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Fertility Testing

Your guide to getting started with fertility treatment.

Infertility is diagnosed through a comprehensive fertility workup. With the right diagnosis, your chances of becoming pregnant increase significantly. The information below contains everything you need to know about fertility testing and treatment.

What is Infertility and How is it Diagnosed?

The short answer is that infertility is a medical condition.

As described by Resolve, the National Infertility Association, infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages and the woman is under 35 years of age. If the woman is over 35 years old, it is diagnosed after 6 months of unprotected, well-timed intercourse. And for women 40 and older, the wait is three months.

Comprehensive fertility testing for both men and women can help you maximize your chance of achieving success in the shortest time necessary.

As the American Society of Reproductive Medicine says, infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction.

The rest of this guide is designed to provide all the information you need when you decide to begin the process of fertility testing.

Table of Contents

Jump to a specific section below.

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Do You Need Fertility Treatment?

According to the Centers for Disease Control, some level of infertility affects one in eight couples. 35% of men and 35% of women are affected by infertility meaning men are just as likely to be infertile as women.

While there are many causes of infertility, about 30% is “unexplained” or “idiopathic.” That label doesn’t mean you can’t be treated. As with any other diagnoses, it leads to decisions about treatment individualized for you, most likely involving intrauterine insemination and in vitro insemination.

The key points to remember are this: You have many fertility treatment options that can increase your chances of having a baby.

Fertility Specialists vs Reproductive Endocrinologists -- Who should you see?

When you decide to pursue fertility treatment options, the first thing you will have to decide is which fertility doctor to see, and at what practice. Often, you will have more than once choice. How do you know who will give you the best chance of a successful pregnancy and healthy baby?

Modern fertility treatments rely significantly on science to determine a cause of infertility and the best way to treat it. That makes the fertility doctors at any practice very important. You want them to have in-depth diagnostic experience, a thirst for new knowledge, and compassion.

A board-certified Reproductive Endocrinologist has received the highest level of training in reproductive medicine. This position requires medical residency and examination in obstetrics and gynecology, followed by another three years of training in reproductive endocrinology and infertility, and additional oral and written examinations. If you are diagnosed with the following conditions, a board-certified Reproductive Endocrinologist is the best option for treatment:

  • Polycystic ovarian syndrome (PCOS)
  • Endometriosis
  • Hypothalamic pituitary dysfunction
  • A congenital adrenal hyperplasia
  • Tubal factor infertility
  • Male factor infertility
  • Diminished ovarian reserve
  • Fertility preservation
  • Congenital uterine anomalies

Don’t be embarrassed to ask questions about your doctor’s background and experience. Any physician can call themselves a fertility specialist. It doesn’t mean they have met the standards to provide the best treatment and guidance.

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Steps to Take When Experiencing Infertility

If you are comfortable trying home options and treatments that are considered non-traditional, you have options. Certain herbs are promoted as useful for fertility. At the same time, many may be harmful and should be avoided. It’s best to consult this list with your doctor before experimenting.

Acupuncture is a safe treatment for many types of pain (remember that if you become pregnant) and according to some studies may enhance fertility. As is often the case with acupuncture, the science behind the treatment hasn’t been settled, and perhaps the experience of relaxing in a calm environment for 30 minutes at a time is as conducive to fertility as the acupuncture itself.

Check for Fertility Treatment Insurance

The company you work for is required to offer “open enrollment” for the insurance plans that cover employees and their families. Open enrollment usually begins on Nov. 1 and ends on Dec. 15, so review your employer’s plan offerings, ask questions, add family members, upgrade your plan or even change medical insurers.

The open enrollment period is usually the only chance to make changes each year (with few exceptions like changing jobs or getting married). Watch company webinars or attend on-site meetings with insurance providers and/or your Benefits Administrator. Ask questions about what the plans offer, obtain and read a copy yourself, and determine specifically what the plan covers for fertility treatments.

Insurance Plans Can Differ from State to State

Connecticut law requires most insurance companies to cover infertility diagnosis and treatment, including up to four cycles of ovulation induction, a maximum of three intrauterine insemination (IUI) cycles, and up to two in vitro fertilization (IVF) treatments. The Connecticut State Mandate requirements do not apply to employees in self-funded insured plans or to employees who work for certain religious groups.

New York requires private health insurance plans to cover the diagnosis and treatment of infertility for patients between the ages of 21 and 44 who have been covered under the policy for at least 12 months. However, several procedures, including IVF, are excluded.

