fertility Blog

Originally Presented by ASRM and the MHPG

Developed by the Mental Health Professional Group

Re-published by Reproductive Gynecology & Infertility

Q: If I’m trying to get pregnant, should I stop trying to conceive due to the Coronavirus?

A: If you don’t have COVID-19, there is no medical reason to change your plans regarding trying to conceive. However, there may be logistical, psychological, and emotional reasons to modify your plans. For example, there may be less access to routine prenatal care. Out of an abundance of caution, you may consider postponing pregnancy. This is a very personal decision, and you should speak with your doctor for specific recommendations.

Q: We are ready to start fertility treatments. Is it okay to continue during the pandemic?

A: As of March 17, 2020, the COVID-19 Task Force of the American Society for Reproductive Medicine (ASRM) issued clinical recommendations. These recommendations were reviewed on March 31st by the ASRM COVID-19 Task Force which chose, at that time, to keep the recommendations substantially the same. The Task Force is committed to review of these recommendations at least every two weeks. The recommendations suggest that clinics:

1. Don’t initiate new treatment cycles — including ovulation induction, intrauterine insemination (IUI), in-vitro fertilization (IVF) (both egg retrievals and frozen embryo transfers), and non-urgent egg or embryo freezing.
2. Strongly consider canceling all embryo transfers (fresh or frozen).
3. Continue caring for patients who are “in-cycle,” or have urgent needs for stimulation or cryo-preservation (egg or embryo freezing), such as in cases of eminent surgery or start of medications that would affect fertility.
4. Postpone elective surgeries and any non-urgent diagnostic procedures.
5. Prioritize telemedicine over in-person contact.

Q: Will contracting COVID-19 now impact fertility later?

A: Research is still ongoing in this area. There are no studies indicating that the virus has any impact on fertility. While Coronavirus fears have caused some people to seek out egg freezing, there is no known medical indication to seek out egg freezing as a preventive measure.

Q: What if I test positive for COVID-19?

A: If you already have COVID-19, the Society for Assisted Reproductive Technology (SART) recommends avoiding getting pregnant for now and waiting until you fully recover before attempting conception (either naturally or via assisted reproductive technology).

Q: What if I’m pregnant and test positive?

A: According to the World Health Organization (WHO), pregnant women don’t appear to be at a greater risk for illness related to COVID-19 — and only 1% of pregnant women infected has experienced severe illness that required medical attention. However, the American College of Obstetricians and Gynecologists (ACOG) notes that very little is known about the effect of COVID-19 on pregnant women and infants. It is unclear if COVID-19 can cross the placenta. Because pregnant women are at greater risk of severe complications from similar respiratory infections, they are considered an at-risk population for COVID-19.

Q: If I test positive, can the virus be passed to my baby?

A: A study was conducted on nine pregnant women infected with COVID-19 in Wuhan, China. All women recovered from their illness and all nine had live births without any evidence of transmitting the virus to the baby. The virus was not detected in samples of cord blood, amniotic fluid, or throat swabs from the newborns, or breast milk. However, the COVID-19 infection was recently found in a newborn, so “vertical transmission” (meaning passage of the virus from mother to baby during the period immediately before and after birth) cannot be excluded at this point.

Q: How can I get through this? Not knowing when this will end is making my anxiety so much worse.

A: Experiencing fertility issues is difficult enough, and is often accompanied by increased levels of anxiety and depression. Adding COVID-19 to the mix exacerbates an already stressed emotional equilibrium. Please see the advice from the ASRM Mental Health Professional Group in the document, A Message from the MHPG and ASRM on Coping During the COVID-19 Pandemic, for additional support.

Contributed by Janet Jaffe, Ph.D., Kristen Chambliss, Ph.D., Alison Fagan, Ph.D., Jennifer Riley, M.S.W., L.S.W., and Deb Levy, M.A., L.P.C.

April is National Infertility Awareness Month, and the fertility specialists at Reproductive Gynecology & Infertility (RGI) wanted to share what happens when we get to meet the babies we help create.

Thrilled. Happy. Joyful.

These are just some of the words that come to mind when a baby conceived through in vitro fertilization (IVF) comes back to RGI for a visit. While we’ve known this little person since it was an impossibly tiny embryo, our eyes soften as we marvel at their tiny fingers and toes. It’s a special moment filled with heartfelt congratulations and well wishes. It’s also a very welcome reminder of why we do what we do.

“It brings me so much joy to reconnect with patients after they give birth. The RGI IVF process itself is highly personalized and gives me the opportunity to really get to know people, learn intimate details about their fertility struggles and help grow the family of their dreams. Meeting the baby is incredibly rewarding. I love to watch couples transform from disheartened to joyful—and so in love with their new little boy or girl.”

