General FAQ’s

GENERAL     

When should I consider seeing a Reproductive Endocrinologist Infertility (REI) specialist?
     
The American Board of Obstetrics and Gynecology recommend that patients under age thirty five try to conceive for one year before pursuing infertility treatment. Patients between the ages of thirty five and thirty nine should try to conceive for six months and women age forty and over should wait no more than three months.
There are a few exceptions to these recommendations. Patients who have irregular menstrual periods (cycles that are thirty five days or longer between periods) or have had previous pelvic infections such as PID should seek advice from their Gynecologist for an earlier referral.

Why should I see a board certified Reproductive Endocrinologist Infertility specialist?
     
Board certified Reproductive Endocrinologist Infertility (REI) specialists have completed: 1) Fours years of medical school, 2) Four year residency training in the OB/GYN specialty, 3) Two to three years of fellowship training in the Reproductive Endocrinology Infertility specialty, and 4) Passed the national Reproductive Endocrinologist Infertility written and oral test along with the OB/GYN specialty written and oral given by the American Board of Obstetrics and Gynecology. The additional two to three years of training beyond the OB/GYN specialty focuses on assisted reproductive techniques, advanced microsurgery of the pelvic organs, disorders of the anatomy which may affect fertility, and disorders of the sperm. This additional training beyond the OB/GYN specialty is invaluable and will increase your probability of conception. Some insurance plans will only reimburse fees for infertility services if the doctor is a Reproductive Endocrinologist and Infertility specialist. The American Board of Obstetrics and Gynecology recommends patients seeking advanced infertility treatments see a board certified REI.

How much does infertility treatment cost?
     
The cost involved with creating a successful pregnancy depends upon the nature of the disorder causing the infertility, the age of the female partner, and if a male factor is involved. Costs can range from a small co-pay for those who have insurance coverage for treatment. For patients who do not have insurance coverage for IVF treatment, we offer discounted package prices. Our practice has been able to greatly reduce the total cost for those patients needing the most advanced treatments such as IVF by having our own egg retrieval suite on site thus eliminating a separate facility fee to a hospital. Our egg retrieval suite is equipped with state-of-the-art equipment and all anesthesia is given by licensed Anesthesiologists

Will infertility therapy be covered by my insurance plan?
     
Most insurance plans cover the initial consult with a Reproductive Endocrinologist Infertility (REI) specialist and the diagnostic portion (the testing) of finding out why you are not able to get pregnant. The infertility treatment itself may be covered in part or completely. Although the trend is toward more insurance plans covering infertility, there are still plans that offer no coverage.
Our staff is highly trained in handling insurance coverage verification and claim filing. We will make every effort to obtain payment from your insurance plan when possible.

How successful are infertility treatments?
     
Improvements in medication, microsurgery, and in assisted reproductive technologies (ART) make pregnancy possible for the majority of the couples pursuing treatment. Over two thirds of infertile couples will be able to make their dreams of having a child come true. In particular, success rates have dramatically improved for couples who require ART. The pregnancy rate for an ART cycle approaches the monthly fertility rate for most couples. After an initial consultation and a review of diagnostic tests we can better determine your probability as success rates vary from patient to patient and from situation to situation.

Is it safe for me to have a baby in my late 30’s or early 40’s?
     
Many women well into their 40’s will have healthy children. The risk for birth defects such as Down Syndrome do increase as you age, as do the risks of developing complications during pregnancy such as Gestational Diabetes (Diabetes during pregnancy) or Hypertension (high blood pressure). Early genetic screening can be used to detect certain defects like Down syndrome. Maintaining a healthy diet and exercise pattern will help reduce the possible health complications. Your physician can help you evaluate your individual risks based on your age and overall health.

What is vitrification (egg freezing)?

Egg Vitrification, or the freezing of unfertilized eggs is one of the newest advances in the field of In-Vitro Fertilization.  Through vitrification, a new flash freezing technique, delicate eggs once un-freezable, without damage, can now be preserved for future use. Vitrification may also benefit young women about to undergo radiation treatments or chemotherapy so that their eggs can be preserved for use at a later time.

This new, exciting medical technique can also help single women who want to save their eggs since egg quality deteriorates significantly after age 35.  The technique is too new to be able to determine how many years the eggs will remain viable.  XPert Fertility Care of California is one of only a handful of IVF programs, nationwide, that offers this new technology to their patients.

SIDE EFFECTS OF FERTILITY DRUGS IVF RISKS

Do fertility drugs cause cysts?

Occasionally, depending on the previous months type and dosage of medication, and on follicular development. Sometimes a follicle that did not mature in one cycle may evolve into a cyst which appears the following cycle. Sometimes an HCG injection can facilitate cyst formation. Cysts do not necessarily mean that you cannot begin another cycle

I have heard that Femara is a cancer drug. Why do you prescribe it in connection with infertility?
     
