Fertility questions, answered.

Infertility is the inability to conceive after one year of regular unprotected intercourse. Unprotected means without birth control pills, condoms or other contraception, whether or not you were trying to get pregnant. For women older than 35, testing should start after six months, because infertility and low egg reserve become more common with age.

• Absent or infrequent ovulation (fewer than 12 to 13 times a year)
• Blocked fallopian tubes
• Low egg number and quality

Read more about female factor infertility.

• A lower sperm count, or reduced sperm movement or shape. In its most advanced form, no sperm appear in the ejaculate (azospermia), because of reduced sperm production or a blockage.
• Difficulty depositing sperm in the vagina, for example because of erectile dysfunction

Read more about male factor infertility.

Age is the most important factor affecting fertility. As women age, both the number and the quality of their eggs decline. The number of eggs in the ovaries falls steadily from about 300,000 at puberty to about 1,000 at menopause. By age 35, a woman has about half the eggs she had at 25, which is why it’s important to seek a consultation early.

Egg quality also declines with age. The most important aspect of egg quality is having the right number of chromosomes. Abnormal eggs carry an extra or missing chromosome, or piece of a chromosome, and for reasons that aren’t fully understood, abnormal eggs become more common with age.

Fewer good-quality eggs lowers the chance of natural conception, lengthens the time it takes to get pregnant, and raises the risk of miscarriage, ectopic pregnancy and abnormal pregnancy outcomes. Fertility treatment, including IVF, is also less successful with age, and the risk of miscarriage after IVF rises. Egg freezing is less successful when done later in life, after about 38 to 40.

Seek an evaluation after one year of regular unprotected intercourse without pregnancy, or after six months if you’re 35 or older. You should also come in sooner if:

• You have a possible fertility issue, such as irregular or absent periods (a sign you may not be ovulating), prior pelvic surgery or endometriosis
• Your partner has an abnormal sperm analysis
• You carry a genetic condition you want to avoid passing on, such as a chromosomal abnormality, sickle cell disease or a BRCA mutation
• You want to extend your fertility by freezing eggs or embryos
• You or your partner are at risk of infertility because of a disease or its treatment, such as breast cancer or lupus
• You’re in a same-sex couple
• You have a medical condition that prevents you from carrying a pregnancy
• You’ve had two or more miscarriages

There’s no harm in an early consultation, but a delayed one can lower the chance that treatment will work if you need it. Read more about your first consultation.

• Ovarian reserve: FSH, LH and estradiol on day 2 or 3 of your cycle, and anti-Müllerian hormone (AMH)
• Fallopian tubes: a hysterosalpingogram (HSG)
• Male factor: a sperm analysis
• Preconception labs for both partners to confirm it’s safe to get pregnant, including genetic screening, infectious disease testing, screening for diabetes, thyroid and prolactin disorders, blood count and type, and immunity to rubella and chickenpox
• Uterine cavity: a saline sonogram if an abnormality is suspected
• Additional tests when needed, such as an MRI of the uterus if a congenital abnormality is suspected, imaging of the pituitary gland if a pituitary tumor is suspected, or screening or sequencing of a specific gene, such as BRCA1 and BRCA2, when there’s a strong family history

Recurrent pregnancy loss is one of the hardest experiences in fertility care, and it calls for extensive support and counseling. We start by asking you to use birth control and not try to conceive until your workup is complete. We test both partners’ chromosomes, antiphospholipid antibodies and clotting (thrombophilia), and we check the shape of the uterus and rule out problems in its cavity. We don’t order tests or recommend treatments that have no proven link to recurrent miscarriage.

When testing is complete, we meet with you to discuss your results, how to address any abnormality, and your chance of delivering a healthy baby.

• Women with a specific abnormality, such as a clotting disorder, are treated with aspirin and heparin.
• Women with abnormalities of the uterus need surgical correction, usually through hysteroscopy rather than major surgery.
• When either partner carries a chromosomal abnormality, such as a translocation, we offer IVF with genetic testing of the embryos (PGT) and transfer of normal embryos.

For women with no abnormalities found, there is a 70% chance of delivering a baby if they keep trying, whether through intercourse, IUI or IVF. Read more about genetics and PGT.

Your chance of success depends mainly on your age, your ovarian reserve and your diagnosis. The right treatment also depends on other factors, such as your risk of a multiple pregnancy. Dr. Elassar will talk through your personal chances at your consultation. You can also review our SART-reported success rates.