Is IVF right for me?

Unfortunately, infertility is very common, occurring in approximately 1 in 8 couples. The fertility specialists at Reproductive Gynecology & Infertility understand the emotional and physical toll fertility issues can take on people—and relationships. If you’ve been trying to conceive for 12 consecutive months, you might want to consider treatments like IVF. IVF is a safe and effective process of fertilization in which an egg is combined with a sperm outside of the body.

How much does IVF cost?

If you and your partner meet all of the IVF qualifications, each fresh embryo cycle can cost approximately $25,000. We understand a financial burden can make an already stressful situation worse. That’s why we created the IVF 100% Success Guaranteed Plan; we wanted to eliminate the stress of success. RGI is the first and only practice in Northeast and Central Ohio to offer a plan that shares the financial risk with IVF patients.

Our IVF 100% Success Guaranteed Plan means that we guarantee you’ll take home a baby or we’ll refund every penny.

“Scientific evidence confirms that stress and fertility go hand in hand. We want to help manage the emotional stress as well as the fertility of our patients. With the IVF 100% Success Guaranteed Plan, we can help ease the financial burden so our patients can focus on their mental and physical wellness during their fertility journey.”

How can I afford IVF?

There are many insurance plans that can help lower your costs—and financial risk. However, we are proud have an exclusive partnership with Samantha’s Gift of Hope, a quarterly monetary award intended for those who are already a part of RGI’s IVF 100% Success Guaranteed Plan in the Northeast Ohio office locations.

If you’d like to learn more about RGI, our IVF 100% Success Guaranteed Plan or applying for a Samantha’s Gift of Hope grant, please call 866-537-2461. We can’t wait to help grow your happily ever after… and marvel at your new baby girl or boy. There is hope, and we can help.

If you’re considering fertility treatment, and live in Ohio, there are many things to consider before making a treatment decision. In addition to finding a conveniently located fertility center and skilled physician you feel comfortable with, it’s important to learn about—and understand—their fertility success rates so you can make an informed decision.

Fertility clinics with high success rates may improve your chances of conception

Reproductive Gynecology & Infertility (RGI) is proud to display our Embryology Lab Success Rates on the Society for Assisted Reproductive Technology’s (SART) website, which demonstrate the quality of our practice. In addition to success rates that are above the national average for both fresh and frozen cycles, we also offer a unique IVF 100% Success Guaranteed Plan, to maximize your chance of conception without the financial risk. When you’re ready to make one of the most important decisions of your life, it’s important to look for fertility clinics with the following characteristics:

• Board-certified reproductive endocrinologists
• Medical malpractice records
• Skilled medical team with extensive experience in fertility diagnosis and treatment
• Fertility success rates
• Hospital affiliations
• Insurance coverage and finance programs
• Convenient location and hours

Frequently asked questions about fertility treatments

If you and your partner have been trying to conceive for more than 12 consecutive months and are considering fertility treatments, there are many important questions to consider. The skilled medical team at RGI is ready to assist you and has created a list of frequently asked questions to help you get started on your fertility journey.

If you’d like more information about the RGI fertility clinic, our success rates for your specific diagnosis and treatment or the IVF 100% Success Guaranteed Plan, please contact us. Our fertility centers are conveniently located in South Cleveland, Columbus, Akron, Canton, and Youngstown. If you’re ready to take the next step on your fertility journey with us, please schedule an initial consultation by calling 844-707-1296.

A fertility test helps determine how easy or difficult it will be for a person to conceive. There are several different types of fertility tests, but most doctors begin with a simple blood test or semen analysis to determine a person’s fertility.

Common fertility tests for men

Common fertility tests for men include:

• Semen analysis
  This test examines the quality and quantity of a man’s sperm to determine whether there are fertility issues like low sperm count, poor sperm morphology or poor sperm motility that need to be addressed.
• Hormone testing
  This is a simple blood test used to determine the level of testosterone and other male hormones.
• Genetic testing
  This is a simple blood test used to determine whether there is a genetic defect that may be causing infertility.
• Testicular biopsy
  This is a medical procedure used to identify abnormalities that may be contributing to infertility. It may also be used to retrieve sperm for certain assisted reproductive techniques, like in vitro fertilization (IVF).