Laws in 13 other states -- Arkansas, California, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, Ohio, Rhode Island, Texas, and West Virginia -- require insurance companies to cover or offer coverage for infertility diagnosis and treatment.

Some companies self-fund their insurance, which means they don’t have to follow state mandates on fertility coverage. You may be able to purchase a rider to the insurance policy that will pay for some or all fertility treatment expenses not covered in your plan, whether it is self-funded or not.

Ask these questions about fertility and infertility

Here are some questions to ask in order to understand the limits of your insurance coverage.

  • Criteria that need to be met before accessing coverage
    • Are there diagnostic or testing requirements? Is IUI required before IVF?
    • Is IUI required before IVF? Will coverage include treatment for ovulation induction? Use of donor eggs or sperm? Surrogacy?
    • What, if any, deductible must be met before reimbursement kicks in?
    • Which state’s laws apply to your employer’s insurance contract? If you work in Connecticut, it may be a New York policy, for example.
    • Make sure you understand how the company defines “unlimited.” It may mean that the treatment is deemed medically necessary, and you may need your medical team to advocate for you.
  • Maximums
    • What is the maximum lifetime amount that will be covered?
    • Are medications included in the lifetime max?
  • Deductibles
    • Is there a pharmacy deductible?
    • What medical services go toward meeting deductibles?
    • How do out-of-network services affect the deductible?

The best thing you can do is to learn how to work with your insurance carrier. The relationship doesn’t need to be adversarial, but patients sometimes need to be persistent before they receive answers that are accurate to their specific situations. Call your insurance representative as often as you need to when you have questions. Don’t forget to check your bills to make sure they are correct.

eBook: Affording Fertility Treatment

Receive our comprehensive reference guide to help answer some of the questions you may have about insurance coverage.

In Connecticut, you can exhaust coverage on a policy, and then switch policies to gain additional coverage. Your new carrier cannot claim a “look back” under previous policies in order to exclude procedures.

If you work for a company that doesn’t offer health insurance, perhaps it’s time to find a family-friendly employer. More firms are realizing the value of supporting the needs of their workers and offer wide coverage at reasonable costs.

When you have health coverage, educate yourself about your rights. In Connecticut, state law requires most insurance companies to cover infertility diagnosis and treatment, including up to four cycles of ovulation induction, a maximum of three intrauterine insemination (IUI) cycles, and up to two in vitro fertilization (IVF) treatments. The Connecticut State Mandate requirements do not apply to employees in self-funded insured plans or to employees who work for certain religious groups.

New York requires private group health insurance plans that are issued or delivered in the state, and that provide coverage for hospital care or surgical and medical care, also must cover the diagnosis and treatment of infertility for patients. They must be between the ages of 21 and 44 and have been covered under the policy for at least 12 months. The New York law excludes certain procedures, including IVF and vasectomy reversal, although a new bill has been introduced that may change the coverage.

Request a Fertility Consultation

Not every fertility clinic offers the same opportunities. At RMA of Connecticut, your first contact will be with a New Patient Liaison, who will schedule an appointment. Soon you will be meeting with your Patient care team, which includes a board-certified Reproductive Endocrinologist.

Budget for about an hour, give or take 15 minutes, for your initial fertility consult. When you arrive, you will be checked in and asked for some information about your referring OB/GYN. Next, you’ll meet a clinical assistant who will take your vitals – height, weight and the date of your last period.

Then you’ll meet with your reproductive endocrinologist, who will ask you about your history and your partner’s history and learn how long you’ve been trying. Your doctor will discuss which exams to schedule. It will probably be a mix of tests to look for hormonal and physical abnormalities. These tests will be scheduled for both the woman and the man because 40 percent of the time, the male will show signs of infertility.

Don’t forget to bring:

  • Medical records
  • Previous test results
  • Family history
  • Insurance information
  • A list of questions. Here are suggestions

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Fertility Testing for Women

Much of the initial testing for women involves examinations of hormone levels. Blood tests, such as AMH (anti mulerian hormone) can easily detect a hormone imbalance that prevents a pregnancy from occurring or continuing.

Day 3

A test conducted on Day 3 of your period can also establish the quantity and quality of eggs (ovum).

A woman’s menstrual cycle is measured from the first day of her period (blood flow, not spotting), so Cycle Day 3 is the third day of her period. When a woman is undergoing a fertility workup, Cycle Day 3 is the day she has blood work performed to check the levels of three important levels: follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2).

