Fertility Treatments: What You Need to Know

Updated February 20, 2020
Baby feet

Sometimes the road to a baby bump can be bumpy. How do you know if you need fertility treatments or just more patience? Reproductive endocrinologist Thomas Price, MD, answers this question and more.

When should I see a fertility specialist?

If you are younger than 35, try to get pregnant for a year before considering fertility treatments. If you are 35 or older, try for six months. These are general guidelines for those who don’t have clear medical problems, including irregular periods or a history of pelvic inflammatory disease.

The older you get, the lower your chances of pregnancy become. After 40, chances of successful pregnancy are low. Stories of older women, especially celebrities, having children in their late forties tend to get a lot of attention. The part of the story that isn’t always shared is that they likely became pregnant with the help of an egg donor and infertility treatments.

Even with in vitro fertilization (IVF), the chances of a woman becoming pregnant after her early forties with her own eggs are very low. In fact, we typically don’t offer in vitro fertilization with a woman’s own eggs after age 44.

Are there still options after age 40?

We offer treatment with an egg donor up to age 49. Egg donation is extremely successful in our program. At the Duke Fertility Center, between 50 and 60% of couples become pregnant on the first try with egg donation.

What are some of the most common causes of infertility?

In women, the most common causes are ovulation problems -- not making an egg. This becomes more challenging as a woman gets older. Poorly functioning fallopian tubes can also be an issue. Tubes can be damaged or scarred by disease. Endometriosis or problems with the uterus also can cause infertility. Low sperm count or poor sperm quality in males can also make pregnancy difficult.

What fertility treatments are available?

Some of the options include medications, surgery, and IVF. But there is not one cure-all treatment. Every woman and couple is different, and we’ll tailor our treatment to each person’s needs.

How does IVF work?

We use hormones to stimulate the production of eggs in a woman’s ovaries. The eggs are retrieved from the ovaries, fertilized in the lab, and then put back into a woman. Then, we hope that implantation occurs and the woman becomes pregnant. IVF bypasses the fallopian tubes that might be damaged. It also increases fertilization rates when there are problems with low sperm count.

How important is the lab at a fertility center?

The lab is incredibly important. In fact, the lab may be the most important factor in a successful in vitro fertilization procedure. There are no labs out there that are better than Duke’s. Our state-of-the-art air filtration unit is extremely important to the success of growing embryos.

Is there a resource that compares success rates of fertility centers?
Yes. The Society for Assisted Reproductive Technology publishes the IVF success rates of clinics nationally.

Will an expensive procedure be my only option for becoming pregnant?

This is a common misconception. Many people have the impression that we only do the fancy procedures like IVF. The fact is many couples get pregnant with simple treatments that are not expensive. For example, simple ovulation problems can be treated with inexpensive oral medication.

My insurance does not cover IVF. How does Duke help put fertility treatment within my reach?

Duke is a member of Advanced Reproductive Care, a corporation that helps people finance fertility treatment. They offer all sorts of packages, financing options, and a partial refund guarantee program.

Even though it may be a few years before I’m ready to have a baby, are there things I could be doing now to prepare my body?

All women should take folic acid in the months leading up to trying to become pregnant. It can help prevent birth defects like spina bifida. Also, make sure you have all your vaccinations up to date, quit smoking, seek treatment for any diseases, and optimize your weight. Being either under- or overweight can adversely affect your fertility.

If you don’t anticipate being ready to start a family by age 35, you may want to explore freezing an egg or embryo. Even as you age, cryopreserved eggs or embryos will not, giving you better odds of a successful pregnancy later on.

What is embryo testing?

Testing embryos has been a significant advancement in infertility care, allowing doctors to look for chromosome abnormalities that can lower the chance of becoming pregnant and increase the potential for miscarriage. As you get into your late 30s and older, there’s at least a 50% chance embryos will be abnormal. If we identify a chromosomally normal embryo, then you may be able to expect a live-birth rate around 65%.

Patients carrying a genetic disease like cystic fibrosis, sickle cell disease, or bleeding and clotting disorders benefit from embryo testing. It allows us to select an unaffected embryo and prevent spread of a disease. This is one of the most rewarding aspects of fertility care.

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