Common fertility tests for women

Common fertility tests for women include:

• Ovulation testing
  This is a blood test that measures a woman’s anti-Mullerian hormone (AMH), which is a hormone released by a woman’s eggs that declines with age. It helps identify how many eggs a woman has left and how she compares with other same-aged women.
• Transvaginal ultrasound
  This is an internal pelvic ultrasound used to examine female reproductive organs including the uterus, fallopian tubes, ovaries, cervix and vagina.
• Hysterosalpingogram (HSG)
  This is an outpatient x-ray procedure used to see whether the fallopian tubes are open and if the inside of the uterus is normal.
• Hysteroscopy
  This is an outpatient procedure that inserts a small, lighted tube into the vagina and allows your doctor to look inside the uterus to diagnose or treat causes of abnormal bleeding. This is often used to evaluate recurrent miscarriage.
• Laparoscopy
  This is a minimally invasive surgical procedure in which a physician uses a small telescope-like instrument with a light and camera to examine the pelvic anatomy for causes of infertility.
• Endometrial biopsy
  This is a procedure used to collect a small sample of the uterine lining to examine, diagnose and treat abnormal uterine bleeding, hormonal imbalances or polyps.

If you have been trying to conceive for at least 12 consecutive months (6 months if you’re over the age of 35) and believe you or your partner may be struggling with undiagnosed fertility issues, call Reproductive Gynecology & Infertility at 844-707-1296 to schedule a fertility test. We can help diagnose and treat your infertility as well as help you along your fertility journey.

About 1 in 8 couples in the United States experiences infertility. This number might seem high, but considering how many things need to go perfectly suitable to conceive, it’s not surprising.

There are many reasons why an individual or couple might have a hard time becoming pregnant, including factors related to ovarian health and egg quality, sperm quality (concentration, motility, shape), uterine health, and more.

For those having trouble conceiving, there are various options to seek or utilize that can help you get pregnant, some of which you can even begin to pursue on your own, like making changes to your diet and lifestyle to optimize your body for pregnancy. You can also work with your current OB/GYN or Primary Care Physician (PCP) to start with preliminary testing, such as basic ovarian reserve testing and a referral for a semen analysis.

For many looking into fertility treatments, two options become top choices to consider pursuing: intrauterine insemination (or IUI) and in vitro fertilization (or IVF).

For people struggling to conceive, an initial evaluation with a fertility specialist can help identify the root cause of infertility and factors that may be creating challenges. Reproductive Endocrinologists have extensive training and experience in evaluating problems that can interfere with conception — such as egg, sperm, uterine, or implantation issues — and are therefore best able to guide patients in choosing which treatments are best for them.

IUIs should be performed by a medical professional trained to do them. In most cases, IUIs are used in conjunction with medicated (oral pills) treatment cycles. IVF is a more involved treatment and should only be managed by an experienced reproductive endocrinologist (REI).

Below we’ll look at what IUI and IVF entail, the pros and cons of both treatments, and knowing which one is the right option for you.

What Is IUI?

IUI stands for intrauterine insemination. It involves having sperm injected into the uterus around the time of ovulation. This is done to bypass any potential cervical issues and decrease the sperm’s travel time to the egg and increase the likelihood of fertilization happening.

For whom is IUI a good option? It’s typically one of the first fertility treatments recommended for patients who have not gotten pregnant on their own within about six months to one year of trying depending on age. It’s a great option for those dealing with hormonal and fertility issues such as:

• Anovulation (lack of ovulation without help from medication)
• PCOS
• Cervical mucus problems
• Sperm quality issues
• It can also help same-sex couples using donor sperm, single mothers using donor sperm, and sometimes couples with unexplained infertility.

You might also hear IUI referred to as artificial insemination. IUI involves the sperm first being “washed” to increase its potency, then being delivered directly to the uterus.

“Washing” sperm means that a sperm sample is first collected, and then the sperm are separated to sort healthy, motile (swimming) sperm from the less healthy sperm and seminal fluid. Only the best quality sperm is used during an IUI; this way, there’s the greatest chance of the sperm being able to reach and penetrate the egg.

It’s essential that the individual is ovulating or just about to ovulate when IUI is performed because this is the only time that a person can get pregnant. Ovulation is when a mature egg is released from an ovary to begin its journey down the fallopian tubes, at which point it can be fertilized.

Before an IUI is performed, a doctor monitors the individual to track the timing of their cycle and ensure they are ovulating. Monitoring can be done using an ultrasound, which looks at egg follicles within ovaries, and sometimes with bloodwork.

Here are the basic steps involved in an IUI cycle:

• The IUI cycle begins on the first day of a person’s period and the egg(s) mature inside the ovaries for about the next two weeks leading to ovulation.
• Some people will take medications to encourage ovulation during this period. For example, medications (such as oral meds like Clomid or Letrozole or injectable hormone medications called gonadotropins) can be used to stimulate more eggs to mature and be released.
• In most cases, the IUI will take place on the day of ovulation or sometimes the day prior. This is determined using monitoring. A “trigger shot” might also be used to time ovulation since this medication induces ovulation within about 36 hours.
• A sperm sample from either a partner or a donor will be provided to the doctor’s office, then washed.
• The doctor/practitioner will insert the washed sperm sample into the uterus using a thin catheter. This is primarily painless and only takes a couple of minutes.
• After the IUI, the person will lay down and relax for about 10 minutes, and then they are free to leave the doctor’s office and go about their day. Hopefully, at this point, fertilization takes place.

