What can we do to guard against genetic diseases in your baby? Should we have genetic testing?
How accessible are the physicians?
What is infertility?
What causes infertility?
How is infertility diagnosed?
How is infertility treated?
What is in-vitro fertilization?
Is in-vitro fertilization expensive?
Does in-vitro fertilization work?
Do insurance plans cover infertility treatment?
What impact does infertility have on psychological well-being?
What if I have Low Ovarian Reserve (high FSH and/or low AMH)?
What if my eggs do not fertilize?
What are my options if I decide not to use my stored embryos?
What if I don't respond to the drugs for ovarian stimulation?
Can you help gay and lesbian couples with infertility?
Q. How long have Drs. Zapantis & Merhi been in practice?
A. Dr. Zapantis and Dr. Merhi have been practicing medicine and specializing in infertility issues for over 10 years. They are responsible for every aspect of your treatment to help you conceive healthy babies. Dr. Zapantis and Dr. Merhi each are personally dedicated to providing compassionate, patient-centered medicine with an exceptionally high standard of care.
Q. What can we do to guard against genetic diseases in your baby? Should we have genetic testing?
A. Genetic testing allows us to evaluate the DNA of the parents (sperm or egg donor) in order to identify specific genetic problems for your baby. Genetic testing also provides useful information for choosing the most effective treatments. Whether or not to have genetic testing is a personal decision for each mother or couple. At New York Reproductive Wellness, we will explain to you the benefits of genetic testing and answer any question or concern you may have.
Q. How accessible are the physicians?
A. Dr. Zapantis and Dr. Merhi are committed to providing exceptional care, and they welcome patients to call or email them at any time, including after hours and on holidays, nights and weekends. Our experienced specialists are happy to answer any questions you may have about your medications and your fertility treatment. In addition, we have flexible office hours and work with your busy schedule, including offering convenient early morning weekday hours and Saturday appointments.
Q. What is infertility?
A. The American Society for Reproductive Medicine (ARSM) defines infertility as the failure to achieve a pregnancy after 12 months or more of regular, unprotected intercourse in women aged less than 35, or after 6 months or more of unprotected intercourse in women aged older than 35. A woman’s fertility peaks at about 20-24 years of age, decreases very little between 30-32, decreases progressively after that until age 40, and then rapidly after age 40. As fertility decreases, the risk of miscarriage increases. Both decreased fertility and an increasing risk of miscarriage appear to be due to decreasing follicle numbers in the ovaries and increasing abnormalities in the remaining aging eggs (i.e., diminished ovarian reserve). Risk factors for diminished ovarian reserve include:
- Family history of early menopause
- Previous ovarian surgery, radiation therapy or chemotherapy
- Previous poor response to fertility treatments
Q. What causes infertility?
A. Many factors can determine infertility, including age, health and environment. In about one-third of cases, the cause of infertility can involve only the male. Male factors affecting fertility include abnormal sperm production, problems delivering the sperm, overexposure to certain chemicals and toxins or damage related to cancer or treatment for cancer. In another one third of cases, it could involve only female factors such as ovulation problems, uterine or cervical abnormalities, fallopian tube damage or blockage, endometriosis, primary ovarian insufficiency, pelvic adhesions, thyroid problems, cancer and its treatment, other conditions and certain medications. The remainder of infertility cases could involve both or have no identifiable cause.
Q. How is infertility diagnosed?
A. Infertility is diagnosed in a number of ways. We begin by asking questions about the woman’s health history, including prior pregnancies and miscarriages, menstrual cycle regularity, the presence of pelvic pain, abnormal vaginal bleeding or discharge, or a history of pelvic infection or surgery, as well as any pertinent male’s health history. Other diagnostic tools may include blood hormone level tests, fallopian tube X-rays, transvaginal ultrasound, hysteroscopy or saline ultrasound. For any testing you may need, we are dedicated to keeping you informed and comfortable while being about your safety.
Q. How is infertility treated?
A. For males, medication can treat some issues, such as hormonal imbalance or erectile dysfunction. Surgery can repair blockages in the tubes that transport sperm or repair varicose veins in the testicles. It is important that every man with questions about his role in infertility go through a consultation to determine an appropriate treatment plan and to review potential outcomes. In-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is one of the best treatments for men who suffer from poor sperm quality or quantity.
For females, infertility treatments include medication, surgery on blocked fallopian tubes and treatments such as intrauterine insemination (IUI) and IVF. Women’s infertility treatments also include third-party assisted reproductive technologies (ART), including sperm donation, egg donation, surrogates or gestational carriers.