Treatment depends on the results of the initial evaluation.

• Men with 10 million or more moving sperm in the ejaculate can try ovarian stimulation with IUI.
• Men with fewer sperm, or with several sperm abnormalities in count, movement or shape, should consider IVF, sometimes with ICSI, where a single sperm is injected into each egg.
• Men with no sperm in the ejaculate (azospermia) should be evaluated for surgical sperm retrieval from the testes.
• Men with erectile dysfunction can be helped with medical treatment or vibratory devices, and the sperm can be used for IUI or IVF.

Men with severe male factor infertility are at higher risk of genetic abnormalities, which should be considered before treatment. Once a few normal sperm are available, the chance of pregnancy depends largely on the female partner’s ovarian reserve, so it’s important to evaluate both partners before any procedure.

There’s no strong evidence that varicocele repair or medication improves the chance of pregnancy for partners of men with male factor infertility. Read more about treatment for male factor infertility.

Sometimes women don’t conceive after several IVF attempts. We start by carefully reviewing your past treatment, including your stimulation protocol, daily ultrasounds and hormone levels, the quality of your eggs and embryos, and any difficulty with embryo transfer. Additional tests may include chromosome analysis of both partners, a saline sonogram, an endometrial biopsy for receptivity (ERA) and inflammation, and a review of ultrasounds and HSG for a dilated fallopian tube (hydrosalpinx), which should be removed before treatment. We address anything we find before starting further treatment.

Depending on your situation, we may:

• Change the stimulation protocol for women with low ovarian reserve or older reproductive age, for example by lowering the dose, pretreating with estradiol and an antagonist in the cycle before stimulation, adding clomid or letrozole, or changing the timing of the hCG trigger
• Test embryos genetically for women who produce many eggs and embryos but don’t get pregnant, or when either partner has an abnormal chromosome arrangement, so chromosomally normal embryos can be selected
• Use a milder protocol for women with high ovarian reserve who produce many eggs but don’t conceive after transferring good-quality embryos. Fewer eggs with better maturity can improve embryo quality.

Read more about prior unsuccessful fertility treatment.

There are many steps you can take, but the most important is an early consultation with a qualified reproductive endocrinologist. It lets us study your fertility factors, especially your ovarian reserve, and point you to the plan most likely to work.

Encourage your partner to get care and advice from a urologist and a reproductive endocrinologist. Remind your partner that no one person is ever the only factor: fertility almost always involves several factors working together.

The only proven long-term risk of fertility treatment is multiple pregnancy. It should be avoided at every step, through careful stimulation and by limiting the number of embryos that reach the uterus. Multiple pregnancy increases the risk of premature delivery, which can mean newborn intensive care and long-term health problems for the children. If a multiple pregnancy happens, fetal reduction should be discussed.

There’s no evidence that fertility treatment itself increases the risk of any cancer or of birth defects.

ART is fertility treatment that involves retrieving eggs. In IVF, its most common form, eggs are retrieved and fertilized in the laboratory, and the resulting embryos are transferred to the uterus.

In a natural cycle, the ovaries usually develop one follicle containing a single egg. Ovarian stimulation uses oral or injectable medication, with monitoring and dose adjustments, to develop more than one follicle and egg. For IUI, the goal is a small number of eggs, about one to three, to limit the risk of multiples. For IVF, the goal is more eggs, because not every egg is mature, not every egg fertilizes and not every embryo keeps growing. The aim is to transfer one or more good-quality embryos and freeze the rest for later.

Ovulation induction is the first treatment for women who don’t ovulate on their own, such as women with PCOS or hypothalamic amenorrhea. These women have eggs in their ovaries but can’t bring them to maturity. Medication, either oral (clomid or letrozole) or injectable, helps an egg mature and release. The aim is one or two eggs, to limit the risk of multiples. Before this treatment, the fallopian tubes should be open and the sperm analysis normal. Weight loss improves ovulation for some women.

For intrauterine insemination, sperm is usually collected by masturbation and prepared in the lab to concentrate the sperm, improve their movement and remove fluid. The prepared sperm is placed in the uterus through a thin catheter, which bypasses obstacles in the cervix such as thick cervical mucus. Read more about simple fertility solutions.

