A semen analysis (SA) is an important part of a male infertility diagnosis. This is how a ‘male factor’ is discovered. A ‘male factor’ is present in about half of all cases of infertility. A male factor can include anything from a total lack of sperm to issues with the sperm themselves. Possible issues include:

- Low sperm count
- Poor sperm motility (how they move)
- How the sperm look (morphology)

Substances like cigarettes, marijuana, alcohol and steroids (like testosterone) may negatively impact sperm count and function.

A semen analysis is almost always done at the start of infertility testing. This occurs even if there is an obvious ‘female factor’ or if the partner has already fathered several children. An SA is important because both partners may have factors contributing to infertility. Semen analysis is inexpensive. It may also save you money down the line if you are treated but fail to conceive due to an unchecked male factor.

If you are planning to undergo intrauterine insemination (IUI), your partner’s semen will be washed and analyzed. The analysis will check for sperm count, motility, and morphology. If your doctor sees any problems, he or she may recommend that your partner visit a urologist for an exam, counseling, and treatment.

If your partner’s sperm count, motility, or morphology are severely diminished, then IUI may not be your best option. In this case, your doctor may recommend that you try donor sperm or in vitro fertilization (IVF).

Henry Bohler, Jr., M.D. ‘Major’ Bohler is Board Certified in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. He is also Medical Director at the University of Louisville’s Fertility Center, University OB/GYN Associates. Besides having a keen interest in IVF, Dr. Bohler’s other interests include polycystic ovary syndrome, recurrent pregnancy loss, and endometriosis.

January is Thyroid Awareness Month. Find out how thyroid issues can affect your fertility, and what you might be able to do about it.

Thyroid issues can be blatantly obvious or invisible. Either way, thyroid problems can be a factor in fertility issues for women trying to get pregnant. Many women who are having trouble conceiving may not know that a thyroid problem is at the root of their fertility issues. Dr. Susan L. Treiser, a reproductive endocrinologist, co-founder and co-director of IVF New Jersey, an Attain Fertility^® Center , sees this situation often and offers information and advice to women.

There are two basic thyroid categories, Hyperthyroid and Hypothyroid.  Women who are having difficulty getting pregnant and recognize any of the symptoms should see a specialist right away.

Hyperthyroid symptoms include:

• Weight loss, trouble maintaining weight
• Trouble sleeping
• Mood swings, feeling nervous and irritable.
• Rapid and irregular heartbeat
• Feeling hot

Hypothyroid symptoms include:

• Trouble losing weight; easy weight gain
• Feeling sluggish and depressed
• Constipation
• Aching joints and muscles
• Feeling cold

In addition, one of the most common symptoms of both Hyperthyroid and Hypothyroid is an irregular menstrual cycle which can be an indicator of infertility.

Dr. Treiser suggests that even if women don’t have any of the symptoms, a simple thyroid test performed by an endocrinologist will help rule out possible causes of infertility. The test will determine whether too much or not enough Thyroid Stimulating Hormone (TSH) is being produced. TSH triggers the thyroid to produce two different hormones, T3 and T4. When the thyroid produces too much (hyperthyroid) or too little (hypothyroid) of these hormones thyroid problems can occur, including fertility problems.

One culprit in cases of hyperthyroidism that can lead to infertility and other health issues is having too much iodine in your diet. “The thyroid gland needs a certain amount of dietary iodine to keep it healthy,” explains Dr. Treiser. “Found in regular table salt and other food sources, too much iodine can lead to a hyperthyroid. Conversely, on rare occasions, low iodine in a diet can lead to a hypothyroid.”

Whether hyper- or hypothyroid, under the care of a fertility specialist, women have very good chances of becoming pregnant.  “There are risks and being monitored by a specialist throughout the pregnancy is extremely important,” said Dr. Treiser. “Women who are hyperthyroid may run the risk of having a low birth-weight baby or have problems with pre-term labor. Those with a hypothyroid may have a higher risk of miscarrying. The bottom line is that women with any type of thyroid issue need to work with a fertility specialist and be monitored regularly to ensure a healthy pregnancy.”

Marcia Clark is the Managing Partner of Shameless Promotions, LLC, a full service Public Relations and Communications firm based in the Lower Hudson Valley of New York. Shameless Promotions provides public relations services to the Attain Fertility Centers division of IntegraMed America, Inc.

If you’re like me, you spent a lot of time trying to figure out exactly how much IVF costs long before hitting the financial office at your fertility clinic. I know I did and the Google wasn’t very helpful. So I’m going to share all of our costs directly associated with IVF. The totals don’t include other medications that I take on a regular basis. And please remember that clinics and insurance coverage vary wildly by geographic region.