What are the advantages of IUI?

Below are some of the main advantages of IUI:

• Less invasive and less expensive compared to IVF. A typical IUI cycle can cost about $1000 (depending on your insurance), while IVF can cost $20,000 per cycle.

• IUI Deposits the best quality sperm possible close to where the egg is waiting, which increases the chances of becoming pregnant in comparison to conceiving through intercourse.
• Uses monitoring to ensure that insemination happens at the time of ovulation.
• IUI cycles can either use medications or not, depending on the specific situation. Those who have difficulties ovulating, such as those with irregular periods or PCOS, can use medications to help release more mature eggs.
• Not using ovulation medication can help lower the cost. This is a good approach for those who ovulate regularly or who are using donor sperm.

Who performs IUIs?

IUIs cannot be performed at home without proper processing and washing of seminal fluid; however, some people may try intravaginal or intracervical inseminations at home, with significantly less success. Most often, people choose to see a medical professional for the procedure. OB/GYNs can perform IUI, which means patients may be able to work with their previous provider if they prefer (only reproductive endocrinologists can perform IVF, however).

That being said, patients often choose to work with a fertility specialist or an REI for an IUI because an REI can perform thorough tests prior to an IUI in order to gain more advanced knowledge of a patient’s fertility status and obstacles.

Specialists typically have cutting-edge technology and equipment and are capable of uncovering a great deal of information about the quality of one’s sperm, eggs, anatomy, menstrual patterns, and so on, which can help increase success with IUI.

How successful is IUI?

IUI is said to have “modest results” in terms of success, meaning it isn’t guaranteed to work and isn’t necessarily more successful than two healthy people having intercourse.

In best-case scenarios, it’s successful about 7% to 20% of the time per IUI cycle, depending on the woman’s age. If a couple tries IUI several times and does not have severe damage to fallopian tubes and has decent quality sperm, they may have a 50% chance of getting pregnant with up to six rounds of IUI.

Overall, success rates depend on the couple’s age, the timing of the procedure, and the health of the eggs and sperm. Individuals younger than 35 tend to have more success with IUI than those over 35 to 40 years old.

Are there any side effects of IUI?

IUI typically doesn’t hurt, although it may feel a bit uncomfortable. Some people experience mild cramping during the procedure. Afterward, it’s okay for the person to resume normal activities, as they’re unlikely to feel any significant side effects.

Side effects can be more noticeable if medications are being taken. For example, ovulation medications can sometimes cause temporary bloating, cramping, water retention, and breast pain.

There’s also a higher likelihood of having multiples (twins or triplets) if using gonadotropin medications with IUI since these drugs can cause multiple eggs to be released and potentially fertilized.

What Is IVF?

IVF stands for in vitro fertilization. It’s a fertility treatment that fertilizes eggs with sperm in a lab (“in vitro” refers to a process performed in a laboratory culture dish instead of inside the body).

IVF is one type of artificial reproductive technology (or ART). IVF aims to stimulate the ovaries to mature as many healthy eggs as possible in a given cycle in order to create embryos. In the majority of cases patients pursuing IVF choose to utilize genetic testing, which entails a few cells being removed from the embryos for testing prior to freezing. Through genetic testing, your REI physician will be able to dramatically increase the likelihood that the embryo being transferred into the uterus is genetically healthy and increase the liklihood of getting pregnant. There are many reasons individuals or couples choose to pursue IVF when growing their family, including various causes of infertility, wanting to utilize genetic testing on embryos, or moving on from other fertility treatments that have been unsuccessful.

The entire IVF process can usually occur within three months. Medications are first used to help eggs inside the ovaries mature, then as many eggs as possible are removed from the body with help from an egg retrieval procedure. The mature eggs are then mixed with a sperm sample in a lab (called insemination), hopefully facilitating fertilization and embryo formation. In frozen embryo cycles, embryos are then frozen to allow for the woman’s body to return to normal after stimulation within a few weeks. The final step is the frozen embryo transfer which occurs after the uterus is primed with estrogen and progesterone for approximately three weeks. In this minor painless procedure, an embryo is released inside the uterus with the aid of ultrasound guidance.

To summarize the steps above, a cycle of IVF includes several steps:

• Ovarian stimulation using injectable medications.
• Egg retrieval from the ovaries.
• Fertilization of retrieved eggs using a semen sample within a laboratory.​​
• Optional but recommended preimplantation genetic testing of embryos prior to freezing them.
• Uterine lining preparation.
• Transfer of the fertilized embryo back into the uterus using a thin tube through the cervix under ultrasound guidance
• Then hopefully, pregnancy occurs!

