General

Q:  What exactly do your doctors treat? Don’t they just help people who want to have a baby? 
A:  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.

Q:  Can I schedule a massage even if I’m not a patient at the Fertility Center?
A:  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.

Q:  I’m having hot flashes. Can you help?
A:  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.

Q:  Do you recruit sperm donors?
A:  No. But we do assist our patients who need donor sperm in coordination with the Fairfax Cryobank in Virginia.

Q:  If I’m being treated for a hormone imbalance or something that’s not related to infertility, can I schedule my annual gynecology exams at your office? 
A:  Yes! We refer our patients who become pregnant to obstetrical specialists, but even some of those women return to us for gynecological care. Our nurse practitioners do most of the annual exams on patients while the doctors address more advanced issues and concerns.

Q:  Do you treat men?
A:  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.

Q:  Can I schedule a 3D/4D at your office even if I wasn’t an infertility patient?
A:  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.

Q:  Isn’t infertility a woman’s problem?  
A:  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.

Q:  Everyone I know is pregnant! How common is infertility? 
A:  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.

Q:  Does my husband need to come with me for a consult about my fertility?
A:  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.

Q:  How long should we try on our own before seeing a fertility specialist? 
A:  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.

Q:  Is it possible that we’re doing something wrong in the bedroom that’s causing our infertility? Should we be having sex every day? 
A:  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.

Q:  What is a low sperm count? 
A:  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.

Q:  Many people tell me that I’ll get pregnant if I just adopt. How often is that true?
A:  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.

Q:  What can I do to improve my pregnancy odds before seeing a fertility specialist?
A:  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.

Q:  Do you do tubal reversals? If so, does insurance cover this procedure?
A:  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.

Q:  Can I have a baby after having my tubes tied?
A:  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.

Q:  What kinds of things hinder or prevent pregnancy?
A:  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.

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

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

Q:  Will I probably get pregnant if I just relax?
A:  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.

Q:  I’m at my wits end about not being able to get pregnant, and I’m not sure what to do next? Do you have anyone I can talk to before I actually make an appointment with one of your specialists?
A:   Good news! 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.

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

Q:  How common are miscarriages?
A:  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.

Q:  When will my biological clock stop ticking?
A:  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.

Q:  Do couples who have a child ever deal with infertility? 
A:  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.