In intracytoplasmic sperm injection, a single sperm is picked up with a very thin needle, which is passed through the outer shell of the egg to release the sperm inside. ICSI is used for male factor infertility, after fertilization failed with IVF alone, and in other situations.

The outer shell of the embryo is opened with a laser to help it implant. It can be useful for older women and when the shell is thick.

After egg retrieval, embryos can be grown in the lab for five to six days. A blastocyst is an advanced embryo made up of hundreds of cells. Embryos that reach the blastocyst stage are more likely to be healthy and to implant, so extended culture helps select the healthiest embryo for transfer.

Embryo transfer is placing embryos in the uterus. It’s a delicate procedure: the goal is to place embryos in the middle of the uterine cavity without damaging them or the lining, and without triggering contractions of the uterus.

Once embryos reach the blastocyst stage, you can choose to test their chromosomes before transfer. A few cells, on average about four, are taken from each embryo and tested for the number of chromosomes and some structural abnormalities (PGT-A). PGT can also identify single-gene disorders (PGT-M) and the embryo’s sex. Read more about genetics and PGT.

Transferring two embryos carries a twin rate of about 30%. With elective single embryo transfer, one embryo is transferred and the other is frozen. If you don’t get pregnant, the frozen embryo is thawed and transferred in a later cycle. This lowers the twin rate to about 1% while keeping a comparable overall chance of pregnancy. Read more about single embryo transfer.

Extra embryos that aren’t transferred are frozen and stored for later use, and they can be stored for a very long time. When you’re ready, an embryo is thawed and transferred after the lining of the uterus is prepared. Read more about frozen embryo transfer.

An egg hasn’t been fertilized yet, while an embryo is an egg that a sperm has fertilized. For egg freezing, several eggs are retrieved after ovarian stimulation and frozen for later use. When you’re ready, the eggs are warmed and each is injected with a sperm, and the resulting embryos are transferred to the uterus. Egg freezing lets women preserve their fertility and use their eggs later. Read more about egg freezing.

Most commonly, fertility preservation means freezing eggs or embryos at a younger age and using them later, for women delaying childbearing for personal reasons. More broadly, it means using medical, surgical and laboratory procedures to protect the ability of adults and children to conceive with their own eggs or sperm when their fertility is at risk. Read more about fertility preservation before medical treatment.

Egg donation is an option for women with a low egg supply or several unsuccessful treatment cycles. A young woman is screened to become a donor, undergoes stimulation and has her eggs retrieved. The eggs are fertilized with partner or donor sperm, some embryos are transferred to the intended mother’s prepared uterus, and the rest are frozen. Egg donation is generally a satisfying experience for women and families. Read more about donor eggs.

In in vitro fertilization, eggs are retrieved from the ovaries and placed with sperm in the laboratory. The eggs are checked for fertilization and embryo development, and one or more embryos are transferred to the uterus three to six days after retrieval. Read more about IVF and ICSI.

1. Stimulating the ovaries
2. Retrieving eggs
3. Fertilizing the eggs
4. Growing the embryos in the lab
5. Transferring embryos to the uterus

Ovarian stimulation takes an average of 12 to 14 days. Embryos are transferred three to six days after retrieval, and a pregnancy test is done about two weeks after retrieval. In total, a cycle takes about three weeks, not including initial testing.

An IVF cycle has a good chance of success when the ovaries have an adequate egg supply, the eggs are of good quality and respond well to medication, the male partner produces at least a few sperm, and one or two good-quality embryos are transferred smoothly into the uterus.

After 35, the chance of pregnancy is lower than at a younger age, and the risks of miscarriage and of chromosomal abnormalities in the baby are higher. These risks aren’t caused by IVF but by the rise in chromosomal abnormalities in eggs with age. Chromosomal abnormalities in the baby are usually detected early in pregnancy. There’s also a higher risk of medical problems in pregnancy, such as diabetes, and of cesarean delivery. These are usually manageable with care from a qualified obstetrician.

No. IVF is a powerful treatment that can address many reproductive problems, but most women can be helped with simpler treatments, such as ovulation induction or IUI, and don’t need IVF.

We recommend two steps. First, complete a consultation with a qualified reproductive endocrinologist, along with initial fertility testing and preconception labs. If you’ve had treatment before, review it in detail with your doctor. Second, make sure you understand your fertility issues, the treatment options available to you and their chances of success.

