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understanding the process and options at cny

The Getting Started Guide

It’s true, no two paths to the creation of life are the same. Everything from your medical history and fertility diagnosis to your location, personality type, and goals can factor into determining the type of treatment that is best for you and your family-building needs.  Know that you are ultimately in control. We never limit the type or number of treatments you pursue, but we are always here to help guide your decisions. Let’s get started!

Understanding the Process

Your process can vary depending on if you live near one of our locations or not.

Local clients live near one of our locations and have the majority of their appointments done right at our offices. They also have the benefit of enjoying our one of a kind fertility wellness spa CNY healing arts for the duration of their treatment and beyond. Generally, your process will follow the main steps below.

  • Scheduling Your Consultation

    It all starts by scheduling your consultation. You can submit a form here or simply call us at 844-315-2229.

    After scheduling your consultation (or even before) we recommend you start many of the non-pharmacological changes found on these pages for males and females: including a high fat low carbohydrate diet (Kiltz’s Keto), taking supplements, and a number of other fertility enhancing lifestyle changes.

    It’s also a great idea to tune in to Dr. Kiltz’s Facebook/Instagram Live on Sunday nights at 8 pm est and Dr. Verdiales’s Facebook Lives in Spanish on Thursdays at 8 pm est.

  • The consultation

    The primary goal of the consultation is for us to listen and understand your hopes and expectations so we can collectively create a suitable plan of action. You can expect the initial consultation to last around 30-60 minutes and is best if both partners can attend.

    The consultation is also a wonderful time to perform some necessary testing for both male and female partners. Most testing is complete the same day and can help us inform a treatment plan. If anything can’t be run that day like an HSG is done later and changes our recommended course of action, you will be notified at that time and have the opportunity to discuss your options again with a provider.

    After reviewing your medical history and goals we may recommend a certain course of action, but we will never force anyone away from the treatment they desire.

    You’ll also have the time to review your insurance with one of our financial coordinators and go over any pricing and payment plan information if need be.

  • Your Treatment

    Outside of a few one day treatments (often surgical procedures like tubal ligation reversals or vasectomy reversals) fertility treatment cycles follow a woman’s natural menstrual cycle and last anywhere from 2-8 weeks. Amazingly, eggs, sperm, and embryos can remain frozen for decades so some treatments could similarly take decades to come to a final resolution.

    Because many fertility treatments use medications to stimulate egg development and properly time procedures, one most often has a number of office visits during the fertility treatment cycle called monitoring appointments. These appointments look at the woman’s follicular/egg and uterine lining development so that your provider knows when to perform the necessary procedure in an IUI, IVF, or other fertility treatment cycle.

Thousands travel to CNY and we are truly honored that people choose to travel thousands of miles for their family-building needs. We also understand that this extra travel can add a good bit of extra stress on top of an already stressful situation and want you to know that we are here for you always. We highly recommend you read this section, our main travel page, and the 10 steps to being a travel client.

  • Schedule Your Consultation

    It all starts by scheduling your consultation. You can submit a form here or simply call us at 844-315-2229. Most people coming from more than a few hours away have their consultation done by phone, facetime, or skype.

  • Preparing for Your Consultation

    Given most people coming from more than a few hours away have their consult done remotely as well, they won’t have the opportunity to have testing done at our office. Many travel clients have also had extensive testing done and many rounds of fertility treatments done and may not need any additional testing.

    We recommend that you have all of our basic male and female fertility testing done and faxed to our office or uploaded into your patient portal. All testing must be completed within one year of your treatment cycle – or sign a waiver acknowledging that failure to do so could drastically and negatively affect the outcome of your cycle. NOT RECOMMENDED.

    We also recommend men and women follow a ketogenic fertility diet, take a number of supplements, and adapt a number of other lifestyle changes.  Read more.

  • The Consultation

    The primary goal of the consultation is for us to listen and understand your hopes and expectations so we can collectively create a suitable plan of action. You can expect the initial consultation to last around 30 minutes and is best if both partners can attend.