There are several additional treatment options available with IVF, including using intracytoplasmic sperm injection (or ICSI), Preimplantation Genetic Testing (PGT), or using donor eggs, donor sperm, or a gestational carrier (surrogate). Including any of these options into your treatment plan will all depend on the couple’s specific needs.

Who is IVF best suited for? Depending on the factors contributing to infertility, IVF may be the best choice and recommended as the primary treatment plan due to its significantly higher success rates than IUI. However, less aggressive initial attempts with IUI cycles would also be appropriate in many situations due to its less invasive and costly nature. In general, IVF would be a good first choice for those with the following conditions:

• Damaged, blocked, or absent fallopian tubes (the procedure bypasses the fallopian tubes, where ovulation typically takes place).
• Poor sperm quality (it can be successful even with very little healthy sperm, as explained more below).
• Prolonged unexplained infertility.
• Problems with ovulation that are not being solved with other treatments.
• Severe endometriosis
• A genetic disorder that can be passed down to offspring.

IVF With ICSI:

ICSI is a procedure only available during IVF and cannot be performed with an IUI. It involves having a single healthy sperm be injected into a mature, retrieved egg. Research shows ICSI typically fertilizes between 50% to 80% of eggs. ICSI is often recommended as a good option when undergoing IVF treatment if:

• The partner produces too few sperm to do IUI or traditional IVF (in which 50,000 sperm are used to inseminate a retrieved egg).
• Sperm aren’t motile, or sperm have trouble attaching to or penetrating the thick outer layer of the egg.
• There’s a blockage in the reproductive tract that is preventing sperm from exiting.
• Traditional IVF fertilization has not worked for unknown reasons.
• Eggs that were previously frozen are being used.

What are the advantages of IVF?

Below are some of the main advantages of IVF:

• Considered the most potent fertility treatment, it can help couples get pregnant when other options cannot.
• It can help address reproductive issues related to both egg and sperm providers, including egg and sperm health and problems with the cervix and fallopian tubes.
• It can help treat age-related infertility and prolonged unexplained infertility, which often lead to unsuccessful treatment with  IUI.
• It offers the option of using ICSI, which IUI does not.
• It offers the option of using genetic testing, which IUI does not. This reduces concerns regarding certain genetic disorders since embryos can be tested before being implanted to identify genetic disorders or chromosomal abnormalities.
• It offers the option of storing embryos to be used and transferred at another time.

Preimplantation Genetic Testing:

One of the significant advantages of IVF is that it allows for genetic testing of embryos, including for inherited familial diseases, which IUI and other fertility options do not.

Called Preimplantation Genetic Testing (or PGT), this type of testing is performed to identify if embryos have a specific genetic or chromosomal condition. This way, those embryos are not transferred to the uterus, and the defect is not passed onto the offspring. The goal is to ensure that healthy embryos are transferred to the uterus in order to sustain a pregnancy and result in a healthy baby.

PGT also helps address the fact that one of the most common reasons embryos do not transfer and result in pregnancies is because of abnormal embryo genetic factors.

PGT may be recommended for couples or patients with a history of single-gene disorders, such as cystic fibrosis or sickle cell anemia, or sex-linked disorders, such as Duchenne muscular dystrophy and Fragile X syndrome.

How successful is IVF?

IVF now accounts for up to 4.5% of all live births in the United States and Europe.

The chances of getting pregnant with help from IVF ultimately depend on a number of factors, including age and overall health status, the underlying reason for infertility, and how many healthy embryos were created.

Like with IUI, IVF is most successful when the person providing eggs is younger than 35 to 40 years old and generally healthy. Overall, women between 30 and 40 have about a 40% to 50% chance of IVF working depending on several factors, and however, with the advent of PGT testing, a genetically normal embryo would have an approximately 70% chance of resulting in a healthy pregnancy in a high-quality fertility clinic.

Are there any side effects?

IVF involves using medications that can cause side effects, such as bloating, nausea, water retention, headaches, and mood swings. These are temporary and usually last about one week or so.

The egg retrieval procedure is performed under anesthesia and takes approximately 15-20 minutes. After the process, there may be some mild discomfort, including cramping, swollen ovaries, light bleeding, and tenderness. Following IVF, patients should avoid anything too strenuous, or that involves twisting of the ovaries.

Depending on the medications used in the IVF stimulation, there may also exist a minimal risk of ovarian hyperstimulation, which is a condition that can cause the ovaries to become temporarily swollen and painful, and in very rare circumstances, requires fluid to be removed from the abdomen.

IUI Vs. IVF: Which Is Right For You?

