Ask the Experts – Dr. William Ziegler

Ask the Experts

For many in our audience who are not familiar with the science of Reproductive Endocrinology and Infertility maybe you can provide a brief overview?

Reproductive Endocrinology and Infertility is a branch of medicine that identifies and treats infertility in both men and women. In the United States, 15 percent of all couples will face fertility issues, and many will be diagnosed with a reproductive disorder. Many infertile couples choose to see a reproductive endocrinologist when deciding upon fertility treatments. The reproductive endocrinologist will identify factors involved in a couple’s infertility and select the appropriate methods to treat these factors.

Overall, for those couples potentially seeking out help, what can you share to provide some guidance in selecting the right practice?

Selecting your infertility doctor or practice should be based on their level of expertise, team approach, availability, certifications, centrally located facilities, and services provided. However, the most important quality a facility can offer is genuine concern and understanding for the patient and spouse’s emotional needs through this stressful time. The advice from a patient’s gynecologist can help facilitate this process. You should feel comfortable and at ease with your physician and your infertility team.

Are there options to help couples preserve their fertility?

Fertility preservation was originally intended for cancer patients prior to chemotherapy and / or radiation. Today, fertility preservation is also a valid option for women who desire to delay child- bearing for medical, professional or personal reasons.

We are able to pause the biological clock until a women is ready for children. Women need to be aware that fertility begins declining in the early twenties but conception rates remain high into the thirties. After age 35, the decline accelerates to reach nearly zero pregnancy potential by the time the woman reaches age 45. In addition, women over 35 have an increased risk of miscarriage and/or genetic abnormalities in their children as a result of age- dependent changes in egg quality. Therefore, the best age to preserve eggs is between 30 – 40 years old. When a woman uses her frozen eggs in the future, even if a number of years have passed, both the pregnancy rates and the incidence of miscarriage would be based on the age of the woman when the eggs were frozen.

Because infertility is a very sensitive subject for any couple–how does someone in your field discuss success and set expectations in that regard?

Fertility treatment is very stressful for a couple. Setting realistic expectations is very important. A couple needs to understand that the success of fertility treatment is dependent upon many variables. Fertility in both partners may be affected by medications, increased weight, social habits and medical issues. Maternal factors include ovulatory disorders and uterine/ fallopian tube abnormalities. In addressing male factor infertility, sperm problems affect 40% of all couples. A physician needs to address each patient’s situation individually and provide them with realistic expectations for treatment.

From an insurance coverage point of view can you comment on how most practices/ insurance companies are working together to help couples in need of your specialty?

Unfortunately, fertility coverage is not yet universal. There are 15 states that mandate infertility coverage and New Jersey is one of them. However, coverage can be limited to just an evaluation of the couple to medical procedures and drug therapy. Some policies have a fixed monetary amount designated for fertility treatment. This may influence a couple’s decision regarding the aggressiveness of treatment. Due to the marked variability in coverage you need to be proactive and take time to know your policy and find out to what extent, you may be covered. Knowing exactly what your policy covers before you see a healthcare provider is a huge time-saver. Your coverage may dictate the types of tests you may have, the sequence of these tests, and which treatments will be covered. When possible, it’s best to get a commitment for coverage prior to seeing a fertility healthcare provider. This is called “preauthorization” or “predetermination.”

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