Questions


New Patient

How long does it typically take to get an appointment with one of your doctors?

Appointment availability is based on the doctors' schedules, any cancellations, and the type of appointment (consult, follow-up, post-op, etc.), but most patients are pleased with how quickly their appointments can be worked in. We've been told that our practice has exceptionally efficient scheduling both in relation to doctor availability as well as waiting time in the lobby after arrival.

What should I bring for my first appointment?

You'll need your new patient forms that were mailed to you or that you printed off our web site. Please have everything completed before you arrive to help us minimize your waiting time. Be sure to bring your insurance card and driver's license so we can make a copy of each, unless you have copies with you. Also bring any medicals records, reports or results that will help explain or clarify your medical history as it relates to your diagnosis and treatment at the Fertility Center.

How long will my first visit take?

Plan to be here an hour, at least. You may finish more quickly, but some new patients spend closer to 90 minutes with our doctors and staff.

What should I expect during a consultation appointment?

You'll meet the doctor first to talk about your medical and family histories and to discuss options. He'll answer your questions and explain his recommendations for treating you. He may want you to have lab work and, if you're in agreement, will order some tests immediately. A woman typically will have blood drawn during her first visit and occasionally may undergo a pelvic exam that day, but other tests will be postponed until her next menstrual period begins. Men may collect a sperm sample in the gentlemen's lounge before leaving the office if a semen analysis is needed.

Are you open on the weekends?

In general, no. One of our doctors or nurse practitioners is always on call, but our office closes at noon on Friday through the weekend. Many of our IVF patients require blood work, ultrasound scans and procedures on the weekends, but those services are scheduled as needed.

What are some of your most common fertility treatments?

Our approach to infertility is broad and runs the gamut, depending on whether the causes of infertility are known or unknown. Plus, each person can be affected differently by the same treatment. Some patients respond to oral medications while others require injections. Surgery may correct a fertility obstacle and allow a couple to conceive naturally without any additional intervention. More advanced therapies like in vitro fertilization require careful monitoring of a patient's response to medication, which can mean daily blood work and ultrasound scans. When we aren't sure what's causing a couple's infertility, we start with the most basic and least invasive tools for testing and diagnosis and work our way towards a solution. Typically, the more involved the procedure, the greater the financial expense. The Fertility Center is committed to being up front about all costs, so that patients are not caught off guard or overwhelmed by steps they aren't ready for or can't afford to take.

Financial/Insurance

Is it true that an IVF cycle costs $20,000?

Assisted reproduction costs vary a great deal among clinics around the country. The fee for the Fertility Center's standard IVF Cycle Package is $11,300, which includes all costs with the exception of medications and diagnostic tests. The Fertility Center's approach is up front and personalized, so each patient understands what his or her doctor recommends and what expenses will be involved before treatment ever begins.

Do you accept insurance?

The Fertility Center accepts most major insurance carriers, including Blue Cross Blue Shield, Cigna and United Healthcare, among others. Currently, we are an out-of-network provider for Aetna. We cannot accept BlueCare/TennCare, Medicaid, Medicare, or PeachCare policies.

How do I find out if my insurance will cover your services?

The financial experts in our office may be able to answer your questions, or you can call your insurance carrier directly. We can give you a series of questions to ask that will help you confirm what's covered and what's not. We also will verify your coverage once you come on board as a new patient.

What's the difference between diagnostic benefits and treatment benefits for infertility?

Diagnostic testing includes exams, tests and procedures to determine what may be preventing conception. Treatment is defined as supplies or measures used to enhance a conception and pregnancy.

Can I get a loan to help with the costs of infertility treatments?

Couples are encouraged to talk with their bank or credit union about affordable rates and loan options. The Fertility Center also refers patients who need financial assistance to American Healthcare Lending at 800.625.7412 ext.2, Springstone Patient Financing at 800.630.1663, Medical Financing at 888.502.8085, or Med Loan Finance at 800.504.4053. Brochures are available in our offices. Applying for assistance may require several days to complete the appropriate forms and receive approval. Using the My Medical Loan link on this website under first timers allows you to avoid the $9.95 credit report processing fee.

IVF Cycle

Do you guarantee that I'll get pregnant?