FSH is secreted by the pituitary gland. It stimulates the production of estradiol (estrogen) and eggs (oocytes) during the first half of the menstrual cycle. The eggs begin to grow in their individual fluid sacs, or follicles, which is the first step in the ovulation process. High levels of FSH are an indication of poor ovarian reserves; in other words, the quality and quantity of eggs is low. This does not necessarily mean that pregnancy is impossible, but it may be more difficult to achieve.

These three hormones can all be checked with a simple performed on Cycle Day 3. Normal value ranges for the FSH, LH and E2 tests may vary among different laboratories, so it's important to get an accurate interpretation of the results from your fertility specialist.

Day 21

A check of progesterone levels, a hormone that indicates whether ovulation has occurred, is done on or near Day 21 to confirm that ovulation has occurred. A low Day 21 progesterone level suggests the cycle was anovulatory (no egg was produced). The timing of ovulation and the associated peak in progesterone is related to the subsequent menstrual period, not the preceding one. In an average cycle of 28 days, the time between ovulation and the next period is about two weeks, so progesterone is measured about seven days before the expected period, or on Day 21. However, if a woman’s cycle is longer or shorter than 28 days, the testing day will be adjusted accordingly. For example, a woman with a 35-day cycle would be tested for progesterone on Day 28.

When hormone testing is concluded and analyzed, physical testing might begin, including:

Fertility Treatment Cost

When you decide to proceed with fertility treatment, the next step to consider is often how to pay for it. You may not realize it, but you have several options, and RMA of Connecticut will help you find the plans that work best for you.

In addition to insurance offered through your employer, individual insurance may be affordable. You might apply for the many available grants or take advantage of savings accounts that give tax advantages while you put money away to pay for treatment.

Babies are expensive, no matter what path you follow. But they are not unaffordable when you work with a team that shares your dream.

Grants to Ease Infertility Costs

Even when you have insurance coverage, infertility treatment can strain your family’s budget. Many states, including Connecticut and New York, offer grants that -- while limited in amount and available only in certain circumstances -- could help lessen the financial strain of treatment.

In Connecticut, the Nest Egg Foundation, (a cooperative, Connecticut-based tax exempt 501(c)(3) not-for-profit), provides grants of up to $10,000 for patients affected by primary infertility who are undergoing in vitro fertilization (IVF). Patients must prove hardship and seek treatment at designated centers, including RMA of Connecticut. The Nest Egg grant will cover only IVF and other restrictions apply regarding U.S. citizenship, income, and written diagnoses.

In New York, the state earmarks nearly $1 million annually for residents who earn less than $195,000 per year and who are good candidates for IVF. Between all fertility programs, they perform more than 100 IVF cycles annually and achieve at least a 30% success rate. The fertility clinics select the patients who will get the grants based on the criteria set by the state.

Several agencies offer fertility grants that are not state-specific. This list was compiled by FertilityIQ, a crowd-sourced fertility services website.

Financing offered through RMA of Connecticut

RMA of Connecticut wants to make it possible for any couple or individual to receive the fertility treatments that they need, no matter what their financial status. We work to eliminate obstacles, allowing patients to budget wisely, avoid cash flow problems and hold on to your savings or investments. There are no pre-payment penalties, hidden fees, or down payment requirements. And payment plans are individually tailored with low fixed or variable interest rates.

At your first visit to an RMA of Connecticut office, an Insurance & Billing Advocate will review your treatment plan and explain the various options to make family building affordable, even without employer insurance.

Core Values

Here are programs offered at RMA of CT:

  • For patients who do not have coverage for an initial consultation or diagnostic cycle, RMA of Connecticut offers the Fertility Consultation Opportunity Plan – a review of your full medical history, previous records review, and a discussion about the next steps to take towards your family building goals – and the Fertility Work-up Opportunity Plan, which allows patients to pay a flat fee for diagnostic testing to determine their individualized treatment plan.
  • Another option for patients without fertility-friendly insurance coverage is IUI Opportunity Plan program, which covers oral and injectable medications and the IVF Opportunity Plan, which includes medication and IVF Opportunity Plan with PGS, which includes embryo screening. Both plans offer access to high-quality care that otherwise might not be affordable.
  • The Essential IUI Plan is a less aggressive approach for infertility treatment and is used to increase the chances of conceiving.

If you are not ready to start a family immediately, the Egg Freezing Opportunity Plan allows you to plan for the future without letting financial concerns get in the way.

We work with a third party lending company, The Lending Club, to offer loans and lines of credit offering a variety of terms to fit your financial profile.

