Q. When should we seek help?

A. That depends on your age and other complicating factors. Generally speaking, couples who experience a year of unprotected intercourse without pregnancy may want to seek professional advice. If the woman is over 35, the couple may want to seek help earlier.

Q. What can I expect at a diagnostic check-up of my fertility?

A. Your physician will likely want a complete medical history from you and your partner. Many previous events can affect fertility including:

• Previous surgeries (internal pelvic scarring and adhesions)
• Previous illnesses (infectious disease, cancer)
• Chronic illnesses that require medication (for example, diabetes, thyroid hormone abnormalities, high blood pressure)
• Family history (for example, maternal use of DES, recurrent pregnancy losses)
• Lifestyle issues (over- or underweight, smoking, recreational drug use, alcohol)
• Exposure to reproductive toxins in your home or work environment
• Previous pregnancies (ectopic or aborted)
• Timing of intercourse
• Failure of testes to descend into the scrotum at puberty
  

Q: What diagnostic tests can we expect?

A: For the woman:

• Pelvic exam (to rule out obvious structural abnormalities)
• Hormonal blood levels of reproductive hormones including follicle-stimulating hormone (FSH), luteinizing hormone (LH, responsible for inducing the release of your egg every month), estrogen and progesterone
• Hysterosalpingogram (HSG) examination of your fallopian tubes to rule out a tubal blockage
• Clomiphene citrate challenge test to evaluate ovarian response to gonadotropins

For the man:

• Blood levels of FSH and testosterone (possibly)
• Semen analysis (always)
• Possible referral to a urologist

Q: What happens next?

A: After your physician has all your test results, she/he will be able to recommend a treatment plan that is most appropriate for you and your partner. Some possible treatment options include:

• Adjustment of chronic medications to facilitate fertility and pregnancy
• Treatment with gonadotropins to stimulate follicular growth and ovulation
• Insemination directly into the uterus with your partner’s sperm
• Surgical repair of uterine, fallopian tube or testicular structural abnormalities
• Surgical or hormonal treatment of endometriosis
• In-vitro fertilization (IVF) with culture to the blastocyst stage
• IVF with intracytoplasmic sperm injection (ICSI) and/or assisted hatching
• Surgical recovery of sperm cells from the testis or epididymis
• Use of donor gametes (eggs or sperm) or donor embryos
• Use of a gestational surrogate to carry the pregnancy

Many patients will become pregnant spontaneously or by using less complicated therapies, but for those with complex causes of infertility, many more options exist today to start a family than existed a generation ago.

Q: Does insurance pay for any of these treatments?

A: Yes, no and maybe. It depends on many factors:

• The state in which you live: Twelve states (Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New York, Ohio, Rhode Island and Texas) have mandated insurance coverage for infertility treatments. Even in states that mandate coverage for infertility treatment, the level of coverage may be limited to certain types of treatments or number of treatments.

Interestingly, the New England Journal of Medicine recently published research findings that suggest that in states that mandated coverage, the rate of multiple gestations and births was lower because fewer embryos were transferred .Fewer embryos were transferred,in part, because insurance coverage relieved some of the financial pressures that induce patients to agree to transfer more embryos to increase the odds of pregnancy. Unfortunately, increasing the number of embryos also increases the odds of becoming pregnant with multiple fetuses, which become an obstetrically difficult pregnancy.

• Your employer’s “customized” health plan: Your employer can choose to exclude or include coverage for treatments so the completeness of the coverage varies widely, even if the same company is underwriting the insurance. Some plans cover medications only, but exclude laboratory or technical procedures that may be needed. Other plans cover technical procedures only, but exclude medications. For instance, your plan may cover some assisted reproductive therapies but not others (e.g., GIFT, but not IVF). Infrequently, some insurance plans cover everything, but may limit coverage to one fertility treatment in your lifetime.
• Level of coverage you select. Even within the plans offered by your employer, the coverage for fertility services may vary.

Since insurance coverage is so complex, confusing and continuously changing, always determine what your coverage will be in advance of receiving treatment and be sure to get prior written confirmation of what’s included and excluded in your specific plan.
We are an In-network provider for Anthem. For other insurance providers, we are an out-of-network provider. However, if you have out-of-network benefits for IVF, we will still be able to bill your insurer for your covered out of network benefits.