Q. What is in-vitro fertilization?
A. IVF treatment is a highly successful form of fertility treatment, especially in younger women with unexplained infertility, endometriosis, blocked fallopian tubes or pelvic scarring, and in cases of male-factor infertility. In some cases, such as when the fallopian tubes are irreparably damaged or when there is a severe male factor, IVF treatment may be appropriate as an initial treatment. In most other cases, IVF treatment is the next step after a trial of several unsuccessful IUI cycles.
Q. Is in-vitro fertilization expensive?
A. At New York Reproductive Wellness, our fees are among the lowest in Long Island and New York City. Beginning a family is a major step, and with all you are going through, extra expense is the last thing you need. We concentrate on providing superior medical and patient care, and while compassion and personal attention may be priceless, they are always provided free of charge.
Q. Does in-vitro fertilization work?
A. IVF treatment involves close monitoring with blood evaluation and vaginal ultrasounds while the ovaries are stimulated with injectable gonadotropins in combination with several other medications. The goal is to yield multiple mature eggs in one cycle, compared to one mature egg in a natural cycle.
While the woman is under anesthesia, the eggs are retrieved from the ovaries using an ultrasound-guided needle placed through the vagina to reach the ovaries. The eggs are then fertilized with sperm, some of which go on to form embryos.
Following a period of incubation, embryos become available for transfer into the uterus through a soft, thin catheter. Cleaved embryos (day 3 following fertilization) or blastocysts (day 5 after fertilization) may be recommended for embryo transfer based on a case-by-case basis.
Q. Do insurance plans cover infertility treatment?
A. Yes. Since the 1980s, 15 states—including New Jersey, New York, and Rhode Island —have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment. Thirteen states have laws that require insurance companies to cover infertility treatment. However, New York prohibits the exclusion of coverage for a medical condition otherwise covered solely because the condition results in infertility. NYRW will be happy to review your particular insurance and the coverage offered.
Q. What impact does infertility have on psychological well-being?
A. At NYRW, we understand that infertility is a stressful experience. It is normal for infertility to cause anxiety and emotional swings, but the staff and the physicians at NYRW are always by your side to help you through this experience with the aim to help you get pregnant.
Q. What if I have Low Ovarian Reserve (high FSH and/or low AMH)?
A. normal follicle-stimulating hormone (FSH) level is typically under 10 mIU/mL and a normal Anti-Mullerian Hormone (AMH) level is usually more than 1 ng/mL. An FSH > 10 or an AMH < 1 might indicate that a low number of eggs is remaining in the ovaries. However, this does not mean that a woman with Low Ovarian Reserve cannot get pregnant. At NYRW, we gladly accept women no matter how high their FSH or low their AMH level. We use protocols such as Minimal Stimulation IVF and Natural Cycle IVF that can produce good-quality eggs and we have shown that this can help women with Low Ovarian Reserve get pregnant.
Q. What if my eggs do not fertilize?
A. We will have a discussion about your treatment options, such as IVF, natural IVF, minimal stimulation IVF and embryo biopsy. These are among the typical treatments to improve your outcome, especially if you are over 40 years of age.
Q. What are my options if I decide not to use my stored embryos?
A. The decision about whether to transfer Day 3 or Day 5 embryos is made on an individual basis, and it depends on the patient’s age, the number and grade of the embryos formed, history of previous IVF cycles, and the number of embryos a couple elects to have transferred. Usually, blastocyst embryo development allows for fewer embryos to be transferred minimizing the risk of multiple pregnancy. Any embryos not transferred but potentially viable may be frozen for future use.
Q. What if I don't respond to the drugs for ovarian stimulation?
A. If you don’t respond to one particular medication to help you ovulate, Dr. Zapantis or Dr. Merhi may then prescribe different medications for ovarian stimulation to ensure egg production. If you are undergoing IUI or IVF, another medication may help you produce several eggs as needed.
Q. Can you help gay and lesbian couples with infertility?
A. Yes. The urge to have a child is universal, regardless of the sexual orientation of the couple or individual. At NYRW, we have all of the technology and treatments to enable same-sex couples to have a baby. Let us sit down with you and/or your partner to discuss the options.
For any patient, male or female, we will first conduct an in-depth interview to discuss your health and fertility history, followed by evaluations to determine your probability of becoming parents and which options may be most appropriate and effective.
Next, we will discuss your treatment options, such as in-vitro fertilization (IVF), natural IVF, minimal stimulation IVF and intrauterine insemination (IUI). Other options we may explore with you include donor sperm freezing or egg freezing, or gestational and traditional surrogates.