No one on earth can make that promise to you, but we will be honest and up front about how and if we can help make your parenting dreams come true. Keep in mind that a multitude of factors affect a person's ability to conceive. Identified contributors often can be corrected or circumvented, but unknown causes of infertility may continue to be road blocks. Our assisted reproduction approaches like in vitro fertilization bypass several of the stages of natural conception, allowing some couples to get pregnant even if no one can uncover why they can't conceive on their own. The Fertility Center's health care fees are lower than many clinics in the Southeast, and we prefer to offer more affordable services to all patients rather than money-back guarantees to some.

Why am I on birth control pills if I'm trying to get pregnant?

Women who plan to participate in an upcoming IVF cycle take birth control simply to regulate and schedule their menstruation. Timing is critical in the IVF world, especially in relation to when eggs are retrieved and embryos are transferred. Our doctors need to control when a woman's period begins so that stimulation medication can be administered at just the right time for optimal response. Also, a dozen couples or more may participate in the same IVF cycle during any given month, so scheduling allows us to ensure adequate space in our procedure and recovery rooms as well as in the embryology laboratory.

Are generic brand prenatal vitamins just as good as prescription ones?

Over-the-counter prenatal vitamins are good, but prescription varieties are better at balancing out nutrition deficiencies and preparing the body for conception. You won't find any brand on a local discount store shelf that can compete with the effectiveness and efficiency of a prescription-strength vitamin. This is a simple way that you can give your baby the very best, even before he or she is conceived.

Do in vitro babies have more birth defects or health problems?

Nearly all infants who have been born following in vitro fertilization appear normal at birth. At the same time, congenital abnormalities, birth defects, genetic abnormalities, mental retardation and other possible deviations from normal may occur in children born following IVF just as they may occur in children resulting from natural fertilization. At present, there does not appear to be any increased risk of birth defects related to IVF, although multiple births may be complicated by prematurity. A pregnancy following IVF usually has a successful outcome but, like any other pregnancy, may end in miscarriage or stillbirth. There is no evidence that IVF increases the frequency of these losses. Even a tubal pregnancy is possible following IVF but less likely than in natural conception.

Can a single woman who wants to get pregnant using donor sperm make an appointment?

Of course. The Fertility Center does not discriminate against patients or withhold treatment based on marital status or sexual orientation. Unmarried men and women as well as same-sex couples use donor eggs and donor sperm to achieve pregnancy success through this practice.

What are the risks associated with an IVF procedure?

Most IVF cycles proceed without difficulty, but factors beyond the Fertility Center's control also are a possibility. The most common disappointment is when a transferred embryo fails to implant in the uterus, so no pregnancy occurs. Even if implantation occurs, the embryo may not grow or develop normally, and spontaneous abortions or miscarriages may occur. Natural ovulation can happen before eggs are retrieved from the ovarian follicles. Pelvic scarring, abnormal anatomy and technical problems can prevent recovery of some or all of the eggs as well as transfer of viable embryos. The eggs retrieved may not be mature or viable for fertilization. Sometimes, men cannot produce the semen sample needed to fertilize the eggs on the day of retrieval, or the quality of the semen sample produced is too poor to allow for fertilization. Even after fertilization, embryos may not grow or divide so the scheduled transfer cannot take place. Other rare risks for women include injury to organs, internal bleeding and infection. Additionally, adverse laboratory conditions, equipment failure, bacterial contamination, human error and/or other unforeseen factors may result in loss or damage to eggs, sperm sample and embryos.

What does a transvaginal ultrasound feel like?

The lubricated scanning probe is similar to a tampon being inserted just at the opening of the vagina. Most women describe feeling pressure without any pain. This technology allows medical professionals to evaluate the uterine lining, monitor ovulation, diagnose conditions and visualize procedures.

I'm sore! Can progesterone injections be given somewhere other than my backside?

Unfortunately, no. Given into the arms or legs, these injections can render your limbs temporarily useless. To minimize soreness, use a heating pad on the upper hip injection site before and after administering the shots and rotate between hips with every other injection.

Can I pick the sex of my baby?

Sperm are the determining factor when it comes to baby gender. New technologies such as preimplantation genetic diagnosis are helping many couples reduce the probability of chromosome disorders and debilitating diseases. PGD also is used for family balancing or gender selection. The Fertility Center recognizes the controversial nature of choosing a specific gender for pregnancy attempts or preservation. The doctors and staff respect each patient's right to make that choice and neither encourage nor discourage the use of sex-selection procedures in the laboratory. Embryo genders are automatically identified through the PGD process, whether needed or not.

