FAQs for Kofinas Fertility Group in New York

Most experts define infertility as not being able to get pregnant after 1 year of trying — or not being able to get pregnant after 6 months of trying if you are 35 or older. Women who are able to get pregnant, but are unable to stay pregnant because of repeated miscarriages, may also be considered infertile. About 10 percent of women ages 14 to 44 in the United States have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control.

If you are unable to become pregnant or have experienced multiple miscarriages, the Kofinas Fertility Group can help. A consultation and fertility workup can provide answers and help you and your doctor establish a fertility treatment plan.

In about one-third of cases, infertility is due to the woman (female factors), and in another third infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.

Getting pregnant is a complicated process. To get pregnant,

a) A woman must release an egg from one of her ovaries (ovulation).
b) The egg must go through the fallopian tube toward the uterus (womb).
c) A man’s sperm must fertilize the egg along the way.
d) The fertilized egg must attach to the inside of the uterus (implantation).

Problems that interfere with any of these steps can result in infertility.

In women, problems with ovulation account for most cases of infertility. Other causes include blocked fallopian tubes, physical problems with the uterus and uterine fibroids.

In men, infertility is most often caused by problems with sperm count (producing too few sperm or none at all) or problems with the sperm’s ability to reach the egg and fertilize it.

One of our fertility specialists, also known as reproductive endocrinologists, will do an infertility workup, which includes a medical history review and physical examination. The doctor will then run blood tests to determine if you are ovulating with adequate progesterone stimulation of the uterine lining. As part of your blood work, we do hormone testing to check for endocrine problems. The fertility workup at the Kofinas Fertility Group typically includes an ultrasound procedure called a hysterosonogram, which allows our physicians to see inside the uterus in order to accurately diagnose for polyps, fibroids or adhesions. We may also conduct a hysterosalpingogram — an X-ray test that we use to look inside the uterus and fallopian tubes, as well as the surrounding area — to find problems such as blocked fallopian tubes or an abnormally shaped uterus. Your doctor may also perform an endometrial biopsy, which involves taking a small sample of the endometrium and checking it under a microscope for problems or hormone levels that are out of balance and can affect the endometrium.

To check for male fertility problems, the reproductive endocrinologist may do a semen analysis with a post-coital test, which checks a woman’s cervical mucus to see whether sperm are present and moving normally after intercourse.

How do you treat infertility?

There are many ways that we can treat infertility. Depending on your specific problem, we may treat you with medication, surgery, artificial insemination or assisted reproductive technology. Doctors recommend treatment based on:

• Test results
• How long the couple has been trying to get pregnant
• The age of both the man and the woman
• The overall health of the partners
• Preference of both partners

We use various fertility medications to treat women with ovulation problems. Often called stimulation medications, these treatments are designed to cause or regulate ovulation. Additionally, there are other medications we use with other assisted reproductive technologies that help with implanting the embryo.

In many situations, we can treat the condition causing your infertility with surgery. For example, we use surgery to look for and sometimes remove fibroids, adhesions or cysts in the uterus or fallopian tubes, or on the ovaries. We can also correct other abnormalities, such as a uterine septum. Surgical options include hysteroscopy, laparoscopy and microsurgery.

Our specialists commonly use artificial insemination, also known as intrauterine insemination (IUI), to treat mild male infertility, women who have problems with their cervical mucus, or couples with unexplained infertility. In this procedure, we inject specially prepared sperm directly into the uterus, and sometimes we’ll also give you medications to stimulate ovulation before IUI.

Assisted Reproductive Technology (ART) is a term that describes several different methods used to help infertile couples. Basically, ART involves removing eggs from a woman’s body, mixing them with sperm in a laboratory, and putting the embryos back into a woman’s body. In vitro fertilization (IVF) is the most commonly known form of ART.

There are several different methods of ART. In vitro fertilization is the most common and considered the most effective.

• In vitro fertilization (IVF) means fertilization outside the body. Our doctors treat you with a drug that causes your ovaries to produce multiple eggs, and once they’re mature, your eggs are removed. We then put them in a dish in the lab along with the man’s sperm for fertilization. After three to five days, healthy embryos are implanted in your uterus.
• With zygote intrafallopian transfer (ZIFT), also known as tubal embryo transfer, we also fertilize your eggs in the laboratory, and then transfer the embryo into the fallopian tube instead of the uterus.
• Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into a woman’s fallopian tube. Fertilization occurs in the woman’s body rather than in the laboratory.
• Intracytoplasmic sperm injection (ICSI) may be used for couples in whom there are serious problems with the sperm, for older couples, or for those with failed IVF attempts. In ICSI, we inject a single sperm into a mature egg and then transfer the embryo into your uterus or fallopian tube.
• ART can involve the use of donor eggs, donor sperm or previously frozen embryos.

