Welcome to the third installment of Prisma Health On Call, our Q+A series that connects you, our readers, to the pros at Prisma Health.
This month, we teamed up with the fertility specialists at Prisma Health’s Fertility Center of the Carolinas, a collective of medical professionals passionate about helping patients build their families.
See the full Q+A below. Thank you to Paul B. Miller, MD; Johanna Von Hofe, MD; Creighton E. Likes, III, MD; Chelsea B. Fox, MD; and Lisa J. Green, MD, for their knowledge + expertise.
Note: If you are dealing with infertility, please know that you are seen, and you are not alone. 🧡
Q: What is the likelihood of being able to freeze and fertilize eggs after age 35? What is the risk for breast and ovarian cancer?
A: If your ovarian reserve (egg number) is normal, then there is an excellent chance of being able to freeze and fertilize eggs after 35. Freezing eggs early in life is optimal. Doing IVF to freeze and/or fertilize eggs later in life still comes with age-related issues in regard to lower egg yield, lower quality (think: chromosome abnormalities as well), and pregnancy rate. However, doing preimplantation genetic testing (PGT) can potentially help lower the miscarriage rate while increasing the pregnancy rate in certain patients.
As for breast and ovarian cancer, there is no increased risk for malignancy.
Q: I had a miscarriage 6 months ago and have been trying to get pregnant since. At what point should I see a specialist? Some websites say 6 months while others say after a year.
A: It is probably a good time to see one. Most sites will tell you that you can wait 12 months to see a specialist if you are under 35 years old; however, it is usually to your advantage to be seen a bit earlier in this situation.
Q: Can a woman in her 50s still receive fertility treatment?
A: Most centers will do donor egg IVF up until a patient’s age of 51 years old.
Q: My husband had a vasectomy, but we want to try to conceive. Is there an option for conception without a reversal? We are struggling to find any urologists who perform them.
A: We work with a fertility trained urologist who can evaluate the male partner to see if he is a good candidate for surgical options to obtain sperm. If that is successful, IVF is the sole route for conception. The other option would be to use donor sperm with office insemination or IVF.
Q: Are there any lifestyle or diet changes that the male partner can make to help with fertility? (i.e. limit alcohol consumption, exercise, etc.)
A: Definitely a healthy lifestyle: alcohol in moderation, no smoking, no drug use, routine exercise, healthy diet and weight, etc., and absolutely no testosterone use. It’s also recommended to get a semen analysis, after which vitamins/supplements may be recommended.
Q: What is the difference between IUI and IVF treatments?
A: Intrauterine insemination (IUI) is the process by which a small volume of washed sperm is placed inside the female uterus, thereby bypassing the lower reproductive tract. The sperm and egg still meet in the female body, and the embryo grows and develops (and hopefully implants!) inside the female partner. The most common reasons we would recommend IUIs are for male factor infertility (seen in up to 40% of couples), a female using donor sperm, and unexplained infertility (which affects up to 30% of couples).
In vitro fertilization (IVF) involves the procedural extraction of eggs from a female with fertilization of that egg in the embryology lab. The egg and sperm then grow into an embryo outside of the female for a few days before the embryo is transferred into the female uterus to continue growing and developing.
Q: My medical insurance will not cover fertility testing or procedures. What is the average cost of fertility treatment? Are there financial assistance options available?
A: We are sorry to hear that you don’t have insurance coverage for fertility testing and treatment. That is (unfortunately) very common, demonstrating that we certainly have continued work to do in advocating for this coverage for our patients. Infertility is a medical diagnosis and deserves to be treated as such.
That said, there is a wide range in pricing for the testing and treatment that patients require. Some medications are quite inexpensive, and some procedures do get expensive. The best next step would be to make an appointment so that testing and treatment that is tailored to your history can be discussed. After we better understand what you need, one of our financial advisors would be happy to talk through cost and payment with you.
Q: What is the likelihood of conceiving “naturally” after over a year of trying?
A: 85% of women under 35 who have regular menstrual cycles will conceive in their first year of trying. An additional 10% will conceive in the 2nd year. The chance of natural conception does decline significantly with age, so we advise women 35-39 to seek an evaluation if they haven’t conceived after trying for 6 months. If you’re 40 or older, we recommend an assessment immediately.
If you have any risk factors for infertility — irregular menstrual cycles, PCOS, endometriosis, fibroids, prior cancer treatment, etc. — we’d also recommend that you talk to your doctor about fertility testing as soon as you know you’d like to be pregnant.
Learn more about Prisma Health’s Fertility Center of the Carolinas.*