How can I avoid having multiples?

The national stories you may have heard about high numbers of multiples usually are the result of patients not being monitored closely or at all while taking stimulation medications. The Fertility Center's female patients who take medications to stimulate egg production undergo ultrasound scans and lab work frequently, even daily at times to assess ovarian response. Mature eggs are removed before ovulation and fertilized in the laboratory. These protocols help control the number of possible resulting pregnancies. Each patient talks with her doctor to determine how many embryos will be returned to the uterus to hopefully implant. Typically, two at most are transferred, but some patients request three or more against doctors' recommendations. Identical twins are always a possibility, since even a single embryo can split on its own. Each year, one or two of our patients may carry a set of triplets to term. 

Do you really freeze eggs that can be used later?

Cryopreservation involves freezing and storing at an extremely low temperature such as liquid nitrogen to keep sperm, eggs and embryos viable until being thawed for fertilization or transfer months or even years later. Men who are fighting cancer often have their sperm preserved prior to treatments that may render them sterile. Women who take stimulation medications may have more eggs retrieved than the one or two needed for transfer that month. Couples can choose to freeze extra eggs or go ahead and fertilize those eggs with resulting embryos frozen and stored for future use. Fewer ethical issues are involved with discarding unused frozen eggs compared to allowing frozen embryos to expire. Cryopreservation is available on site at our Chattanooga facility and helps make multiple attempts at conception more economical for patients since an IVF cycle with frozen embryos is less costly than a cycle with “fresh” embryos.

Why do some couples need an egg donor?

Donors are used by women whose eggs are not viable because of the effects of age, genetic disease or hormonal irregularities. Women who have healthy ovaries and regular menstrual cycles but do not respond to fertility medications also will consider choosing an egg donor. Couples with unexplained infertility that have not become pregnant using assisted reproduction techniques often considering trying another cycle with donor eggs. Overall, donor egg cycles have higher success rates than IVF cycles with women using their own eggs.

How do you choose your egg donors?

Potential egg donors must be non-smokers between the ages of 21 and 33 with no new tattoos or piercings within six months of applying. Each undergoes extensive medical and psychological screenings (including blood work and a physical exam) with embryologists, doctors and mental health professionals. Participation also requires notarized consent forms.

Do donors have any rights to or contact with the children that result from their eggs?

Couples using egg donors from the Fertility Center's established pool remain completely anonymous as do their donors. The two parties never meet or have any contact. All donors sign legal consents waiving their rights to any children resulting from their donated eggs, and the couple receiving the eggs takes complete ownership of the oocytes. Situations involving a couple using a known donor that they themselves have recruited are rare and require modified consent forms.

General

What exactly do your doctors treat? Don't they just help people who want to have a baby?

Our reproductive endocrinologists specialize in treating conditions related to hormones secreted by the endocrine glands – including the pituitary, thyroid and adrenal – which affect reproductive organs and other body systems. In addition to treating infertile couples, the doctors also address advanced gynecological conditions such as endometriosis, hormone imbalances in both men and women, and fertility preservation for cancer victims.

Can I schedule a massage even if I'm not a patient at the Fertility Center?

Definitely. Many of our former patients as well as people who have never received care at the Fertility Center enjoy the services of our licensed massage therapist who is also a certified neuromuscular therapist.  Appointments are scheduled through our front desk receptionist.

I'm having hot flashes. Can you help?

The doctors at the Fertility Center address all conditions related to the reproductive system – including menopause and other hormone changes and imbalances. Medications and lifestyle changes are two ways that our specialists help many patients minimize or even eliminate uncomfortable side effects triggered by fluctuations in the endocrine glands.

Do you recruit sperm donors?

No. But we do assist our patients who need donor sperm in coordination with the Fairfax Cryobank in Virginia.

If I'm being treated for something that's not related to infertility, can I make an appointment?

Yes! We refer our patients who become pregnant to obstetrical specialists, but even some of those women return to us for gynecological care or hormone treatment. Our nurse practitioners do most of the annual exams on patients while the doctors address more advanced issues and concerns.

Do you treat men?

Nearly every day. Our male patients come to us for help with sperm-related infertility challenges as well as hormone imbalances, sexual dysfunction and fertility preservation.

Can I schedule a 3D/4D at your office even if I wasn't an infertility patient?

