In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Impaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.

Yes. About 6% of married women 15–44 years of age in the United States are unable to get pregnant after one year of unprotected sex (infertility). Also, about 11% of women 15–44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status (impaired fecundity).

No, infertility is not always a woman’s problem. Both men and women contribute to infertility. Many couples struggle with infertility and seek help to become pregnant; however, it is often thought of as only a woman’s condition. A CDC study analyzed data from the 2002 National Survey of Family Growth and found that 7.5% of all sexually experienced men younger than age 45 reported seeing a fertility doctor during their lifetime—this equals 3.3–4.7 million men. Of the men who sought help, 18% were diagnosed with a male-related infertility problem, including sperm or semen problems (14%) and varicocele (6%).

Infertility in men can be caused by a variety of factors prompting them to seek fertility treatments to become a parent. A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.

Conditions that can contribute to abnormal semen analyses include:

• Blockage (obstruction) of the male reproductive tract.
• Hormonal factors affecting the formation and development of sperm.
• Varicocele (an enlargement of the veins within the scrotum).
• Certain genetic diseases (i.e. cystic fibrosis).
• Exposure to environmental toxins and excessive heat.
• Lifestyle factors (smoking, drinking, drug use, steroids, obesity).
• Cancer and other medical conditions and treatments.

Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.

Female fertility is known to decline with age. Many women are waiting until their 30s and 40s to have children. In fact, about 20% of women in the United States now have their first child after age 35, and this leads to age becoming a growing cause of fertility problems that bar them from becoming a parent. About one-third of couples in which the woman is older than 35 years have fertility problems. Aging not only decreases a woman’s chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.

Aging decreases a woman’s chances of having a baby in the following ways—

• Her ovaries become less able to release eggs.
• She has a smaller number of eggs left.
• Her eggs are not as healthy.
• She is more likely to have health conditions that can cause fertility problems.
• She is more likely to have a miscarriage.
• Smoking.
• Excessive alcohol use.
• Extreme weight gain or loss.
• Excessive physical or emotional stress that results in amenorrhea (absent periods).

Most experts suggest at least one year for women younger than age 35. However, women aged 35 years or older should see a healthcare provider after 6 months of trying unsuccessfully. A woman’s chances of having a baby decrease rapidly every year after the age of 30.

Some health problems also increase the risk of infertility, so women should talk to a healthcare provider if they have the following issues and require infertility treatments.

• Irregular periods or no menstrual periods.
• Very painful periods.
• Endometriosis.
• Pelvic inflammatory disease.
• More than one miscarriage.

It is a good idea for any woman and her partner to talk to a healthcare provider before trying to get pregnant. They can help a woman prepare her body for carrying a pregnancy and delivering a healthy baby, and can also answer questions on fertility and give tips on conceiving.

Fertility doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.

Infertility can be treated with medicine, surgery, or assisted reproductive technology such as intra-uterine insemination, IVF, etc. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on
• The factors contributing to the infertility.
• The duration of the infertility.
• The age of the female.
• The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.

Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. Medical and surgical therapies are usually managed by a urologist who specializes in infertility & its treatments. A reproductive endocrinologist may offer intrauterine inseminations (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.

Some common medicines used to treat infertility in women include—

• Clomiphene citrate (Clomid®*): A medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken orally.

• Human menopausal gonadotropin or hMG (Repronex®*; Pergonal®*):  Medicine often used for women who don’t ovulate because of problems with their pituitary gland—hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.

• Follicle-stimulating hormone or FSH (Gonal-F®*; Follistim®*): Medicine that works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.

• Gonadotropin-releasing hormone (Gn-RH): Medicine often used for women who don’t ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH: Analogs that act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.

• Metformin (Glucophage®*): A medicine doctors use for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.

• Bromocriptine (Parlodel®*): A medicine used for women with ovulation problems because of high levels of prolactin. Prolactin is a hormone that causes milk production.

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicine that stimulates ovulation before IUI.

Assisted reproductive technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).

The success rates of fertility treatments vary and depend on many factors, including the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. This last factor—the woman’s age—is especially important when trying to become a parent.

According to the CDC’s 2011 Preliminary ART Success Rates, the average percentage of fresh, nondonor ART cycles that led to pregnancy were—

• 40% in women younger than 35 years of age.
• 32% in women aged 35–37 years.
• 22% in women aged 38–40 years.
• 12% in women aged 41–42 years.
• 5% in women aged 43–44 years.
• 1% in women aged 44 years and older.