There’s a lot to consider when deciding between IUI and IVF, including the cost, invasiveness, time commitment, use of medications, potential side effects, and success rates.

An IVF cycle is more involved, invasive, and expensive than an IUI cycle; however, it can also be significantly more successful when IUI and medications are not.

If you’re dealing with infertility, your provider will help guide you through the process.

Your fertility provider will run tests to determine things like your egg and sperm quality and then be able to advise you on options that are most likely to be successful. Because every infertility situation is unique and complex, it’s best to listen to your provider’s recommendations regarding your treatment plan.

Is it worth trying IUI before IVF?

You and your doctor together can review your current health status and the specific conditions you’re facing to determine if IUI should be performed first or if it is in your best interest to move directly to IVF as your first-line treatment choice.

In many cases, if appropriate, your physician may recommend trying up to three cycles (sometimes up to six) of medicated IUI before moving onto IVF, assuming there are no significant obstacles that can interfere with IUI being successful. Sometimes certain insurance companies will require this before paying for IVF.

Some doctors may suggest that women in their 40s only try IUI once or twice before going to IVF, or even that they go straight to IVF to not waste time.

How do you know if you should do IUI first or go straight to IVF?

According to fertility experts, here is when to consider IUI before moving on to IVF:

• Try IUI first if your infertility is mainly related to ovulation issues. This includes individuals with PCOS or other forms of anovulation, plus cervical mucus problems.
• If the partner providing sperm has moderate sperm health issues but is still producing healthy amounts of sperm, try IUI first.
• Same-sex couples and single parents trying to conceive with donor sperm can also try IUI first.
• If the egg provider is under 35 or between 35 and 40 with no significant known fertility issues, IUI is typically done before IVF.

IVF may be a better option if 3-6 IUI cycles have been unsuccessful, or if the individual providing eggs or carrying the pregnancy is in their 40s, there is very little good quality sperm, or if there are known problems with uterine or fallopian tube function.

Family planning is another crucial element to consider when deciding where to start. If more than one child is desired, and advanced female age is one of the issues, IVF may be the best option in order to provide ample opportunity for fertility preservation through embryo creation. This future planning can allow individuals and couples to build the family of their dreams instead of enduring a long fertility journey that results in a significant decrease in the chance of additional successful cycles and future children.

Don’t forget to discuss these issues with your trusted REI so they can guide you appropriately.

By The Time You’re 30, Here’s What You Should Know About Your Fertility

Many individuals are having their first child later in life than in previous generations. Therefore, it’s important for people to understand the timeline of their fertility.

In the U.S, the average age that a woman has her first child is 26, up a full five years from the average age of 21 in 1972. A growing percentage of women are choosing to wait to have children until their 30s. This is influenced by factors including demanding careers, longer times spent in college or graduate school, or getting married at a later age.

By the time you’re 30 or 35, what do you need to know about your ability to conceive and have a healthy pregnancy?

Below we’ll look at how hormones, egg count and quality, and other factors involved in reproduction change once you’re in your 30s. We’ll also cover fertility treatments most often recommended for those over the age of 35 and cover the basics of freezing your eggs.

Fertility In Your 30’s

If you recall learning about reproduction in high school biology class, you may remember that women are born with all of their eggs. Unlike men who continuously make sperm throughout their lives, women don’t make any new eggs over time. Therefore, the quantity and quality of a person’s eggs start to diminish the older they get, starting from a young age.

According to the American College of Obstetricians and Gynecologists, “Peak reproductive years are between the late teens and late 20s. By age 30, fertility (the ability to get pregnant) starts to decline. This decline becomes more rapid once you reach your mid-30s.”

By the age of 45, the average person’s ability to get pregnant naturally has substantially decreased, to the extent that they’re very unlikely to get pregnant without any intervention.

“Ovarian reserve” refers to the number of healthy, normal eggs that a woman has left inside her two ovaries. This number decreases with age. Having “diminished ovarian reserve” becomes more likely in a person’s 30s, indicating that reproductive potential is lower based on the number and quality of eggs left.

Not only does the quantity of eggs decrease over time, but egg quality also diminishes as a person gets older; remaining eggs in older women are more likely to have abnormal chromosomes compared to eggs in those that are younger.

Changing hormones and pre-existing conditions are two other fertility factors to consider during your 30s. Women in their mid to late 30s have a higher risk of having disorders that can affect a healthy pregnancy, such as uterine fibroids, ovarian cysts, endometriosis, and pelvic inflammatory disease.

Levels of estrogen, the key hormone that controls a menstrual cycle, start to decrease in your mid-30s, resulting in less regular ovulation and irregular periods. Estrogen does not control the menstrual cycle. I would say something like the incidence of ovulation dysfunction increases as we age, resulting in fewer ovulatory cycles per year and irregular periods. Some women enter perimenopause (the stage prior to menopause) as soon as their late 30s, which can make conception less likely.

