Infertility Introduction – Who Needs Testing and Treatment?
As an introduction to the problem, infertility affects from 5-25% of the population. The following graph looks at married women in the US. The study defines impaired fertility as the sum of those who fail to conceive and those with an adverse pregnancy outcome. The study defines Infertility as only those couples who cannot conceive.
The incidence of infertility has not changed much over the years. People are certainly more willing to discuss their infertility problems. We also have more effective treatments for people with infertility.
Does Infertility Treatment Work Well Enough That I Should Do Anything About It?
Yes, more people will succeed from treatment than fail given enough time and effort. Having said that, some disorders cannot be treated. Men without sperm, women without eggs or only poor quality eggs and women with severe pelvic organ damage cannot conceive. Overall, I think most people should be optimistic and enter into evaluation and treatment with a hopeful attitude. We have many treatments and pathways to parenthood.
When should I get tested for infertility problems?
Women or couples who fail to conceive in 1 year (<35 yrs old) or in 6 months (35 yrs and older) should be seen. The impact of infertility touches each person across a wide range of emotions. Some people feel the pain of not becoming pregnant earlier than others. So the decision to pursue an infertility evaluation and/or treatment depends on your circumstances and personal reaction to infertility.
Is infertility testing and treatment expensive?
Infertility testing is no different from other medical conditions. Fortunately, most insurance plans cover at least some testing. Most people can know what their problem is and what their options for treatment are. Many insurance plans do not cover treatment. Actually this statement is not technically correct. I believe that all insurance companies allow for infertility treatment, but the employer must choose infertility coverage as an option for employees. Since health care costs are going up, one way to cut insurance costs is to reduce what problems are covered.
Many people do not think infertility is a disease. Since a person can live their entire life without children and enjoy perfect health, many people do not think there is a problem. Many people who easily conceive seemingly have a difficult time understanding the pain of those who are not as fortunate. Also, the pain of infertility can be just as difficult for people trying for additional children (secondary infertility).
Many IVF centers offer “shared risk” or “refund guarantee” programs. These financial programs effectively allow you to purchase IVF with the guarantee of a live baby or a significant refund of your costs. We can do this because we are confident in our ability to achieve a live-born baby within a certain number of cycles based on medical factors. We do not have the same confidence in non-IVF treatments. (I believe that tells us all something about the success rates of non-IVF therapies.)
Do I need a fertility expert or can my primary care physician/obstetrician-gynecologist do what need?
The answer to this question depends on your PCP or OB-GYN. Some non-REI physicians provide infertility evaluation and treatment. If your primary physician devotes at least 25-33% of their practice to infertility, then they probably maintain the level of care as REI docs, with some exceptions. You may want to inquire about your physician’s experience level before investing much time with them for infertility.
Many PCP and OB-GYN physicians will initiate an evaluation and then refer you when they reach the limit of what they can offer. We also offer advise to your doctor before they refer you, which can be helpful to you both.
Reproductive Endocrinologists are obstetrician gynecologists who have spent and extra 2-3 years of formal fellowship training in the sub specialty of reproductive endocrinology and infertility. Reproductive Endocrinology and Infertility is a board certified specialty.