If you’re just starting your fertility journey, please don’t let these costs scare you. Only a very small percentage of fertility patients will need IVF. So go see a specialist sooner rather than later.

Now, I’m still hoping that will win the lottery before I start my first injections on February 9th, or “I Day” as we’re calling it. But that doesn’t really seem like a viable long-term financial plan. So T and I had to sit down and figure out how to pay for this.

First, we added up the cost of 1 fresh IVF cycle with ICSI, which has been recommended because of T’s low motility, as well as all of the medications we need.

*A little reminder that our insurance covered these, but that doesn’t mean that every policy will. I suspect that they’re only covered for us because the big I diagnosis (Infertility) didn’t accompany the prescriptions.

If we’re unsuccessful, we wanted to plan for the costs of a FET, frozen embryo transfer, cycle.

T and I also know we’ll increase our odds of a successful IVF cycle by trying more than once, so we also looked up programs like the Attain IVF multi-cycle plan. With the multi-cycle plan, you get up to four tries (two fresh and two frozen). The Attain IVF cost for this program is about $18,000. That’s 30% less than the same treatment plan if you were to pay for it on a cycle-by-cycle basis – about $27,000.

If you’re under 38, the Attain IVF Refund plan may be an option. The Attain IVF Refund Program includes up to six tries (three fresh and three frozen). The Attain IVF cost for this program is about $24,000. That’s 40% less than the same treatment plan if you were to pay for it on a cycle-by-cycle basis – about $40,500. T and I don’t qualify for this, so the program isn’t an option for us, but something we would definitely consider if we were a few years younger. I’m actually kicking myself that we didn’t more aggressively pursue treatment when we started trying for baby number 3, back when I was the young age of 36. Or at least it seems young now while I’m 39. It’s amazing the difference that just 3 years can make on your fertility.

Now, aside from programs like Attain IVF’s multi-cycle plan, T and I know we’re going to have to hand over a pretty big chunk of change. We’ve saved approximately $12,000 to put toward IVF and we’ll handle the remainder on a monthly payment plan of up to six months. Of course, we realize that not everyone can save up that amount of cash and IVF should still be an option if you need it. That’s why the Attain IVF clinics offer financing through Springstone. Springstone has some great new interest rates, so check with your clinic for more information.

Even if we’re successful on our first try, we’ll be paying at least $17,000 for IVF with ICSI. That’s a daunting amount, I know. But I hope that by breaking it down for you, you’ll have more information while you’re making your own financial decision.

The emotions from infertility can drag us down and around, so let’s find some ways to remain balanced, focused and hopeful. Here are some suggestions given by our wonderful callers that we can keep tucked away in our mental tote/satchel/hobo bag and use when needed.

Talk, chat, speak, converse; you get the message. Seek the support of someone you feel comfortable sharing your feelings with to be your “shoulder” during the bumps in the infertility road. Always, always remember you are loved even when those closest to you have a difficult time providing the support you need.

It’s okay to be choosy. Not everyone and every situation is going to work for you and that’s okay. You can decide and choose who to be around, what gatherings work for you and so on. Listen to your intuition. You may have to distance yourself from the people who don’t have the where-with-all to handle changing emotions or the parties where the kids out number the adults. Keep the balance you need to stay focused.

Fun, laugh, fun. Yes! Go to the latest comedy movie and share some popcorn with milk duds or stay home, turn on the TV and watch reruns. (You know laughter releases endorphins which help to decrease the stress hormones in our bodies).

Please hold on to your dreams for parenthood. We hope that the Year of the Dragon will be your year.

Until next time, all my best.

One day I was sitting with a patient talking about how it becomes more difficult to get pregnant as you get older. We discussed how many women put off trying to conceive, waiting for that “better” time, when supposedly life gets easier. I remember looking at her and realizing that we were the same age and that I was doing exactly what I was telling my patient not to do!

Time passes quickly when you are busy completing medical residency training, finding a job, getting married, establishing a practice, studying for certification exams and all the other things that occupy the daily grind of a young doctor’s life. I realized that I was 35 years old …and I thought to myself: when did that happen? My husband and I definitely wanted to have a family of our own and we had put it off, waiting for a “better” time to come. The truth is that I hadn’t even considered trying to become pregnant. I had so many other things to accomplish first.