Certainly. The best time to schedule these multi-dimensional ultrasounds is between weeks 28 and 32 of your pregnancy, although the position of the fetus and the amount of amniotic fluid can affect scan results. The cost for an elective scan is $175 and includes complimentary pictures on a CDR disk. Call at least two weeks in advance for an appointment to ensure availability, and bring a VHS tape if you want the images recorded on video. These prenatal scans are done just for fun and are not used for diagnostic or treatment purposes.

Isn't infertility a woman's problem?

Conception obstacles are just as likely to be linked to male causes, which account for 40 percent of infertility cases. Female factors are linked to another 40 percent, and combined male and female issues make up about 10 percent. The remainder of infertility cases have unknown or unexplained causes. Both members of a couple need to be evaluated by our specialists in order to determine the most effective treatment approach.

Everyone I know is pregnant! How common is infertility?

One in six couples will experience infertility at some point in their lives. The National Center for Health Statistics reports that about 4.5 million couples deal with infertility each year, but less than half will pursue professional medical help.

Does my husband need to come with me for a consult about my fertility?

Because infertility strikes both men and women alike, we strongly encourage couples to visit our office together since possible male factors as well as female contributors need to be explored. Semen analysis typically is the least expensive non-invasive approach to infertility testing at a cost of less than $200.

How long should we try on our own before seeing a fertility specialist?

The general recommendation is after one year of unprotected intercourse without conception. Couples over the age of 35 shouldn't wait more than six months. Anyone with a condition known to impede fertility – such as low sperm count, irregular cycles, pelvic inflammatory disease or a history of miscarriages – should make an appointment as soon as possible. The earlier you seek help, the greater your chances for success.

Should we be having sex every day?

Infertility is a medical condition, not a sexual disorder. During the days just prior to ovulation, frequent sex can increase the chances of conception, so intercourse every 36 to 48 hours is sound fertility practice. Normal, healthy sperm remains active in a woman's reproductive system for several hours. Two or three days of abstinence allows sperm counts to build, but longer periods without sex may have a negative impact on fertility. Daily sex can be counterproductive for couples dealing with low sperm counts that replenish slowly.

What is a low sperm count?

Most men have between 40 and 300 million sperm in each milliliter of ejaculation. Generally, a low count is anything fewer than 20 million. The Fertility Center's standard for subnormal is below 14 million. In addition to numbers, semen analyses also evaluate the movement and shape of sperm, which are as important as count. For example, a man may have plenty of sperm, but fertility may still be a challenge if those sperm cannot move quickly enough to find and penetrate an egg.

People tell me that I'll get pregnant if I just adopt, does that happen?

Studies have proven that the pregnancy rate after adoption is five percent. Ironically, pregnancy success happens just as often for those who do not adopt.

What can I do to improve my pregnancy odds before seeing a fertility specialist?

Purchase an ovulation predictor kit at any drugstore, and time intercourse appropriately. Take vitamins to clean up and balance your system. Avoid tobacco, alcohol and chemicals. Keep testicles cool when trying to build sperm counts. Find out if any of your prescription medications can affect fertility. Don't wait too long to be evaluated if you have a history of irregular periods, pelvic infections or surgery, endometriosis, venereal disease or abdominal cavity scarring. If you are a woman age 35 or older, schedule an appointment as soon as possible.

Do you do tubal reversals? If so, does insurance cover this procedure?

Both doctors at the Fertility Center are trained in micro-surgical techniques and can attempt to reattach your tubes, but not all tubal ligations can be reversed. The charge for a laparoscopic reversal done through small incisions in the belly button is $8,500 and includes the fees for anesthesia, a surgery facility and the physician. Based on doctors' recommendations, a tubal reversal may need to be done through an abdominal incision for a cost of $16,000. If you have the operative report from your original procedure, please bring it to your initial consult with our specialist. Typically, insurance companies will not pay for a reversal procedure after voluntary sterilization unless physical problems have resulted, but you need to call your carrier directly for clarification about your policy's specific benefits and exclusions.

Can I have a baby after having my tubes tied?

If your tubal ligation cannot be successfully reversed, you still have the option of achieving a pregnancy through in vitro fertilization, which bypasses the fallopian tubes and allows for fertilization of an egg and sperm outside the body before the resulting embryo is transferred into the woman's uterus.

What kinds of things hinder or prevent pregnancy?

