1. What does age have to do with fertility?
a. As a woman ages, the number of eggs remaining in her ovaries decline. This process actually begins before a woman is even born. No more than 250,000 to 500,000 eggs are present in a woman’s ovaries at the time of her first period. By menopause, when her periods stop, no eggs are left. Women achieve their peak fertility by their mid-20’s and maintain their fertility until about age thirty. At this point it starts to decline gradually picking up after age 35 and plummeting beyond age forty. By her fortieth birthday, a woman’s fertility is down by about 50% of its peak.
The age related decline in fertility is partly due to the fact that human eggs remain in a state of suspended animation from fetal life until ovulation. That means that they can exist in an arrested state for decades and it is at this stage that they can experience damage from environmental insults and waste products that the body naturally produces. Such exposure translates to egg damage and a reduced likelihood of the egg to yield a baby. At the same time, the potential for a miscarriage or chromosomally abnormal pregnancy increases.
If you would like to learn more about the effect of age on your chances of getting pregnant, please call 202.741.2520 to set up a consultation with one of our doctors.
2. What is ovarian reserve testing?
a. Ovarian reserve refers to the quantity and quality of remaining eggs. There are a host of different types of tests you can undertake in order to get a sense of your ovarian reserve. These include an ovarian ultrasound or various blood tests. Frequently, ovarian reserve testing is done at a specific time of your cycle. Ovarian reserve testing can provide you with information on whether a treatment intervention would be appropriate as well as the type of treatment that would work for you.
If you would like to learn more about ovarian reserve testing, please call 202.741.2520 to set up a consultation with one of our doctors.
3. What is IVF? How does it work? How does it help? Who is it for?
a. In Vitro Fertilization (IVF) is a process by which egg are fertilized outside the womb. The treatment begins with fertility drug treatments that stimulate the production of multiple eggs. The eggs are then extracted from the ovaries and are placed together with sperm in an incubator. This allows for the generation of fertilized eggs or early embryos. The embryo can then be transferred to the uterus in an effort to establish a successful pregnancy.
IVF can help by bypassing the source of the problem like blocked fallopian tubes, low sperm numbers and absent ovulation.
Currently, IVF is used to address a host of fertility related problems including blocked fallopian tubes, sperm issues, ovulation troubles or unexplained infertility.
If you would like to learn more about IVF, please call 202.741.2520 to set up a consultation with one of our doctors.
4. What is endometriosis?
a. Endometriosis occurs when cells from the uterine lining break off and travel to other organs such as the ovaries or fallopian tubes. Because these cells do not belong where they migrate, the body tries to get rid of them. This leads to inflammation and this can damage the structures involved. When Endometriosis damages and blocks the fallopian tubes, it causes infertility. Otherwise, it is not clear if Endometriosis causes infertility, however, it is often is associated with infertility.
Endometriosis can be diagnosed through laparoscopic surgery. Treatments can include medications such as birth control pills or other hormone supplements for milder forms of the disease; surgery may be appropriate to manage moderate to severe cases.
If you would like to learn more about endometriosis and your fertility, please call 202.741.2520 to set up a consultation with one of our doctors.
5. What are fibroids? Do they effect fertility?
a. Fibroids are overgrowths of the uterine muscle. They are very common during the reproductive years. Depending on their location, they may influence the ability of a pregnancy to take hold. Large fibroids may also block the fallopian tubes. Fibroids can cause issues during pregnancy, however the majority of women with fibroids experience no ill effects when they are pregnant.
If you would like to learn more about the effect of fibroids on your chances of getting pregnant, please call 202.741.2520 to set up a consultation with one of our doctors.
6. What is ICSI?
a. Intracytoplasmic Sperm Injection (ICSI) is a procedure commonly used to overcome male infertility problems, although it may also be used when eggs cannot easily be penetrated by sperm. It is also a common method of in vitro fertilization.
If you would like to learn more about intracytoplasmic sperm injection (ICSI), please call 202.741.2520 to set up a consultation with one of our doctors.
7. What is a blastocyst?
a. A blastocyst is an embryo that has gone through the first step of human differentiation. This means that the early embryo is no longer composed of identical cells, but rather contains two distinct groups of cells. Those that become the fetus/baby and those that become the supporting structure like the placenta and the membranes that surround the fetus. Human embryos generally become blastocysts by about the fifth day of development. During an IVF cycle, blastocysts can have a higher chance of taking hold than embryos at earlier stages of development.
If you would like to learn more about the use of blastocysts during IVF, please call 202.741.2520 to set up a consultation with one of our doctors.