Finally, although it’s usually only temporary, past birth control use can also impact fertility, especially birth control forms such as injectables/shots. It can sometimes take up to 18 months for ovulation to resume once stopping birth control injections, which is something to take into account if you currently use birth control and wish to get pregnant in the near future.

Success Rates of Getting Pregnant

The average 30-year-old woman without any preexisting reproductive conditions has about a 20% chance of getting pregnant each month. In comparison, someone in their 20s has an even greater chance, about 25% per month.

By the time a woman reaches 40, the success rate of getting pregnant naturally drops to about 5% per month, meaning about one or two out of 10 would be able to get pregnant each month when actively trying to conceive.

Once an individual reaches their mid-30s, the older they get, the higher the risk of having a miscarriage or having a baby with fetal abnormalities. It’s estimated that about 15% of pregnancies in those under 35 result in miscarriage, but this number increases up to 25% to 50% if the person is between 39 and 44 years old.

Other factors to consider are the increased likelihood of chromosomal abnormalities, including Down syndrome, the most common chromosome problem that occurs among women who have children in their 40s. Down syndrome affects about 1 in 85 fetuses if the mom is 40 or about 1 in 35 if the mom is 45.

There are also increased maternal risks involved in having a baby at a later age, including preeclampsia (high blood pressure during pregnancy that can lead to organ injury). Older people pursuing pregnancy also have a higher chance of having twins/multiple pregnancies since the ovaries are more likely to release more than one egg per month.

Fertility Treatments Available

Tracking Your Cycle

If you’re in your 30s and trying to conceive, first start by tracking your menstrual cycles to get an understanding of how regular your periods are and when you’re most likely ovulating.

You can use any number of fertility apps on your phone to help you track your cycles, plus ovulation strips to help you pinpoint which days are best for having sex (a strip will turn positive 24 to 36 hours before ovulation, indicating to have sex at that time).

Additionally, you can monitor changes in your cervical mucus and basal body temperature to determine if and when you ovulated, which is helpful for predicting the following month’s cycle.

Visiting A Reproductive Endocrinologist (REI)

If you haven’t conceived on your own after trying for 6 to 12 months, it’s best to visit a healthcare provider for help with an infertility evaluation.

How long should you wait before seeking professional help?

Once you’re in your mid-30s, it’s recommended that you meet with a Reproductive Endocrinologist (REI) sooner rather than later. The recommended point is after about 6 months of trying on your own. REI fertility specialists can help pinpoint any fertility issues that may make conception more challenging.

REIs perform extensive exams and tests to uncover the full picture of a patient’s reproductive health, including a pelvic ultrasound (which can spot issues such as endometriosis or ovarian cysts), tubal evaluation, ovarian reserve testing, hormonal panel tests, and semen analysis for a partner.

Based on test results, your REI can help you decide which treatment options are most likely to be successful. Treatment for infertility, including if it’s related to advanced age, always depends on the individual case, as there are many potential pathways to having a successful pregnancy.

Potential fertility treatments that may be used to help you get pregnant in your 30s or 40s include IUI (most often for women under 35), IVF, or use of donor eggs, donor sperm, or possibly a gestational carrier (surrogate) if necessary.

Assisted reproductive technologies, including in vitro fertilization (IVF), can help with a variety of infertility causes that come into play in your late 30s or 40s, such as damaged or absent fallopian tubes, genetic abnormalities of embryos, low ovarian count, or a partner with low sperm quantity or quality.

Your REI can also perform prenatal and diagnostic screening tests, both before you become pregnant and once you’re pregnant, to assess the risk of birth defects or genetic disorders, including those that are more common in later-age pregnancies.

Keep in mind that no matter how you plan to become pregnant, and no matter the age, it’s important to take care of your body holistically — by maintaining a healthy weight, eating a nutrient-dense diet, quitting smoking, exercising enough, and managing stress.

Freezing Your Eggs

Egg freezing (fertility preservation) may be a good option for women in their 30s if they want to build their families later in life.

Also called oocyte cryopreservation, egg freezing essentially pauses the progression of chromosomal abnormalities that eggs experience past a certain age. This option allows women to preserve higher-quality eggs that are more likely to be chromosomally normal so that they can get pregnant at a later age through IVF.

Egg freezing can result in a lower risk of miscarriage and a lower risk of Down’s syndrome. One drawback is that it can be expensive and somewhat invasive, considering it involves many of the same medications and steps as IVF; however more employers and insurance companies are beginning to cover some costs of egg freezing.

If egg freezing seems like it may be a good fit for you, speak with your OB-GYN or an REI to discuss your future family building plans and next steps that will help you prepare as best as possible.