Then weigh other factors before making a final decision, including time commitment, cost and risks such as multiple pregnancy. For example, if you don’t ovulate and all your other tests are normal, the first treatment is usually ovulation induction with IUI. But if that treatment would significantly raise your risk of multiples and you wouldn’t accept fetal reduction, you may prefer IVF with single embryo transfer.

Above all, we offer counseling and advice that may help you conceive without medical intervention, and often that’s enough. Only a minority of patients are offered IVF early on, but we won’t hesitate to recommend IVF when it’s the most appropriate treatment. Our options include:

• Ovulation monitoring
• Ovulation induction
• IUI
• IVF with ICSI
• Mild stimulation IVF
• Treatment for male factor infertility
• Preimplantation genetic testing (PGT) and sex selection
• Egg freezing
• Donor eggs
• Fertility preservation
• In vitro maturation
• Laparoscopic and hysteroscopic surgery

See all our treatments.

If you’re looking for a fertility clinic that gives you all the time you need to understand your fertility and applies only as much science as you need to reach your goals, NYC IVF is the place for you. Care is centered on you, built around your schedule and provided by the same physician at every visit. We work to reduce the risks of multiple pregnancy and ovarian hyperstimulation syndrome at every step. Meet our team.

Please bring records of any previous testing or treatment, including:

• Sperm analysis
• Hysterosalpingogram (HSG) report and films, if available
• Lab test results
• Genetic consultation records, if any
• Medical reports from your physician about any significant disease
• Operative reports from any abdominal or pelvic surgery
• Records of prior fertility treatment, including stimulation records (cycle sheets) and embryology records showing sperm quality, the number of eggs retrieved, mature and fertilized, embryo quality, the number of embryos transferred, and the number and stage of embryos frozen

Allow about 90 minutes for your consultation, and write down any questions you have.

A structured consultation with a reproductive endocrinologist takes about 90 minutes and includes:

• Your history, covering ovarian, tubal and male factors along with your medical, surgical and personal history. A detailed family and genetic history helps identify, and possibly test for, genetic risks for your baby.
• An examination, including a general, abdominal and pelvic exam
• A pelvic ultrasound to look for abnormalities of the uterus, ovaries and pelvis. Ultrasound is also an excellent way to estimate ovarian reserve by counting small (antral) follicles.
• An explanation of the tests you need to check ovarian reserve and male and tubal factors, plus the prenatal tests recommended for anyone trying to conceive
• A provisional plan for investigating and treating your infertility

Read more about your first consultation.

Before making any treatment decisions, focus on completing the recommended tests, including a sperm analysis, a test of the fallopian tubes (HSG) and ovarian reserve testing. Prenatal tests before trying to conceive, including reproductive hormones, an infectious disease profile and genetic screening, should also be done. All required tests can usually be completed within two to three weeks.

We strongly recommend a second visit or phone call to go over your results, and your treatment plan is finalized based on them. Before you start treatment, consider:

• Time commitment: treatment may require several visits over a few months, so we plan visits around your schedule to limit time away from work.
• Cost, along with the resources available to help you
• Possible undesired outcomes, especially multiple pregnancy. For example, if you want only a singleton pregnancy, you may lean toward IVF with single embryo transfer rather than ovulation induction with injectable medication.
• Pregnancy risks for older women and women with medical conditions
• Whether surgery is needed first, such as removing polyps or fibroids

If you decide to go ahead with treatment, we’ll walk you through your treatment schedule and teach you how to take your medications. Watch our medication teaching videos.

We’re at 693 Fifth Avenue, 7th Floor, between 54th and 55th Street.

• Subway: E, M, N, Q, R, B, D, 1, 4, 5, 6 and C
• Bus: M1, M2, M3 and M4

• Phone: 800.853.7595
• Email: reception@nycivf.org
• Fax: 800.780.6167
• Address: 693 Fifth Avenue, 7th Floor, New York, NY 10022

You can also contact us online.

Cost depends on:

• The amount and type of medication used
• Additional procedures, such as embryo biopsy, genetic testing of embryos or embryo freezing
• Whether you use your own eggs or donor eggs

Please contact our office for the cost of a specific procedure.

We can work with your insurance. Every plan is different, and insurance may cover part or all of your treatment, including visits, ultrasounds, lab work or medication. Contact our team for a review of the benefits available under your plan.