This depends on your age. We recommend that women over the age of 35 initiate a basic fertility evaluation after 6 months of regular intercourse without conception. Many of our patients are in their mid-thirties and anxious to start a family. We understand that you may be hesitant to begin the process but realize that having a family is a wish for so many people and encourage you to come and see us if you are in the unfortunate situation of not conceiving after trying for many months. Delaying evaluation is usually not a good option as fertility decline really starts to speed up after age 35.
For the both partners, an initial consultation consists of your medical history with one of our physicians. There is also a physical exam for the female partner. For the female partner, we start with a pelvic ultrasound and hormone testing on the third day of your period. The hormone testing gives us an idea of your ovarian/egg reserve and if it is appropriate for your age. This is followed with a test called a hysterosalpingogram (HSG), done between the 6th to the 12th day of your cycle, which involves passing a radiopaque dye through your cervix (transvaginally) and then taking an X ray of the pelvis. The dye shows up on the X ray and based on the pattern of the dye on the X-ray film, we can determine if your fallopian tubes are open. If there is a male partner, he will need to perform a semen analysis to determine the quality of the sperm.
This will be based upon a thorough review of your insurance coverage. Any people have coverage for fertility testing. Insurance coverage for fertility treatment can vary significantly. Once a treatment course has been determined for you by one of our physicians, we will have one of our finance specialists go over your coverage and detail your out-of-pocket expenses. Every patient has a unique situation and we make sure to share this information with you once we have it available.
IUI is a typical first course for couples where the male partner has normal sperm and the female partner has normal egg reserve and patent fallopian tubes. It is also commonly used for our female same-sex couples using donor sperm. With IUI, ejaculated semen is processed in our lab to get the more motile (faster) sperm. This sperm is then placed directly into the uterus though the cervix in the office. This method allows the sperm to be placed in close proximity to the egg(s) being ovulated and increases chances for pregnancy. IUI can be done in a natural cycle (no medications) or in conjunction with oral of injectable medications. The decision on a natural or medicated IUI will depend on your medical history and test results.
IVF is a technology that was initially developed over 40 years ago. Over the years, it has been refined to improve pregnancy rates. People usually need IVF if they have failed multiple IUI cycles, blocked fallopian tube(s), a partner with a very low sperm count or abnormal ovarian reserve. Patients who also plan to do preimplantation genetic screening (PGS) or preimplantation screening diagnosis (PGD) are also candidates for IVF. In IVF, the female partner takes hormone injections daily for about 8-11 days to effect growth of multiple eggs. After final injection to allow the eggs to mature, she goes under anesthesia to have the mature eggs removed from the vagina with needle aspiration under ultrasound guidance. This process usually does not take more than 20 minutes. The eggs are then fertilized with sperm to create embryos. If there is a sperm problem or a history of poor fertilization with a previous IVF cycle, then the eggs are fertilized with the sperm in a process called Intracytoplasmic sperm injection (ICSI). As opposed to conventional IVF, in ICSI, the sperm is injected directly into the cytoplasm of the egg to improve chances of fertilization. After developing in our incubator for five days, depending on the age of the female partner, number of embryos and their quality, the best 1 or 2 embryos are returned to her uterus through the cervix in a process called embryo transfer. Pregnancy test follows nine days later.
IVF has offered many families the chance to have the family they thought may never happen. It is not the treatment for everyone but may be the treatment for some.
Indications for PGS include multiple failed IVF cycles, recurrent miscarriage, and even gender selection. PGS is not indicated for everyone. With PGS, embryos are biopsied to see which of them carry an abnormal chromosomal complement (i.e. anything above or below 46 chromosomes). Embryos that are abnormal are not selected for transfer as they typically result in miscarriage and failed implantation.
Yes! We provide this option to patients who are single, undergoing planned cancer treatment, or who want to delay childbearing. If you think you want a family, but for any reason have to delay the process, please speak with us. We have helped many patients this way and are happy to speak with you about the details of the process at the time of freezing, and for the future as well.
Prior to undergoing IVF, it is standard of care to have an evaluation of the uterus to rule out uterine fibroids, scar tissue, or endometrial polyps. Any of these problems can result in failed implantation or miscarriage after IVF. We usually perform hysteroscopy before IVF as it is both diagnostic and therapeutic, meaning any abnormalities can be taken care of the same day as the hysteroscopy so the IVF cycle can move ahead immediately. For some patients, another option for a uterine evaluation is a saline infusion ultrasound. However, any abnormalities will still need a hysteroscopy for treatment prior to the IVF cycle.
Birth control pills are a very common method used to cause downregulation of the ovaries prior to IVF. Downregulation allows us to prevent premature ovulation and actually improves the outcome of IVF by allowing us to harvest mature eggs that have are synchronized and are of better quality. For some patients with low ovarian reserve, down regulation is not good and may result in cycle cancellation.
Use of an egg donor is indicated in those with multiple failed IVF cycles or very poor ovarian reserve, among others. We have a range of donors at the Diamond Institute. If none of them are an option, we work with reputable agencies that can help you find an egg donor.
We have long experience taking care of same sex couples and helping them achieve pregnancy. We work with some of the largest and most experienced sperm banks in the country. After your physician evaluation, and once you have selected a donor from a sperm bank, we assist you in the process of ordering your donor sperm so it can be shipped to our laboratory. Once we have the sperm on our premises, you are good to go!
Not at all. We have worked with donors and gestational surrogates all over the country and in Bermuda. We have patients from all over the world and are committed to providing you the same excellent care no matter where you live. We keep you updated on the status of your donor and will help you every step of the way!