Please see RSMC success rates here….

• 75% in women younger than 35 years of age.
• 73% in women aged 35–37 years.
• 55% in women aged 38–40 years.
• 44% in women aged 41–42 years.*
• 50% in women aged 43–44 years.*

Women using Donor Eggs: 58% fresh, and 68% frozen.

* 2 years combined (2011-2012)

Common ART procedures include—

• Intrauterine insemination (IUI), in which processed sperm is injected directly into the uterus by-passing the cervix. The insemination may be combined with ovarian stimulation to increase the chance of fertilization of one or more eggs occurring inside the fallopian tubes.
• In vitro fertilization (IVF), meaning  fertilization outside of the body. IVF is one of the most commonly used infertility treatment techniques in which eggs are combined with sperm in a dish in a laboratory. Once fertilization has occurred, the resulting embryos develop for several days before being placed into the uterus.
• Intracytoplasmic sperm injection (ICSI) is often used for couples with male factor infertility, unexplained infertility, or for those patients with failed conventional IVF attempts. In ICSI fertility treatment, a single sperm is injected into a mature egg with a microscopic needle. Once fertilization occurs, the embryos are grown for several days and then transferred into the uterus.
• Egg Donation is used for women with no eggs or unhealthy eggs. A young egg donor undergoes ovarian stimulation and an egg retrieval procedure to donate her eggs to another patient. The eggs are fertilized with the partner’s sperm and resultant embryos are transferred to the patient’s uterus.
• A Gestational Carrier (gestational surrogate) is implanted with an embryo that is not biologically related to her, for the purpose of achieving a pregnancy for an infertile couple. It is recommended for women who have no uterus or for medical reasons are unable to carry a pregnancy. Couples undergo an IVF procedure and the resultant embryos are transferred into the surrogate’s uterus.
• Donor Sperm or Donor Embryos for women who are unable to conceive and become parents using their partner’s sperm or own embryos.

This depends on whether or not infertility treatment has been purchased as a benefit. Some insurance providers may cover a portion of treatment if it is a medical necessity. Benefits vary by insurance policy. We always encourage our patients to reach out to their providers for an explanation of coverage.

Physician’s Surrogacy – the partner surrogacy agency of RSMC, accepts both “in-network” and “out-of-network” insurance. We work with Aetna, Anthem Blue Cross, Blue Shield, Cigna, Healthnet, Tricare, and United Health Care. Before your consultation, we will verify your insurance benefits and review detailed coverage information at your consultation. In cases where insurance is not accepted, our coordinators will arrange for discounted cash pricing. In cases where your insurance plan is not accepted, or your insurance does not offer coverage, we will work with you to make fertility treatment expenses affordable.

Following your initial consultation, your physician will outline a treatment plan and the associated costs. The costs will vary depending on what type of treatment is recommended. We have several financing options if you don’t have insurance. Schedule a consultation now so we can discuss the costs.

Couples often find out that infertility diagnosis and certain treatments are covered by their insurance. However, IVF and others may be excluded. California is one of 13 states with an infertility mandate in place. This is a “soft” mandate, which gives employers the option to offer infertility benefits. Since it is not required, not many employers will purchase the coverage. 

If your insurance coverage doesn’t include infertility benefits, consider speaking with your Human Resources representative to explore the possibility of adding infertility treatments to your benefits package.

Typically, PPO insurance does not require pre-authorization for an initial consultation. If your insurance requires a pre-authorization to see a specialist, then you must get a referral from your OB/GYN to see a fertility specialist. Pre-authorizations may also be needed for any testing, ultrasounds, or blood work. Your assistance in coordinating authorizations is important in order to protect you from the surprise of becoming financially responsible if they do not pay.

Here are some important questions to ensure that you have the right coverage for treatment:

1. Does my insurance cover diagnostic evaluation for infertility (lab work, ultrasound, etc.)?
2. Do they cover physician, hospital, and lab charges?
3. Is treatment for infertility such as IUI or IVF covered?
4. What is my co-payment?
5. Are injectable or oral medications covered (Clomid, Lupron, etc.)?
6. Do I need to use a specific contracted pharmacy?
7. Do I need to use a specific contracted laboratory?