Deciding to start a family can be one of the most exciting life decisions a person can make. However, if a couple or individual has difficulty conceiving, joy and excitement can turn into stress and despair.

Unfortunately, infertility is not uncommon. This global issue affects about 48 million couples and 186 million individuals worldwide. So even if you’re not personally struggling with infertility, chances are likely that you know someone who is.

Infertility takes a mental, physical, and emotional toll on those longing to become parents. So how can you best support a friend who’s going through infertility?

What is Infertility?

Infertility is being unable to get pregnant after a year or more (6 months if over the age of 35).

Infertility affects all genders and can be due to several causes. Issues with any of the many steps that lead to conception can cause infertility.

For many people, infertility can occur when there are problems with their reproductive organs — such as the fallopian tubes, uterus, ovaries, testicles, or sperm. Smoking, obesity, alcohol or drug use, radiation exposure, genetic factors, and some medications increase the risk of infertility.

Infertility impacts everyone differently, and people may cope in various ways. It can be heartbreaking when someone wants to become a parent and is met with challenges.

You may be unsure what to do or say if your friend or family member is dealing with infertility. Still, there are several ways to support them.

Talking to Those Struggling With Infertility

When talking to a loved one with infertility, the most important thing is to let them know you’re there for them. Just asking how you can help goes a long way. Infertility comes with many complex emotions, so let your friend know they can talk to you if they feel like discussing it.

What Not to Say to a Friend with Infertility

What NOT to say is just as important as what you say. You may be trying to frame things in a positive light. For instance, saying things like “at least you don’t have cancer” or “at least you have freedom since you don’t have kids” is not helpful. But instead, statements like these minimize the pain of infertility. Just because infertility isn’t life-threatening doesn’t mean it’s not devastating to those trying to conceive.

Don’t Give Advice

Also, avoid advising on what they should do, like telling them to adopt. Adoption is a different journey that comes with its complexities. Your friend may not be ready to think about adoption just yet. On top of that, adoption can be a significant financial strain.

Fertility treatments can also be costly as well as mentally and physically taxing. So it’s best not to push your friend to pursue fertility treatments or tell them what to do about their infertility. In addition, you may not know everything they’ve tried or what it’s like to undergo fertility treatments.

Communicate Openly and Mindfully

Open communication is vital; you shouldn’t hide your pregnancy just because your friend is struggling with infertility. They’re probably very happy for you! But it’s a good idea to drop the news to them in private, so they have time to process it on their own time. You could even give them an individual heads up before posting about your pregnancy on social media.

Supporting a Friend With Infertility

Besides mindful and empathetic communication, there are more concrete ways to support someone struggling with infertility.

Learn About Infertility

Everyone in your friend’s circle may be curious about their infertility and ask them lots of questions about it. Yet, it can be exhausting to constantly rehash all the same information to different people.

You can take some of the burdens off your friend by researching and learning about infertility. Educate yourself about infertility and fertility treatments, like in vitro fertilization or intracytoplasmic sperm injection, so you’ll be on the same page if your friend ever wants to discuss it.

Offer to Help out with Tasks.

Infertility and fertility treatments are mentally and physically exhausting. You can support your friend by helping out with mundane tasks like housework or dropping off a meal. You could offer to attend fertility appointments with your friend or watch their pets so they can have time for self-care.

Ask How They’re Doing and if They Need Anything

The best way to support your friend on the journey to becoming a parent is to ask what they need. For example, some people want a listening ear to talk about it, while others require a mental break.

Remember to check in with your friend and say, “I’m here if you want to talk about it. What do you need from me?”

Don’t Be Afraid to Talk About It

While you want to avoid giving advice, don’t be afraid to talk about infertility. This is where you should let your friend take the lead. They may or may not want to discuss it, but it’s a profound part of their life.

Those struggling with infertility may feel isolated. Many of their friends and family are throwing baby showers and starting families while they fight a silent battle to become a parent. Let your friend know you’re here if they want to talk, and respect their medical decisions surrounding infertility. Don’t try to convince them to do something you may think they should do, and also respect their decision to stop treatments.

Hold Space to Help Your Friend Get Through Their Infertility Struggles

Infertility affects everyone differently, and it’s never an easy journey. The most important thing you can do is lead with love and hold space for whatever your friend is going through. Be a haven for them to laugh, cry, and everything in between. If you communicate with empathy, love, and honesty, you can provide the support your friend needs most.

If you or anyone you know is dealing with infertility, you don’t have to do it alone. At Reproductive Gynecology and Fertility, we provide comprehensive fertility care so those struggling with infertility can successfully become parents. Visit us at Reproductive Gynecology & Infertility to learn more about how we can help.