Government rules also allow people to save money, in many cases with taxes deferred, to pay for health costs, including infertility treatment.

Core Values

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Fertility Testing For Men

Men particularly can feel isolated as they don’t often speak to their friends about their infertility experiences. They also typically concentrate on how the women in their lives are managing fertility treatment and ignore their own feelings or struggles.

There are many reasons why couples have trouble achieving pregnancy. Male infertility accounts for up to 40% of the difficulties. Male fertility hinges on having healthy sperm, so semen analysis is the most important test for the male half of a couple that is experiencing fertility issues. It is an inexpensive test that should be done early in any infertility evaluation.

A semen analysis is one of the tests your doctor will use to evaluate your problem. Your test results will tell your doctor the number of sperm in your semen (your sperm count), whether they are normal (morphology), and how well they swim (motility). A low sperm count may be caused by certain medications or a medical problem such as a blocked duct, low testosterone level, or a condition in which sperm back up into the bladder. Fever can also reduce sperm count. Some men may have enough sperm, but their sperm may not swim well enough to reach the egg. Also, sperm that are not normal in shape may not be able to penetrate and fertilize the egg. Your doctor can treat many of these problems.

Semen Collection

Your doctor will want you to provide a semen sample. The sample is collected by masturbation at your doctor’s office in a private, comfortable room. You will be asked to collect your semen in a sterile specimen cup. Another option is to collect your semen at home. You must deliver your sample to the doctor’s office within 45 to 60 minutes after collecting it. Speak with your doctor about instructions for transporting the sample to the office. Theoretically, it only takes one sperm to fertilize an egg, but the odds of one sperm reaching the egg are very low. Consequently, a low sperm count reduces a man’s chances of fathering a child. A urologist can suggest medical or surgical treatments to increase those odds, and men are advised to avoid smoking, excessive drinking and illegal drugs, maintain a healthy weight, and stay out of sources of excessive heat (like tubs and saunas) that can temporarily reduce sperm count.

How long must I abstain from sex before the analysis?

You should abstain from sex for at least two to five days before the analysis, but not longer than one week. Check with your doctor to see if there are any other recommendations specific to you.

How long does it take to get the results?

The test results are generally available within a 7-10 days.

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Your Infertility Diagnosis: What You Should Expect

After the infertility testing is done, your doctor will discuss the results with you and explain treatment. Often the most frustrating diagnosis is “unexplained.” As explained at Resolve.org, “some diseases and medical conditions defy explanation. They just happen. The term ‘unexplained infertility’ really reflects the present limitations of medical science. The fact is that current technology does not have the tools for revealing the cause of your infertility.”

Even with the frustrating diagnosis, you will have options. Your doctor will prescribe individualized treatment for you and your situation.

More Diagnoses For Women

Endometriosis

During menstruation, while most of the blood and tissue flows out of the vagina, a small amount of blood and tissue travels up backwards through the uterus and fallopian tubes and into the pelvic cavity. In most women, the immune system gets rid of that blood and tissue. By contrast, the immune system of women with endometriosis is unable to fully eliminate the backflow. Endometriosis creates scars that physically block the sperm from meeting the egg, and also causes inflammation that impairs embryo implantation. Patients with moderate to severe endometriosis have more lesions and scar tissue than women with minimal or mild disease.

PCOS

Polycystic ovary syndrome, also known as PCOS, is a common hormone disorder that affects 5-10% of all women in their reproductive years. PCOS accounts for nearly one-third of all infertility diagnoses and is very common among women with ovulatory disorders. PCOS is one of the most under diagnosed diseases in the United States and surprisingly, most women who have it do not even know it. The truth is that most women are never officially diagnosed with PCOS until they start attempting to get pregnant.

Multiple Miscarriages

While many women can get pregnant, they often struggle through multiple miscarriages. Studies suggest that 50% to 70% of all miscarriages are due to embryos with too few or too many chromosomes.  Chromosomal testing can address that diagnosis.

Leuthal Phase Defect

The luteal phase begins during the second half of a menstrual cycle, usually lasting around 12 to 14 days after ovulation. During the luteal phase, production of hormone secretions such as progesterone and estrogen begin to increase and help to prepare the uterine lining for a possible fertilized egg. If there is no presence of a fertilized egg or the hormones levels are not optimal, then the menstrual cycle begins.

Poor Responder

For some women, their ovaries and body does not respond to fertility medications. Usually they will require much higher doses of stimulation medications to produce 4 or less than optimal number of eggs needed to proceed in an IVF treatment.

