Infertility Myths – Part Three

In Part 3 of our series on common infertility myths, we sit down with Dr. Beth Malizia, a reproductive endocrinologist with Alabama Fertility Specialist. Dr. Malizia breaks down our final myths covering initial evaluation, infertility treatments and the risk of multiples. Check out Part 1 and Part 2 of the series for more myths.

Myth #10 – I’ve heard the HSG evaluation hurts.

I have had patients tell me that it took them a year to come see me because they were so scared about this test. The hysterosalpingogram (or HSG) is an evaluation of the uterus and tubes. It involves going to a hospital (or clinic with an x-ray machine), laying on an x-ray table and having a speculum in place for a few minutes to set up a small catheter (straw) to the outside of the cervix – this should not be any more uncomfortable than your annual pap smear. The x-ray machine then moves over you and injects dye into the uterus. When the dye fills the uterus and comes out the ends of both tubes we can ensure they are open. This injection may cause what feels like a menstrual cramp. I have patients take ibuprofen 30-45 minutes prior and I utilize numbing medicine to the cervix. I assure you the stuff you are reading on Google is far worse than the actual test (don’t Google it!) – keep in mind, the injection of the dye usually takes less than 10 seconds.

Myth #11 – It is too expensive to see a fertility specialist.

Infertility treatment can entail many different options (pills, shots, inseminations, surgery, in vitro fertilization (IVF), etc.). With counseling from your doctor, these options are your choice and there is not a set treatment plan that every couple must follow.   Most of the evaluation for fertility treatment is covered by private insurance plans. Other parts of your treatment are usually covered as well (blood work, ultrasounds, office visits, surgery, some medications, etc.). Don’t let this concern stop you from an initial consultation with a fertility specialist and don’t be deterred by your insurance company telling you they don’t cover infertility treatment. Do your homework – oftentimes insurance companies cover everything except the actual treatment (inseminations or IVF for example).

Myth #12 – If I see a fertility specialist, I’ll have to do IVF.

Treatment options are discussed with you after considering the results of any tests and other specifics of your case. Many treatment options are simple and can be done at home (such as taking pills for only 5 days each month and monitoring your urine for release of an egg). The job of your fertility specialist is to present you with your options, plus details of treatment, success rates, etc. Then, you and your family can make the decision that’s right for you.

IVF involves stimulating the ovaries to produce multiple eggs, draining the eggs in an office procedure and putting the eggs together with sperm in the laboratory to fertilize and grow into embryos. The embryos are then placed back into the uterus in a simple office procedure which feels no worse than your annual pap smear. IVF is not the only option for fertility treatment – while it is the most invasive and expensive option, it is also usually the treatment with the highest success rate. Most other treatment options (fertility pills, fertility shots, inseminations, etc.) are less expensive and less invasive. These other options can bring your fertility chances closer to those of the general population (20% per cycle – see myth #1 in previous post) but not above the rate as IVF can. The choice of when and if to pursue fertility treatments such as IVF are made by you and your doctor, but IVF is by no means the only option available.

Myth #13 – If I see a fertility specialist I will definitely have multiples.

A multiples pregnancy is a desire, a fear, or both for all fertility patients. It’s also the most common complication resulting from fertility treatments, The majority of fertility clinics in the United States follow national guidelines for the number of embryos to transfer back to the uterus after IVF treatment. In fact, limiting the number of embryos placed back into the uterus is one of the benefits of IVF over other treatments.

In situations such as stimulation of the ovaries with pills or shots and intrauterine insemination (IUI) (Think “Jon and Kate”), we have less control over the number of eggs released and resulting embryos fertilized. Because of this lack of control, we monitor these cycles closely with ultrasound and blood work. We try our best to limit the risk of multiple pregnancy but we cannot totally eliminate this risk with inseminations. Multiple pregnancy occurs in 20-25% of cycles, the majority of which are twins with less than a 1% risk of triplets or more. There is a constant balance between optimizing your chance of a single pregnancy and the risk of multiple pregnancy.

Myth #14 – If my tubes have been tied I have no way to become pregnant.

Having your tubes tied (bilateral tubal ligation) after you thought you were done having children is a very common method of birth control. If your tubes have been tied you have two routine options for achieving pregnancy:

  1. You can undergo a cycle of IVF where the ovaries are stimulated to produce eggs; the eggs are drained from the ovaries and then placed in a culture dish with your husband’s sperm. They are allowed to grow into embryos for a few days and then placed directly into the uterus (thereby by-passing the tubes that are blocked).
  2. You undergo a surgery that removes the blocked portion or your tubes and stitches the healthy ends back together (tubal reversal).

A visit to a fertility specialist will allow you to get more information about these options and decide what is right for you and your family.

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