Without going into all the details, I found out after some simple tests that, like many of my patients, I might have some difficulty getting pregnant. I decided that it didn’t matter that it wasn’t a good time and that I had a lot of other things to do. If we wanted a family, we were going to have to start trying right away. I was very lucky and conceived fairly quickly. When we decided to try again, I started fertility treatment and hoped for the best. In our hearts, we felt that if we only had our one daughter, we would still feel very blessed. I ended up doing more treatment cycles than I would generally recommend for most of my patients. Right when I was ready to give up, I became pregnant again.

Sometimes I think that there was a reason that I had difficulty conceiving, and yet was able to overcome it. It allows me to fully empathize with my patients, and at the same time offer them hope. I have been in their shoes, walked the same journey, and made it to a very happy ending (twice).

Dr. Faber is co-medical director of Arizona Reproductive Medicine Specialists, a faculty member of the Division of Reproductive Endocrinology and Infertility at Good Samaritan Regional Medical Center and an assistant professor at the University of Arizona. Her interests include all aspects of infertility as well as the endocrinologic disorders affecting reproduction. Dr. Faber has extensive experience in Assisted Reproductive Technologies (IVF), ovulation induction, and endoscopic surgery for the evaluation and treatment of infertility. She has been named a “Top Doc” in Phoenix Magazine.

The CDC just published a report describing U.S. trends in births in twin deliveries between 1980 and 2009. The results are interesting.

The rate of multiple gestations has been rising in America since the advent of assisted reproductive technologies like IVF. The CDC just published data that reveals how the trend in multiple gestations is rising faster in some populations than others.

Here are the key findings as reported by the CDC:
1. In 2009, 1 in every 30 babies born in the United States was a twin, compared with 1 in every 53 babies in 1980.
2. The twin birth rate rose 76 percent from 1980 through 2009, from 18.9 to 33.3 per 1,000 births.
3. If the rate of twin births had not changed since 1980, approximately 865,000 fewer twins would have been born in the United States over the last three decades.
4. Twinning rates rose by at least 50 percent in the vast majority of states and the District of Columbia.
5. Over the three decades, twin birth rates rose by nearly 100 percent among women aged 35–39 and more than 200 percent among women aged 40 and over.
6. The older age of women at childbirth in 2009 compared with three decades earlier accounts for only about one-third of the rise in twinning over the 30 years.

Dr. Lowell T. Ku, M.D. is an award winning and leading Reproductive Endocrinology and Infertility specialist at Dallas IVF, one the nation’s premiere infertility centers. Doctor Ku clarifies the many confusing terms used in the world of Infertility using straightforward explanations.

I know. It seems so strange to be excited about birth control. I don’t think I’ve been this excited about birth control pills since my…um…early twenties.  After I was married.  I swear, Mom. Look! There’s a polar bear on a unicycle!

Anywho…. now that I’ve started my pills we have our big day on the calendar marked with an I.  We’ll call it I Day.  The day we start IVF; the day I start injections.  Now, after two pregnancies with gestational diabetes and then full blown diabetes, I am no stranger to injecting myself several times a day. But still, it’s been awhile.  So I unearthed this great video we did last year with the American Fertility Association.

Ouch! Well it doesn’t seem so bad now after watching the video. And I’m just as excited about injecting myself as I am about starting birth control. Another thing I never thought I’d say!

January is C

1. Cervical cancer is the second most commonly occurring cancer in women.

2. Pap smears are crucial in detecting and preventing many cases of cervical cancer each year in the United States. The majority of women with cervical cancer were probably skipping their annually recommended Pap smears (or not following their doctor’s recommendations afterward).

3. Most women with cervical cancer are diagnosed after age 35.

4. Women with cervical cancer rarely have symptoms until the cancer is advanced.

5. Smoking can increase the risk of cervical cancer (and a host of other infertility problems). If you smoke, quit today to protect your fertility.

6. Human papillomavirus (HPV) is the most common cause of cervical cancer.

7. An HPV vaccine, Gardasil, is FDA-approved to prevent and reduce the risk of cervical cancer. Ask your doctor about this vaccine if you are younger than 26.

8. HPV is largely spread through sexual contact – so practice safe sex. (Condoms are helpful but do not always prevent the spread of HPV).

9. Having sex with multiple partners can also increase your risk of cervical cancer, so be wise when it comes to your love life.

10. Treatments for cervical cancer, including radiation, chemotherapy, and surgical treatments, often lead to infertility and sterility. However, some women with cervical cancer qualify for fertility sparing surgery. In these procedures, doctors are able to treat cervical cancer without affecting the entire cervix, protecting a woman’s ability to get pregnant.

If you are diagnosed with cervical cancer, and are hoping to become pregnant one day, talk to your doctor about fertility preservation. This conversation about fertility preservation needs to happen as soon as possible after cancer diagnosis, and may offer you a chance of getting pregnant after cancer treatment.

