You might be surprised to learn quite how common infertility issues are. According to the Centers for Disease Control and Prevention (CDC), 12% of Americans, or 7.3 million people are infertile. In England one in seven couples have difficulty conceiving, so if you are having problems, then know you are not alone.
Where to Start
The timings for when to see a fertility specialist depend largely on your age and how long you’ve been trying to conceive naturally. It is generally recommended that you see someone right away if:
You’re under 35 and have been trying to conceive for 12 months or more
You’re between 35 and 40 and have been trying to conceive for six months or more
You’re 40 or over
You already know you have fertility issues because you’ve had your tubes tied or you don’t get your period
One thing that is important to talk about is the emotional rollercoaster that couples go through when dealing with infertility. The hormones, poking, prodding, waiting and devastating disappointment (if it fails) can test even the most resilient and glass-half-full kind of person. There is also the cost to discuss: fertility treatment is often not covered by insurance and it can be very expensive. An initial round of IVF in the US can cost at least US$15,000, possibly more depending on the clinic, where it’s located, and the difficulties in the way. Then you have flights and hotel costs on top of that, not to mention time off work. The Cayman Fertility Centre offers all levels of fertility testing and treatments. This is a good alternative to going abroad, as local IVF starts at US$6,700 and you do not need to travel or take as much time off work.
Success cannot be guaranteed however, and many couples need to be prepared to have more than one round of IVF before they consider other options. A couple who can be honest with each other and are prepared to discuss all the possible outcomes have the best chance of getting through it.
Your OB/GYN or fertility doctor will want to try and establish why you are not getting pregnant. In your initial consultation they will discuss testing options (physical exam, blood tests, sperm analysis and then imagining tests) and your doctor will work out a plan with your agreement on which tests to do. They will need to test both you and your partner and often couples go to the initial visit together. According to the American Society of Reproductive Medicine, of the known causes of infertility, roughly one-third of infertility problems are male-related, half are female-related and the rest are often unexplained.
Female fertility testing often begins with a medical examination, an ultrasound and a series of blood tests. A basic gynaecological exam and an ultrasound are done to rule out polycystic ovaries, ovarian cysts, fibroids or uterine polyps, among other things. Blood tests such as anti-müllerian hormone (AMH) can tell you how many eggs you have, and other tests are done to make sure you are in good health to carry a pregnancy. Another step is to check if the fallopian tubes are open or blocked. There are two tests that can show this: the Hysterosalpingography or Sonohysterosalpingography test and, if the results are abnormal, this may be treated with IVF or laparoscopy. In the latter case, a small incision is made through the belly button and in two other places to examine the abdomen. This test is useful for ruling out endometriosis, if the tubes are blocked, and if there are adhesions (scarring in a wrong place) or fibroids etc.
Male fertility tests start with a simple semen analysis. Usually this is all that is needed to diagnose or rule out male infertility, however, further tests might include a general physical exam by a Urologist and blood work to check hormone levels. Both partners will also have STD tests.
Other fertility tests involve both partners and might include genetic tests to look for inherited disorders, especially if recurrent miscarriages are the problem.
Fertility Tests & Insurance
Insurance companies are fairly clear on the fact that they consider fertility testing and fertility treatments as ‘off plan’ and they do not cover them. What they are less clear about, and something you must talk to your OB/GYN about, is the possibility that health insurance companies may limit substantially the cover to the resulting pregnancy and birth if that pregnancy has come about via fertility treatment.
Some may cover a very small portion of infertility investigation but then significantly limit the cover to any resulting pregnancy.
Ovarian Stimulation and Insemination
OB/GYNs talk of the ‘first tier’ of fertility treatments being ovarian stimulation and insemination. This usually involves you taking either oral or injectable medicines to stimulate the follicles of your ovaries to release eggs. This process needs to be monitored carefully with both vaginal ultrasounds and blood tests.The timing of ovulation or release of the egg can be controlled using an injection hormone. At this point the doctor will ask the male partner for his sperm, which will then be ‘washed and concentrated’ and inserted via a very thin tube directly inside the uterus; a technique called ‘Intrauterine Insemination’ (IUI). This procedure, which is similar to a pap smear, should not be too uncomfortable. It takes about five minutes and you can return to regular activity afterwards. The ‘two week wait’ for the results of your pregnancy test is the hardest part.
Ovarian stimulation and IUI is routinely conducted in the Cayman Islands and, for many people, may be a good option that is not too expensive.
In-Vitro Fertilisation (IVF)
IVF is the next option if IUI did not work (or a first option for some people). Reasons to go straight to IVF include severe cases of male infertility, poor ovarian reserve, blocked fallopian tubes, an egg donor is being used, or a surrogate is needed, amongst other things.
Once you have decided to consider IVF, finding the right clinic for you may require some research. Cayman Fertility Centre is a full spectrum clinic providing the latest IVF technology and is the only local practice that offers IVF. A few other Caribbean countries have IVF centres, including Barbados. The US and UK also have numerous options.
The cost of IVF varies significantly depending on the country and the clinic. You can pay as little as US$6,750 at clinics in Cayman, Barbados and Jamaica, whereas treatment in America starts at around US$15,000 and can go up to US$50,000+ for top clinics in larger cities.
The 5 major steps of IVF:
egg retrieval and sperm collection
fertilisation and embryo culture
hormonal support of the pregnancy and pregnancy test
Guidelines of the step-by-step process of IVF can be found online or you can talk to your OB/GYN. You may also want to consider the additional step of Preimplantation Genetic Testing (PGT, formerly called PGS). This is where the DNA of an embryo is screened for abnormal chromosomes. Embryos with abnormal chromosomes often end up in a failed treatment cycle, or a miscarriage, or the child may have a condition such as Down Syndrome.
Visit the following websites for more information on IVF:
Further Fertility Treatment
If neither of these options are possible, there are some alternative routes available:
Egg Donation with IVF: If a woman is unable to use her own eggs for IVF, finding an egg donor can be an effective solution. Selecting an egg donor is an emotional and difficult process so should only be undertaken with professional guidance and support.
Egg Freezing: Women who might want to have children sometime in the future, or women who need treatment for cancer, for example, can freeze their eggs for later use. The cost of egg freezing starts around US$4,950 in both Cayman and the US. Those who freeze their eggs will need IVF when they eventually want to use them.
Gestational Surrogacy: This is when a surrogate carries a baby she is not biologically related to – so the sperm and eggs come from the intended parents or an egg donor. This differs from “traditional surrogacy”, which is no longer common practice, where the baby being carried is genetically derived from the eggs of the pregnant woman and the sperm of the male intended parent. If you go down the gestational surrogacy route, you will need to go through a surrogacy agency who will manage the matching and screening, offer counselling and give legal advice. They will also refer you to a surrogacy attorney. The legal process around surrogacy is complicated and can be expensive. It also differs by country and state, so you will need to take professional advice before going down this route. The cost of surrogacy can accumulate and often exceed US$100k.
Fertility treatment can be draining – both emotionally and financially. It’s important to speak with a fertility specialist to get accurate information about the process, cost and success rates of different options before you get started. If you are struggling with the emotional aspect of infertility, please contact a counsellor.