Both clomiphene citrate (Clomid), and letrozole (Femora) are oral medications used to stimulate ovulation. Letrozole is emerging as a viable alternative to clomiphene citrate for women undergoing ovulation induction and ovarian stimulation, although no broad scientific studies have et established the drug s efficacy as the first course standard treatment. Several preliminary studies have shown letrozole to be useful, and it provides few side effects, especially for women whose uterine lining may be thinned out by clomiphene citrate. As to its exact mechanism, letrozole falls in the category of drugs known as nonsteroidal aromatase inhibitors, meaning it is highly specific in suppressing estrogen synthesis. Aromatase is an important enzyme prompting the creation of estrogen. If the body makes less estrogen, FSH level increases, follicular development increases, and ovulation is stimulated. Letrozole was originally developed for breast cancer treatment, as certain types of breast cancer cells slow their growth in response to decreasing estrogen levels. Some time ago, one journal published an article about a study in Canada in which a very limited number of patients showed an increase of neural tube defects in fetuses of women who had taken letrozole. However, there have been several subsequent larger studies which did not substantiate these findings. Since letrozole does not block the estrogen receptors, it is less effective than clomiphene citrate in preventing LH from surging. Therefore on rare occasions, premature ovulation can occur, so we monitor our patients taking letrozole more frequently. We have also observed that clomiphene citrate seems to work better for our younger patients, but we do not have conclusive data to support this yet. Generally, clomiphene citrate is used for women who are freezing embryos, and letrozole is used for older women who are doing fresh embryo transfers. At XPert Fertility Care, we evaluate each patient’s individual needs and circumstances and choose medications accordingly. Letrozole has shown to be particularly helpful for a subset of women whose endometrial lining may become thin while taking clomiphene citrate. As an anti-estrogen, clomiphene citrate can limit the development of the endometrial lining, making it, we believe, more difficult for an embryo to implant. For reasons that aren’t quite yet clear, letrozole appears less likely to affect the uterine lining. Furthermore, letrozole has a short life span in the body whereas clomiphene citrate can last for 4-6 weeks following an oral dose. At New Hope, we are pleased with what we’ve seen so far with letrozole and we look forward to seeing the outcome of studies that are underway to further assess its efficacy as standard treatment.

I have heard that Clomid is bad for older women. Why do you use it for older women?
     
I do not believe that Clomid is bad for older women. Older women do even better with natural and low stimulation cycles (like with Clomid). Bear in mind that Gonal-F and Follistim are man-made FSH themselves. Repronex contains natural FSH, extracted from menopausal women because their FSH is very high. Clomid works by tricking the pituitary gland, causing a woman’s body to produce additional FSH. In older women or "poor responders" we usually find high baseline FSH or "day 3" FSH due to lower ovarian reserve. These women generally produce higher FSH in response to Clomid, as demonstrated by responses to so-called Clomid challenge tests. It also provides gentler stimulation than injectables, and therefore does not recruit follicles that are not ready for the antral stage, resulting in improved quality of eggs retrieved, and allowing eggs which are not ready to have additional time in the ovaries. It allow women’s bodies to select the best eggs, instead of getting a larger number eggs and letting the embryologists and lab incubator select the best eggs through in vitro embryo development.

What are the side effects of Clomid? I read that it can contribute to chromosomal re-arrangement.
     
You can find a list of confirmed side effect on the official FDA site .Of course, before you start a course of medication your treatment team will discuss in detail the doses and side effects of all the drugs you will be taking. Chromosomal re-arrangement is the only side effect not proven.

How long should I remain on Clomid/Serophene/Clomiphene Citrate therapy
     
The majority of patients who respond to Clomiphene Citrate do so during the first month of therapy. Three ovulatory courses constitute an adequate therapeutic trial. If pregnancy has not been achieved after three ovulatory responses, further treatment is not recommended. Other treatment options should be considered.

What side effects, if any, can gonadotropins cause?

No pronounced side effects have been associated with any of these drugs. However, the patient should inform the physician of ANY allergies she has or of any previous adverse reactions to drugs.

Is supplementary progesterone safe?

You do not need to worry about using natural progesterone and here’s why. Most IVF programs use Progesterone in oil (intramuscular injection) and some use Crinone or Prochieve (progesterone vaginal gel) and/or Prometrium (oral progesterone). There must be progesterone hormone support given in order to adequately develop and maintain the lining of the uterus (endometrium). After egg retrieval, most women can’t make enough progesterone hormone because many of the progesterone producing cells in the ovary are removed when the eggs are retrieved.

Progesterone is a natural hormone produced in women by the ovary after ovulation. Progesterone acts directly on the endometrial lining of the uterus to prepare it for accepting a pregnancy. Progesterone is also made by the placenta during pregnancy.

 Although there is still controversy, the synthetic Progestins have been previously blamed for a slightly increased incidence of certain birth defects. More recent studies have indicated that the risk of congenital anomalies in women who inadvertently take synthetic Progestins during pregnancy are either not increased at all or are only slightly worse.  Although these studies are reassuring, the FDA does not support the use of synthetic Progestins (Provera, birth control pills) during pregnancy.  Most of us who specialize in infertility and hormonal therapy will use only natural progesterone for patients actively trying to conceive. The most commonly used natural progesterone preparations include:

• Progesterone in oil (intramuscular injection)
• Crinone or Prochieve (vaginal gel)
• Prometrium (oral tablet)
• Edometrin

Currently, no studies have demonstrated that the use of natural progesterone increases the risks to a baby. The FDA unfortunately lumps all natural progesterone and Progestins (synthetic) together, even though not a single study in over 50 years of use has convincingly demonstrated any problem. At times, natural progesterone has gotten a bad rap by being lumped into the same category as synthetic Progestins.