Uterine Factors

Abnormalities of the uterus result in a diagnosis of uterine factor infertility. Some women have an abnormally developed uterus from birth while others may develop a uterine problem from surgery or a past infection. Many different problems that involve the uterus contribute to infertility and recurrent miscarriage including uterine fibroids, congenital abnormalities, Asherman’s syndrome, adenomyosis, and DES.

More Diagnoses For Men

LOW SPERM COUNT

A low sperm count is fewer than 20 million sperm per milliliter ejaculated.  The normal range is between 40 million and 300 million sperm per milliliter ejaculated. Low sperm count is also called oligospermia.

LOW MOTILITY

Motility describes the movement of the sperm.  Low motility may reduce the changes of the sperm reaching and fertilizing the egg, especially if your sperm count is also low.  In a normal semen sample, approximately half of the sperm have appropriate movement.

ABNORMAL MORPHOLOGY

A normal sperm has an oval head, slender midsection, and a tail that moves in a wave-like motion. Sperm that do not have all these may not be able to swim effectively or penetrate the egg. Both morphology and motility are factors in male infertility because they impair the sperm’s ability to reach and fertilize an egg.

Your Fertility Treatment Options

In vitro fertilization (IVF) is the process of fertilizing an egg with sperm outside the body and is the procedure that most people associate with fertility treatment.

IVF has been demonstrated to be a highly effective option for addressing infertility, with more than 200,000 IVF cycles performed by U.S. fertility clinics alone in 2015.

During the in vitro fertilization (IVF) process, eggs are removed from the woman’s body and combined with sperm in the laboratory to create embryos, which several days later are then transferred into the woman’s uterus. Nearly 60% of IVF procedures in the United States are performed on women 35 and older.

Before undergoing an IVF cycle, you will be prescribed several medications to stimulate the development of multiple ovarian follicles containing eggs to be fertilized. The process is closely monitored using blood tests and ultrasound. Once the eggs have matured, they are retrieved through a simple procedure under ultrasound guidance. The retrieved eggs are exposed to sperm and one – or no more than two  of the resulting embryos are transferred back into the uterus.

Intrauterine insemination (IUI) is a type of artificial insemination in which sperm are injected directly into your uterine cavity near the time you ovulate.

Your doctor may recommend IUI to treat many causes of infertility, especially when there is a diagnosis of unexplained infertility, low sperm count or low motility. IUI therapy decreases the distance the sperm needs to travel and increasing the chance of sperm reaching the egg to achieve fertilization.

Sometimes surgery is required to address a physical issue. A doctor performs a hysteroscopy to look at the lining of your uterus with a viewing tool called a hysteroscope. The procedure is performed to find the cause of abnormal bleeding, to remove uterine growths like polyps and small fibroids, and to examine the uterus to see if there’s a problem with its shape or size that’s preventing you from becoming pregnant or causing repeated miscarriages.

Laparoscopic surgery is a minimally invasive diagnostic and therapeutic procedure that uses a telescopic camera system to visualize abdominal and reproductive organs (uterus, fallopian tubes, and ovaries). The surgeon makes tiny incisions in the abdomen through which a thin, fiber-optic tube fitted with a light and camera is inserted. Suspicious growths can be biopsied and repairs can be made during a laparoscopy, making more invasive surgery unnecessary.

Planning Your Infertility Testing

Fertility treatment requires planning, patience and lots of time – much of it in the clinic office. RMA of Connecticut has four offices in Connecticut (Norwalk, Stamford, Trumbull, and Danbury) and one in New York (Poughkeepsie). When you search for “fertility clinic near me,” you will find a location that best suits you and your convenience. You can choose the one nearest you for every visit, or mix and match based on your schedule.

We do our testing in our own accredited labs in our offices so that you don’t have to travel to a bunch of different offices for testing. Other fertility clinics cut costs by farming out testing so that patients travel to many unfamiliar sites to complete their work-ups.

They also may limit access to doctors and hide the true cost of their plans, neglecting to mention the medications that are needed in most treatments.

At RMA of Connecticut, your personal support team of nurses, physician assistants and others are accessible 24/7. We tell you about all your fertility treatment costs and provide financial experts to help you navigate the expense.

As you consider all the information available to you about fertility rates, board certification, accessibility, and support, we know that your No. 1 consideration is to bring home a baby. That’s our No. 1 goal, too.

We’re proud to say that over the past 15 years, RMA of Connecticut has helped parents conceive and bring into the world more than 7,000 babies. That’s more than one a day.

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