For more information about cervical cancer, check out the Attain Fertility article series on Cancer and Fertility.

Britt Berg is Content Manager and medical writer for Attain Fertility. Co-author of Making a Baby, Britt is obsessed with all things fertility, pregnancy, and birthing.

One worry that many hopeful parents-to-be share is whether their baby will be born with birth defects. So what do the statistics say? Birth defects noted before, at, or shortly after birth, remain one of the leading causes of infant mortality in the U.S. Birth defects in the general population are estimated to occur at 3 to 5 percent of all births. In other words, there is a 3 to 5 percent chance that any woman who gets pregnant naturally will have a child born with some type of birth defect. The good news is that the vast majority of these birth defects are not fatal and can be treated.

Some of the most common types of such birth defects (making up about 90 percent of all birth defects) include:
- Abnormalities in one of the chambers of the heart (ventral septal defect)
- Blockages of the stomach (pyloric stenosis)
- Defects in the flow of urine from the penis (hypospadias)

The cause for about half of all birth defects remains unknown. Some are attributed to genetics and cannot be prevented. Causes for some birth defects include:
- Spontaneous alterations in the child’s DNA or chromosomes (13-15%)
- Something in the genetic makeup of the parents (20%)
- Illnesses in the mother (5%).

Some publications note that in vitro fertilization (IVF) may increase the likelihood of giving birth to a child with a birth defect. This increase may be described as “more than twice the normal rates.” Actual increases range from the “normal” risk of 3 to 5 percent to around 6 to 8 percent with IVF. The actual cause of a potential increase of birth defects with IVF has never been determined, although different groups cite the following reasons:
- The use of hormonal medications
- Culture systems used to grow and sustain the eggs and the embryos with IVF
- Unknown mechanisms, like the parents’ genetics

Some speculate that a parent’s genetic makeup, or struggle to get pregnant, might impact the health of the child. It is important to note that increases in birth defects have not been found in children conceived with donor sperm when the mother has no fertility issues. Similarly, births following egg donation when the male has no fertility issues have also not caused an increase in birth defects.

It is important that patients considering IVF understand that the literature is fairly consistent in noting some increase in birth defects with IVF. It is still unclear whether IVF is associated with a significant negative impact on a child’s intelligence (at least regarding those pregnancies not complicated by multiple gestations (twins, triplets) or premature delivery).

Ultimately, any parent considering IVF has to take the above information into consideration and ask themselves the following questions:
1. Is having a child that has a genetic connection to both of you important enough to accept the above risks?
2. Are you prepared to move towards adoption, foster care, or a childfree existence if unwilling to accept the risks of IVF?
3. Would you consider donor sperm or donated eggs to potentially reduce the likelihood for birth defects? That is, if fertility problems have only been identified in either the male or female partner.

For some couples, IVF represents the best, and sometimes only, option for having a genetic connection to their child. Our group at the Froedtert and Medical College of Wisconsin Reproductive Medicine Center strongly believes that all prospective parents deserve appropriate counseling on all of their options for having a family and strive to provide the best information available.

Estil Y. Strawn, Jr. M.D. is doubly board certified in Reproductive Endocrinology and Infertility and Obstetrics and Gynecology.  He is the medical director of the Froedtert and Medical College of Wisconsin Reproductive Medicine Center. Dr. Strawn is also full professor with tenure at the Medical College of Wisconsin where he serves as the director of the division of Reproductive Endocrinology and Infertility in the department of Obstetrics and Gynecology.

Dr. Strawn has been helping patients overcome their fertility problems for 19 years, and has directed a center that is one of the largest providers of fertility services in the state of Wisconsin. This center provides some of the most advanced types of technologies in the country including pre implantation genetic diagnosis (PGD), egg freezing, egg and embryo donation, gestational carriers, as well as robotic surgery for uterine fibroids and reversal of fallopian tube sterilization.

“Life is what happens while you are busy making other plans.” (John Lennon).

My wife Peggy and I are proud parents of three beautiful daughters. We started our family when Peggy was in her mid-30s and we did not complete our family until she was in her early 40s.

Peggy and I were in our second year of marriage when we conceived our first daughter, Olivia. Olivia was easily conceived. Peggy’s pregnancy with Olivia was every woman’s dream pregnancy…a spontaneous conception, an easy beginning to our family without difficulty, and a pregnancy that grew easily and delivered without complications.

