Frequently Asked Questions

Most experts define infertility as not being able to get pregnant after 1 year of trying — or not being able to get pregnant after 6 months of trying if you are 35 or older. Women who are able to get pregnant, but are unable to stay pregnant because of repeated miscarriages, may also be considered infertile. About 10 percent of women ages 14 to 44 in the United States have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control.

If you are unable to become pregnant or have experienced multiple miscarriages, the Kofinas Fertility Group can help. A consultation and fertility workup can provide answers and help you and your doctor establish a fertility treatment plan.

In about one-third of cases, infertility is due to the woman (female factors), and in another third infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.

Getting pregnant is a complicated process. To get pregnant,

a) A woman must release an egg from one of her ovaries (ovulation).
b) The egg must go through the fallopian tube toward the uterus (womb).
c) A man’s sperm must fertilize the egg along the way.
d) The fertilized egg must attach to the inside of the uterus (implantation).

Problems that interfere with any of these steps can result in infertility.

In women, problems with ovulation account for most cases of infertility. Other causes include blocked fallopian tubes, physical problems with the uterus and uterine fibroids.

In men, infertility is most often caused by problems with sperm count (producing too few sperm or none at all) or problems with the sperm’s ability to reach the egg and fertilize it.

One of our fertility specialists, also known as Reproductive Endocrinologists, will do an infertility workup, which includes a medical history review and physical examination. The doctor will then run blood tests to determine if you are ovulating with adequate progesterone stimulation of the uterine lining. As part of your blood work, we do hormone testing to check for endocrine problems. The fertility workup at the Kofinas Fertility Group typically includes an ultrasound procedure called a hysterosonogram, which allows our physicians to see inside the uterus in order to accurately diagnose for polyps, fibroids or adhesions. We may also conduct a hysterosalpingogram — an X-ray test that we use to look inside the uterus and fallopian tubes, as well as the surrounding area — to find problems such as blocked fallopian tubes or an abnormally shaped uterus. Your doctor may also perform an endometrial biopsy, which involves taking a small sample of the endometrium and checking it under a microscope for problems or hormone levels that are out of balance and can affect the endometrium.

To check for male fertility problems, the reproductive endocrinologist may do a semen analysis with a post-coital test, which checks a woman’s cervical mucus to see whether sperm are present and moving normally after intercourse.

There are many ways that we can treat infertility. Depending on your specific problem, we may treat you with medication, surgery, artificial insemination or assisted reproductive technology. Doctors recommend treatment based on:

• Test results
• How long the couple has been trying to get pregnant
• The age of both the man and the woman
• The overall health of the partners
• Preference of both partners

There are several different methods of ART. In vitro fertilization is the most common and considered the most effective.

• In vitro fertilization (IVF) means fertilization outside the body. Our doctors treat you with a drug that causes your ovaries to produce multiple eggs, and once they’re mature, your eggs are removed. We then put them in a dish in the lab along with the man’s sperm for fertilization. After three to five days, healthy embryos are implanted in your uterus.
• With zygote intrafallopian transfer (ZIFT), also known as tubal embryo transfer, we also fertilize your eggs in the laboratory, and then transfer the embryo into the fallopian tube instead of the uterus.
• Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into a woman’s fallopian tube. Fertilization occurs in the woman’s body rather than in the laboratory.
• Intracytoplasmic sperm injection (ICSI) may be used for couples in whom there are serious problems with the sperm, for older couples, or for those with failed IVF attempts. In ICSI, we inject a single sperm into a mature egg and then transfer the embryo into your uterus or fallopian tube.
• ART can involve the use of donor eggs, donor sperm or previously frozen embryos.

Fertility assessments and therapies can be expensive and therefore require careful consideration and thorough understanding of the treatment options, costs involved, insurance coverage, and out-of-pocket expenses. Insurance coverage can range from nonexistent to comprehensive. Each insurance company offers many different plans, and each plan has different policies regarding infertility coverage. The Kofinas Fertility Group’s team contacts your insurance carrier with a list of questions to obtain information regarding the extent of your coverage for fertility; however, this “verification” of benefits does not guarantee payment. 

Please note that New York recently passed the new FAFTA Fertility Mandate that provides extended insurance coverage for individuals seeking certain fertility treatments.

Over the years, the Kofinas Fertility Group has developed several efficiencies with the advantage of using state-of-the-art equipment and facilities in order to provide superb care at an affordable cost. We also offer several financial programs for patients who seek treatment and do not have insurance coverage.

FAFTA, or the "Fertility Mandate", is a mandate that was passed in New York that goes into effect January 1, 2020. It expands insurance coverage for individuals seeking IVF and medically necessary egg freezing.

To find out if you qualify for these benefits, take our quiz!

Endometriosis is a condition in which tissue from the inner lining of the uterus (the endometrium) grows outside of the uterus and in other parts of the body, such as the ovaries or fallopian tubes. These misplaced tissues behave like normal endometrial tissue and build up each month, break down and cause bleeding. However, unlike the lining of the uterus, the blood from these growths has no way to leave the body. This internal bleeding inflames the surrounding areas and forms scar tissue, which can make it hard to get pregnant.

We diagnose endometriosis through a laparoscopy exam. A number of treatment options for endometriosis exist, including pharmaceutical treatments that put a woman into chemical menopause, which stops ovulation. We can also perform a hysterectomy. However, if you wish to restore fertility, conservative surgery is the method we use to repair the problem and correct any distorted anatomy.

For conservative surgery, we use minimally invasive laparoscopy or laparotomy (conventional “open” surgery through normal incision) to remove endometrial tissue without removing any normal tissue or reproductive organs. The most common surgical procedures we perform with the laparoscope are removing pelvic adhesions that surround the ovaries, fallopian tubes and uterus, as well as the surgical removal of endometrial implants (endometrial tissue that has grown outside the uterus) and ovarian endometriomas (cysts consisting of endometrial material found within the ovaries).

A fibroid uterus is when a woman has uterine fibroids, which are noncancerous growths of the uterus that often appear during childbearing years. These growths are also called fibromyomas, leiomyomas or myomas. Fibroids are not associated with an increased risk of uterine cancer and almost never develop into cancer. Women with uterine fibroids may experience symptoms such as heavy menstrual bleeding, pelvic pressure or pain, and frequent urination. Fibroids can range in size from undetectable by the human eye to large, bulky masses. Bigger fibroids can distort and enlarge the uterus and fallopian tubes, interfere with the passage of sperm from your cervix to your fallopian tubes, or prevent the implantation and growth of an embryo.