Frequently Asked Questions
You have questions about fertility. Our doctors have the answers.
What is infertility?
Infertility is commonly defined as not being able to get pregnant after one year of trying. Experts often recommend that women who are older than 35 years and have not conceived during a six-month period of unprotected sex should make an appointment with an infertility specialist. Women who do not have a regular monthly period should also consider seeing a reproductive endocrinologist because ovulation problems are the most common infertility factor in women.
What causes infertility?
About 40% of infertility cases are attributed to male factors, and about 40% to factors that affect women. In 10% of infertile couples, the inability to conceive is caused by a combination of issues in both partners. In the remaining 10%, diagnostic tests do not provide the answer.
Ovulation disorders are the leading cause of infertility in women. Anovulation (no ovulation) is a disorder in which eggs do not develop properly or are not released from the follicles of the ovaries. Women who have this disorder may not menstruate for several months, while others have periods even though they are not ovulating. Oligo-ovulation is a disorder in which ovulation doesn’t occur on a regular basis. With oligo-ovulation, menstrual cycles may be longer than the normal 24 to 35 days. Other causes may include blocked fallopian tubes and other abnormalities.
Problems with sperm quality (concentration, motility and shape) are the most common infertility factors in men. These include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Another cause of male infertility is attributed to sperm cells that are malformed or die before reaching the egg. Sometimes, infertility in men is the result of medical issues, such as low testosterone and varicoceles.
How long should women try to get pregnant before calling their doctors?
Most doctors advise women to try conceiving for at least one year. However, women aged 35 years or older should see an infertility specialist after six months of trying unsuccessfully because a woman’s chances of having a baby decrease rapidly every year after the age of 30.
Since certain health problems may also increase the risk of infertility, women should also make an appointment with a reproductive endocrinologist if they have been diagnosed with endometriosis or pelvic inflammatory disease, or if they experience painful or irregular periods.
How is infertility diagnosed?
A reproductive endocrinologist will conduct a physical examination of both partners to determine their general health and to evaluate any physical disorders that may be causing infertility. If no cause can be identified at this point, more specific tests may be recommended. For women, these tests include X-rays of the fallopian tubes and uterus, and laparoscopy. For men, initial tests will focus on semen analysis.
How do doctors treat infertility?
Infertility can be treated with either medicine, surgery or assisted reproductive techniques—or a combination of treatments. Experts recommend specific treatments for infertility based on the factors contributing to infertility as well as the age of the woman. A reproductive endocrinologist may recommend intrauterine insemination (IUI) or in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) to help overcome male factor infertility.
What is assisted reproduction technology (ART)?
Assisted reproductive technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning the fertilized eggs or embryos to the woman’s uterus.
The most common and most effective form of ART is in vitro fertilization (IVF). IVF means “fertilization in glass.” Intracytoplasmic sperm injection (ICSI) is another common procedure indicated for couples with male factor infertility and for those with failed IVF attempts. In ICSI, a single sperm is injected into a harvested egg, as opposed to conventional fertilization where the egg and sperm are placed in a culture dish together and the sperm fertilizes an egg on its own.
What is in vitro fertilization (IVF)?
IVF involves retrieving a woman’s eggs from her ovaries and mixing them with sperm outside the body in a culture dish. The following day, the eggs are examined to see if they have fertilized and are developing normally. Fertilized eggs (embryos) are transferred several days later into the woman’s uterus for implantation and continued development.
Do insurance plans cover infertility treatment?
Insurance coverage for fertility evaluation and treatment varies by insurance provider and individual plan terms. We encourage you to contact your employer’s Human Resources Department or insurance carrier directly to learn more about the details of your coverage.
After you have completed your initial consultation, you will meet with our dedicated financial counselor to discuss cost, insurance coverage, and payment options tailored to your specific treatment plan. We work with every patient and couple to find the best financial solution to complement their treatment plan.
Does TFI provide any type of financing?
On average 70% of IVF patients require more than one IVF cycle. Tennessee Fertility Institutes understands the financial cost associated with treatments, with most families needing more than one cycle. We offer our patients financing with Bundl. With Bundl, patients do not pay until they have a baby, and if treatments are unsuccessful, Bundl may refund some of all of your patient’s investment.
How do I know who to contact for financial questions?
Please contact our office at (615) 721-6250 or email us at [email protected].
Who determines the “success rates” of a fertility clinic?
All certified IV laboratories are required to submit their success rate data to the Center for Disease Control each year. The CDC then publishes their data if they are members of the Society for Assisted Reproductive Technology (SART), which is why we often refer to this data as SART data. Our SART data can be found here.
How long will it take before I can start a treatment cycle?
It depends on your treatment path, but usually, it takes around 1 month to complete all tests before starting treatment.
Does my spouse or partner have to be present during my appointments?
We welcome all spouses and partners to be present during your appointments, but it is not required.
I feel uncomfortable providing a semen sample in the office. Is there another way?
We always consider our patients’ comfort when we recommend tests or treatment paths. If you prefer, you can also do this at home and then bring the specimen to the lab within an hour. If neither of these methods produces sperm, our doctors offer a pain-free method of aspirating sperm from your testes.
What are my chances for conceiving?
There are no two cases of infertility alike, and these unique differences contribute to different outcomes for each patient. That’s why our doctors work with you personally to determine the best treatment path possible for your health and fertility goals. Our doctors can then provide statistical data based on similar scenarios and treatments.
Should we have genetic testing?
Pre-implantation genetic testing is a technique in which one or more cells are taken from a fertilized egg for testing to provide information about the genetic make-up of the rest of the cells in that embryo. Testing typically takes place five days after the egg has been harvested and fertilized in an IVF laboratory.
We recommend pre-implantation genetic testing for couples with certain inherited diseases, such as a history of single-gene disorders (i.e., cystic fibrosis or sickle cell anemia) or sex-linked disorders (i.e., Duchenne muscular dystrophy and Fragile X syndrome). Genetic screening may also be indicated for those with recurrent pregnancy loss, previous IVF failures, severe male factor infertility, or advanced reproductive age.