In a given year, 85% of couples under 35 who are not using birth control will conceive naturally. If you’re in the 15% that hasn’t, you should seek a fertility evaluation. The sooner you do it – meaning the younger you are when you come in – the more likely it is that you will be successful with simple and affordable treatment options.
There are many reasons why patients wait to seek treatment from a specialist. Some couples are waiting on the approval of their gynecologist while others believe their only treatment option will be more expensive In Vitro Fertilization (IVF).
At Shady Grove Fertility Center, we believe in a stepped care approach to treatment, which means we start with the simplest, most affordable treatment options first and move up to more advanced treatments only when medically indicated. There are some conditions such as advanced maternal age and factors associated with the fallopian tubes and sperm quality that may cause a physician to suggest IVF treatment as a first line of treatment. For many patients going to IVF initially, they will save valuable time and increase their chances of success.
Isaac E. Sasson, MD, PhD of Shady Grove Fertility’s Chesterbrook, PA office says that most couples have the option of starting with “low tech” forms of treatment. “So many couples are able to use these simpler and more affordable forms of treatment that they make up half of all the treatment cycles we do. In 2012 to date, nearly a 1,000 patients became pregnant using low tech treatments such as oral medications or IUI treatment.”
What’s more, every patient’s treatment is tailored specifically to meet their individual medical, emotional and financial situation. Dr. Sasson adds, “The patient is in charge. I give them my best medical advice and show then the historical success rates based on their diagnosis. Patients tell me what they are comfortable with and when they want to begin.”
When to See a Fertility Specialist
The best way to know whether it’s time to see a fertility specialist is to check your calendar.
Medically accepted guidelines say that couples in which the woman is under 35 should have a complete infertility workup after 12 months of unprotected intercourse without a pregnancy. Couples with a female partner over 35 should be evaluated after only 6 months. Couples with a female partner 40 or older should speak with a physician as soon as they begin trying to conceive.
Your First Visit with a Fertility Specialist
When new patients meet with their physician for the first time, the physician’s goal is to get a complete understanding of their medical history and any fertility-related testing or treatment they’ve done.
“Often times, during a new patient consultation, this is the first time the couple has discussed theintricacy of their fertility journey. It can be emotional and it is important that patients understand that they are not alone. Infertility is not uncommon, and together, we will come up with a plan to help them overcome their infertility.”
If it hasn’t been done already, basic fertility testing will be scheduled at this appointment. This testing consists of bloodwork, an ultrasound, an x-ray test called an HSG for the female partner, and a semen analysis for the male partner.
Of patients with insurance, 90% have coverage for this initial consultation and basic infertility testing.
Low Tech Fertility Treatments
Once a diagnosis is identified from the test results, your physician will review them with you and make recommendations for treatment options. These recommendations are always based on the physician’s commitment to helping their patients conceive in the most efficient and cost-effective way possible. Depending on the couples’ diagnoses and age, there are several steps a fertility specialist might recommend before IVF.
For example, many couples begin their treatment path with the female patient taking Clomid, an oral medication that helps women ovulate, while still under the care of their OB/GYN. The medication is taken on specific cycle days and intercourse is timed to coincide with ovulation. Many patients are successful with Clomid within the first three cycles. If you find yourself exceeding 3 or 4 cycles with your OB/GYN without success it may be time to see a specialist.
One difference between doing this type of treatment with a fertility specialist is that you will be monitored with ultrasound and bloodwork during your treatment cycle. That way, you and your doctor can monitor the number and size of your follicles and avoid the risk of multiples.
Intrauterine Insemination or IUI
A next step up in treatment that is still considered “low tech” is Intrauterine Insemination or IUI, and it is the most successful low tech treatment option. With IUI, the woman takes medications to develop several eggs during her cycle. She is monitored closely with ultrasound and bloodwork. In addition to, of having intercourse at the time of ovulation, a prepared sample of her partners sperm is inserted directly into her uterus.
The sperm sample is prepared in a procedure commonly known as “sperm washing.” This involves placing the sperm sample in a centrifuge. The spinning of the centrifuge causes the sperm to collect at the bottom of the test tube. The most active and healthy sperm will swim up into the top of the tube where they will be separated out and prepared for insemination.
During the insemination procedure, a speculum is inserted into the vagina and the cervix is visualized with an ultrasound. A soft, thin catheter is placed through the cervix and into the uterus. The sperm is then introduced into the uterus through the catheter. The procedure is done in the office and takes less than 5 minutes. It is not painful and does not require anesthesia.
“For most women, the insemination is no more uncomfortable or complicated than a regular visit to the ob/gyn,” says Dr. Sasson. “Furthermore, the couple can still be sexually active up until the time of the insemination to increase their chances.”
Chances of Success with IUI
IUI helps patients achieve pregnancy at rates closer to the natural chance of pregnancy for women their age without infertility. Because the success rates are not as dramatic as those for IVF, it may take several cycles of treatment in order to achieve a pregnancy. However, you’ll know relatively quickly whether IUI will work for you.
“If IUI is going to be successful for you, it will usually happen within 3 cycles,” says Dr. Sasson. “Age is the biggest predictor of success. So, the younger the woman is when we start, the more time we can spend using low tech treatment like IUI. With older women, I’d recommend moving to more aggressive treatments sooner.
Low Tech Treatments are Affordable
Fear of the high cost of treatment keeps many couples from seeking the help of a fertility specialist. That’s another factor that makes low tech treatment options so appealing. Low tech treatments are the most affordable treatment options available. IUI cycles, for example, are about a third of the cost of IVF cycles.
These types of treatments are also much more likely to be covered by insurance. Of patients with insurance, 70% have some level of coverage for fertility treatment. Those with fertility coverage frequently have coverage for IUI as the first step in their care.
For patients without insurance coverage for IUI’s or fertility treatment, there are several financial options available to help ease the cost associated with low tech treatment.
Knowledge is Power
If you’re having trouble becoming pregnant, don’t be afraid to schedule an initial consultation with a fertility specialist. Find out what’s keeping you from becoming pregnant and whether there is a simple, affordable option for you.”Think of it as simply gathering information,” says Dr. Sasson. “You are going to learn about yourself and about all the ways we can help.”
“Every treatment option has varying success rates, risks and costs, but you can’t make a choice without knowing what those are. After that initial appointment, you can choose to pursue treatment or not, but you’ll be informed, and having that knowledge puts the power back in your hands.”
We know the first few steps can be the hardest part, to help our patients we have a dedicated New Patient Center available to answer your questions and help walk you through the process of seeing a specialist. To speak with a new patient liaison call 877.264.3311 or send your questions electronically.