Fertility assessments and therapies can be expensive and therefore require careful consideration and thorough understanding of the treatment options, costs involved, insurance coverage and out-of-pocket expenses. Insurance coverage can range from nonexistent to comprehensive. Each insurance company offers many different plans, and each plan has different policies regarding infertility coverage. The Kofinas Fertility Group’s team contacts your insurance carrier with a list of questions to obtain information regarding the extent of your coverage for fertility; however, this “verification” of benefits does not guarantee payment.

Over the years, the Kofinas Fertility Group has developed several efficiencies with the advantage of using state-of-the-art equipment and facilities in order to provide superb care at an affordable cost. We also offer several financial programs for patients who seek treatment and do not have insurance coverage.

Laparoscopy is considered the gold standard of the infertility evaluation procedures, and no infertility evaluation is complete until a laparoscopy is performed. Your fertility doctor will use a thin, lighted tube called a laparoscope to examine the outside of your uterus, ovaries and fallopian tubes. A laparoscopy examination takes about 30 to 90 minutes, but it can take longer if your doctor finds something that can be corrected at the same time. The exam determines if you have scar tissue or blockages in your fallopian tubes that could be causing fertility problems. This procedure also allows your doctor to find and treat conditions such as endometriosis or pelvic inflammatory disease (PID).

A hysteroscopy is a way for your fertility doctor to look at the lining of your uterus (endometrium). Your doctor will use a thin, lighted viewing device, called a hysteroscope, to see inside your uterus. Hysteroscopy exams are performed in the operating room, with anesthesia. The procedure takes about 10 minutes, but it could take longer if your doctor finds something that can be corrected during the procedure. We perform a hysteroscopy to see if your fertility problems are due to scar tissue or an abnormally shaped uterus caused by fibroids, congenital anomalies or polyps. It may also determine the cause of repeated miscarriages.

Endometriosis is a condition in which tissue from the inner lining of the uterus (the endometrium) grows outside of the uterus and in other parts of the body, such as the ovaries or fallopian tubes. These misplaced tissues behave like normal endometrial tissue and build up each month, break down and cause bleeding. However, unlike the lining of the uterus, the blood from these growths has no way to leave the body. This internal bleeding inflames the surrounding areas and forms scar tissue, which can make it hard to get pregnant.

We diagnose endometriosis through a laparoscopy exam. A number of treatment options for endometriosis exist, including pharmaceutical treatments that put a woman into chemical menopause, which stops ovulation. We can also perform a hysterectomy. However, if you wish to restore fertility, conservative surgery is the method we use to repair the problem and correct any distorted anatomy.

For conservative surgery, we use minimally invasive laparoscopy or laparotomy (conventional “open” surgery through normal incision) to remove endometrial tissue without removing any normal tissue or reproductive organs. The most common surgical procedures we perform with the laparoscope are removing pelvic adhesions that surround the ovaries, fallopian tubes and uterus, as well as the surgical removal of endometrial implants (endometrial tissue that has grown outside the uterus) and ovarian endometriomas (cysts consisting of endometrial material found within the ovaries).

A fibroid uterus is when a woman has uterine fibroids, which are noncancerous growths of the uterus that often appear during childbearing years. These growths are also called fibromyomas, leiomyomas or myomas. Fibroids are not associated with an increased risk of uterine cancer and almost never develop into cancer. Women with uterine fibroids may experience symptoms such as heavy menstrual bleeding, pelvic pressure or pain, and frequent urination. Fibroids can range in size from undetectable by the human eye to large, bulky masses. Bigger fibroids can distort and enlarge the uterus and fallopian tubes, interfere with the passage of sperm from your cervix to your fallopian tubes, or prevent the implantation and growth of an embryo.

If you wish to eliminate your fibroids but not become infertile, your fertility doctors will recommend having a surgical treatment called a myomectomy. A myomectomy is most commonly performed through an abdominal incision, allowing your fertility doctor to remove large or multiple fibroids and reconstruct a strong uterine muscle. However, depending on the size and location of the fibroids, myomectomies may also be done with minimally invasive techniques, including using a hysteroscope inserted through the vagina and cervix, or by using a laparoscope threaded through small abdominal incisions. These minimally invasive procedures produce excellent outcomes with less pain, shorter recovery times, fewer risks and no large visible scars.