8. What is Pre-implantation Genetic Diagnosis (PGD)?
a. Pre-implantation Genetic Diagnosis evaluates for either an abnormal gene linked to a specific disease within embryos or the chromosomal integrity of embryos themselves. It allows for selection of normal or unaffected embryos for use in IVF treatments. This helps avoid the need to interrupt a pregnancy by identifying problem before embryos are placed within the womb.
If you would like to learn more about the use of PGD during IVF, please call 202.741.2520 to set up a consultation with one of our doctors.
9. What is natural cycle IVF?
a. In vitro fertilization is usually associated with medications that stimulate the ovaries and increase the number of eggs available. However, there are some women that over-respond to these drugs. In such instances, there may be a benefit to natural cycle IVF (NF-IVF). With natural cycle IVF, an egg can be obtained without the use of stimulating drugs. The egg can then be fertilized to allow for the generation of an embryo. This embryo would then be transferred to the womb. Besides avoiding the use of shots that stimulate the ovaries, Natural Cycle IVF essentially eliminates the risk of multiple birth.
If you would like to learn more about natural cycle IVF, please call 202.741.2520 to set up a consultation with one of our doctors.
10. What does fertility testing involve?
a. Much of the fertility assessment derives from one’s story. It is important to discuss your situation with a fertility specialist also known as a reproductive endocrinologist. Your detailed history will become the basis for your clinical evaluation and guide the range of tests to be performed. The clinical assessment may include blood work, an x-ray or ultrasound imaging, and an assessment of your partner.
If you would like to learn more about fertility testing, please call 202.741.2520 to set up a consultation with one of our doctors.
11. What is a hysterosalpingogram (HSG)?
a. An HSG is a special type of X-ray that involves passing radio-contrast material into the uterus and fallopian tubes to assess whether the fallopian tubes are open. It can also be used to determine if there are abnormalities of the uterine lining like fibroids (over growths of the uterine muscle) or polyps (over growths of the uterine lining). It is performed in a radiology office by either a radiologist or gynecologist.
If you would like to learn more about the HSG, please call 202.741.2520 to set up a consultation with one of our doctors.
12. What is infertility?
a. Infertility is defined as 12 months of regular unprotected intercourse without a pregnancy for women under the age of 35. For women over the age of 35 it is 6 months of regular unprotected intercourse.
If you would like to learn more about infertility, please call 202.741.2520 to set up a consultation with one of our doctors.
13. What is a reproductive endocrinologist?
a. A reproductive endocrinologist is an obstetrician/gynecologist that specializes in diagnosing and treating infertility. Reproductive endocrinologist must complete an OB/GYN residency (4 years of training after medical school) and a fellowship in reproductive endocrinology and infertility (3 additional years after residency). In order for a reproductive endocrinologist to be certified by the American Board of Obstetrics and Gynecology, they must complete an accredited OB/GYN residency, an accredited reproductive endocrinology fellowship and pass two written and two oral board examinations. According to The American Board of Obstetrics and Gynecology, there are currently about 1500 reproductive endocrinologists practicing in the U.S.
14. What is egg freezing?
a. For more than half a century, men have been able to preserve their fertility by freezing and “banking” sperm. Because of the fragility of the human egg, the same has not been possible for women. Recent advances in freezing technology, what is known as “cryo-preservation”, allow for eggs to be frozen, stored and used at a later time.
It is clear that a woman’s reproductive potential is limited by age and that almost all women are infertile by their 45th birthday. A woman’s reproductive potential is at least 50% reduced by her 40th birthday and this fact has driven many to attempt conception when the time may not be ideal.
The ability to freeze eggs during one’s peak fertility and use them when needed is no longer science fiction but rather a reality. Egg freezing allows such reproductive freedom. This process does require the use of medication to allow the ovaries to mature multiple eggs. The eggs can obtained through an office procedure and then be stored until the time comes for their use.
If you would like to learn more about egg freezing, please call 202.741.2520 to set up a consultation with one of our doctors.
15. What is egg donation?
a. Egg donation is a process whereby a woman undergoes IVF to mature multiple eggs. Those eggs are used by women that have insurmountable egg problems in an attempt to get pregnant. Recipients of donated eggs can get pregnant even if they have lost their ovarian function to chemo-therapy, early menopause, natural menopause or because of an underlying problem with their ovaries.
If you would like to learn more about donating or receiving eggs, please call 202.741.2520 to set up a consultation with one of our doctors.