Hormone deficiencies and imbalances often make conception more difficult as can blocked fallopian tubes, scar tissue, other structural abnormalities and anatomical irregularities. Issues with sperm including the number available as well as their movement and shape can affect fertility. Some women do not ovulate regularly or at all, so achieving a pregnancy is nearly impossible. Also, advancing age is connected with infertility.

How can an intrauterine insemination help us get pregnant? And how is that procedure different than in vitro fertilization?

During an IUI, sperm are placed inside the uterus through a catheter to bypass the vagina and cervix and get closer to the site of natural fertilization. From there, nature takes its course. Some couples will try this approach to achieving conception multiple times. With IVF, both sperm and eggs are taken from a couple and combined in the lab to achieve fertilization outside the body. Several days later, resulting embryos can be transferred to the women's uterus or cryogenically preserved. Transferred embryos must implant in the uterine lining on their own before a pregnancy can result.

My husband had a vasectomy. Can we still have a baby together?

Our doctors work closely with a urologist who has expertise in fertility planning. He can either do a vasectomy reversal (which is most successful if the vasectomy was done less than five years ago) or a sperm aspiration (which extracts sperm from the epididymus or from a testicular biopsy while the patient is under anesthesia). You may be able to conceive naturally after a reversal, or aspirated sperm can be used to fertilize eggs retrieved during an IVF cycle.

Will I get pregnant if I just relax?

If you have a physical problem such as blocked tubes, no ovulation, poor egg or sperm quality, or uterine abnormalities, then all the relaxation in the world won't help you get pregnant. However, it's also true the people who lead a stressful life tend to be less healthy overall – and that includes reproductive health. Some say that stress doesn't cause infertility but rather infertility causes stress, especially on top of an already busy life. At the Fertility Center, we have a licensed clinical therapist and a massage therapist available to help patients reduce stress and find new ways to relax as they deal with the inevitable worries that come with infertility testing and treatment. We also have outside counseling agencies and holistic health professionals that we can recommend.

I'm at my wits end about not being able to get pregnant, and I'm not sure what to do next!

Good news! Before or after making an appointment with one of our specialists, you have the option of making an appointment with Ann Ramey, our licensed clinical therapist whose professional counseling experience encompasses a range of issues from marriage to grief. Ann's support services are free to patients and women in the surrounding communities. We refer our Knoxville patients to the Complete Counseling psychotherapy group near our office on Kingston Pike. Additionally, there are other mental health specialists that we can recommend in both Chattanooga and Knoxville.

Should I still make an appointment if my gynecologist has already done some fertility testing on me?

We're always happy to pick up where your regular ob/gyn left off exploring your infertility. Hopefully, we'll return you to your doctor as a pregnant patient in your second trimester! Remember, fertility is our specialty, and we're privileged to have advanced testing and treatment options at our disposal. It is helpful if you can bring copies of relevant medical records with you to bring us up to speed. Some testing may have to be repeated if too much time has passed for the results to still be considered valid.

How common are miscarriages?

One out of every four pregnancies ends in a miscarriage, and one third of women who conceive experience more than one loss. Assisted reproduction does not affect those general statistics, but infertile women are subject to the same miscarriage odds as those who conceive naturally. The risk of miscarriage increases with the intake of tobacco, caffeine and alcohol as well as some over-the-counter medications.

When will my biological clock stop ticking?

For most women, fertility begins to decline at age 35 when egg quality starts to decrease. By age 40, the majority of eggs produced are chromosomally abnormal. Some women face this transition in their 20s, while others remain fertile well into their 40s. Simple blood tests are available to help determine the “age” of your ovaries and the quality of your eggs. Women of all ages who find that their eggs are no longer viable can take advantage of the egg donor program available through the Fertility Center. Young, non-smokers who are willing to anonymously give their eggs to couples who need them are recruited, carefully screened, tested and counseled before being added to the donor pool.

Do couples who have a child ever deal with infertility?

Surprisingly, secondary infertility is more prevalent than primary infertility with millions of Americans affected by the inability to become pregnant or carry a pregnancy to term following the birth of one or more biological children. Couples are far less apt to seek treatment for this condition if they conceived easily the first time or believe that past fertility insures future fertility. Once they do see a specialist, many feel regretful for not having taken a more aggressive approach to treatment when they were younger since advancing age is often an issue in secondary infertility. Another challenge for couples with secondary infertility involves balancing their grief and worry about having another child with the joy they find in their existing child.