It was an exciting, optimistic time for us as a couple. Before I specialized in reproductive endocrinology and genetics, I had practiced as an obstetrician. I had cared for more than a thousand pregnant women and I had shared in the joy (and sometimes the difficulties) of delivering their babies. Peggy was a prenatal genetics counselor. She had listened to and counseled hundreds of pregnant women through their pregnancies.  Through our experiences with our patients, we had come to know the pregnancy process. This time the pregnancy experience was happening to us.

As the months passed, we watched Olivia grow and Peggy and I grew together as future parents in anticipation of her birth. We were blessed with an uncomplicated pregnancy that delivered Olivia naturally on an August Sunday afternoon in UCLA Santa Monica Hospital overlooking the Pacific Ocean. It was the perfect culmination of an easy conception and the beginning of our lifelong adventure of parenting.

By Olivia’s second birthday we had moved from Los Angeles to Florida.  The private practice opportunity in Florida did not succeed as planned and we became homesick for the west coast. By Olivia’s third birthday we had moved across the country again, settling in Phoenix.  A second pregnancy conception had not yet occurred. Peggy was three years older and well into her late 30s.

As the years passed since Olivia’s birth, we had been busy working, making plans, and enjoying being parents. We were not thinking about Peggy’s ticking ovarian biologic clock. Although we were very aware that a woman’s fertility declined with increasing age, we assumed that our next child would be as easy to conceive as our first. We had taken our previous fertility for granted and never thought that infertility could happen to us.

As Peggy approached 40, I finally confronted the fact that we needed to pursue fertility treatment in order to have our second child. We started with clomiphene citrate and inseminations and slowly moved up to high dose gonadotropin injections with inseminations.  After a year of ovarian stimulations and inseminations, our best outcome was only a biochemical pregnancy. After repeated tearful disappointments and way too many shots, it was time to move to in vitro fertilization (IVF). Our first cycle of IVF produced embryos that went to transfer, but no pregnancy. More tears, more worries.

It was still hard for us to believe that after such an easy experience having Olivia, that only a few years had dramatically affected Peggy’s fertility, resulting in her decreased ovarian reserve and low egg quality.  We intellectually knew that as a woman advanced past her mid 30s and into her early 40s that the normal aging process was associated with decreased fertility. We intellectually understood that normal aging was associated with a decline in the number of eggs available within the ovaries, We also knew that the quality of the eggs would start to suffer from increased chromosome abnormalities, resulting in a higher rate of embryos that failed to implant, miscarriages, and fetal aneuploidy (Down syndrome).  Our personal emotional understanding of our reduced fertility as a couple was finally confronting our intellectual understanding of our biologic aging.

We took a break to regroup our emotions. The repeated treatment failures would have been a difficult reality to confront as a childless couple. Having our daughter, Olivia, at home in our family was a big comfort for us.

It was around this time that we considered adopting a beautiful girl in our church who was the same age as Olivia. The adoption process would be complicated. The little girl was in foster care and her biologic mother still retained parental rights and showed an occasional interest in her.  We kept the possibility of adopting a child into our family as an open option.

After some time, we decided to restart fertility treatments with plans to proceed with IVF.  Finally, after years of trying, our second cycle of IVF was successful.  Peggy’s high HCG levels had hinted at a twin pregnancy, but it was not until the ultrasound revealed two tiny beating hearts that we knew that our hopes and prayers were answered.  We were blessed with a twin pregnancy. Under the care of Dr Jordan Perlow, our Perinatal Obstetrician, Peggy carried to 38 weeks without complications and delivered Sophia and Arianna by Cesarean section. It was one of the happiest days of our lives.

Peggy and I have been blessed with three daughters. I am thankful every day for our family. I am also thankful that we have closed the infertility chapter of our lives. We are both thankful to move on to the everyday challenges of being a family: of raising three daughters and living our marriage and our lives together.

The lessons from our experience are simple: be aware and listen to your body. Your biological clock is ticking and as you live each busy day you are aging in different ways.  Don’t procrastinate your health care responsibilities. Be proactive and check your biological clock with annual well woman exams and appropriate medical testing.  The reproductive window of opportunity for a woman is limited in time. Your fertility is a gift that will one day fade and come to a close in your lifetime.

Mark D. Johnson, M.D. has practiced reproductive medicine and fertility in the Phoenix valley since 2000. He came to Phoenix with an extensive professional experience in reproductive medicine. His background is unique in that he is both an experienced reproductive endocrinologist and infertility specialist and a clinical geneticist. He is Board Certified in Obstetrics and Gynecology with subspecialty Certification in Reproductive Endocrinology-Infertility and is Board Certified in the specialty of Medical Genetics. To make a consultation with Dr. Johnson at Arizona Reproductive Medicine Specialists, call (602) 281- 9032.