance plan that will cover the cost of treatment. One of the first things I do when I meet with a couple is discuss exactly what they have coverage for, and how much they are willing to spend out of pocket.