    After reviewing and discussing your medical history and your goals we may suggest a suitable plan of action, but we will never force anyone away from the treatment they desire.

    Similarly, many of our travel clients have already faced numerous treatment cycles and come to us knowing exactly what they want.

     

  • Your Treatment

    As long as you inform the provider during your consult that you would like to start as soon as possible, someone from our travel team will contact you within a week to review your plan and order your medications.

    In order to start a treatment cycle you will need to: have submitted an insurance prior authorization/claim, paid in full signed a financial contract and started a payment plan, submitted all of your required testing, have a monitoring facility set up for all bloodwork and ultrasounds, and have all medications that will be used in your cycle.  After all of this is complete you can start with your next menstrual cycle (or right away if not applicable). Most can start within a few weeks to two months following the day of their consult.

    All of your monitoring appointments will be conducted at offices near your home with faxes being sent to our office later that day. Each day you will receive a call from a travel nurse reviewing your results and providing you with any next steps.

    Depending on your treatment, most only need to be away from home for 2-7 days.

Decisions, Decisions, Decisions

Choosing the Fertility Treatment That's Right for You

People often want to know “what is the best fertility treatment. While there is no best fertility treatment, there may be a fertility treatment that is best for you at this moment. When deciding on your treatments during your consultation (or before or after) it’s important to consider many different things. There is a surprising number of reasons people come to seek fertility treatment – some of which lead down fairly straight forward treatment paths or options while others will require testing and will even factor in things like personality when choosing their treatment.

Our provider will listen to your story and help you through these things, but it’s always good to be thinking ahead!  Let’s start by discussing two general philosophical approaches to fertility treatments.

 

  • The Path of Least Resistance

    Most people choose a treatment path that follows a path of least resistance. That means you do all of your testings, then you start with basic treatments and slowly move on to slightly more invasive procedures if unsuccessful with the previous.  In addition to having less invasive procedures, many insurances cover these less more basic solutions while not covering the more advanced treatments.

  • The Fast Track

    Some people with testing supportive of starting with a less invasive treatment prefer to jump straight to a treatment like IVF which offers much higher odds of success per cycle than simpler solutions like ovulation induction or IUI. Others choose to skip basic treatments out of medical necessity (ie those pursuing fertility treatments for genetic reasons), sex selection, after a sterilization surgery, or those in the LGBTQ community looking to both be involved in their child’s creation (reciprocal IVF).

The Path of Least Resistance Continued

General Progression of Fertility Treatments

Given the (slight) majority of people continue down the path of least resistance, that’s a good place to start for a more in-depth conversation and exploration of the generic progression of fertility treatments from the more simple to the progressively more complex.

Ovulation Induction

For women with ovulation disorders, PCOS, or irregular menstrual cycles many start with simple oral medications (aka ovulation induction) and timed intercourse.

IUI

Helps put sperm in the right place at the right time. Many will go straight to IUI. Most often uses medications to stimulate the ovaries and help time the “procedure.”

IVF

The gold standard of fertility medicine. Highest level of control for high-level results.

Enhancement Protocols & Surgery

Comprehensive immunological protocols. Primarily for those with failed implantation/IVF cycles or recurrent pregnancy loss. Most often paired with IVF, but can be paired with IUI. Also, a great time to consider Laparoscopy & Hysteroscopies to explore things like endometriosis and other inflammatory pathologies (inflammation is the #1 cause of “unexplained infertility”).

Donor Gametes or Embryos

Used in combination with IUI/IVF for LGBTQ, advanced age, specific diagnosis, or unexplained repetitive IVF failures.

Surrogacy/Gestational Carriers

If unable to carry – often, but not always combined with donor gametes.  Also the starting place for homosexual male couples.

One should always be following our recommendations for improving male and female fertility – ideally for 90 days prior to the start of any treatment.

See all our Treatment Options
The Path of Least Resistance Continued

How Testing Effects Treatment Options

The above outline of fertility treatment progression is most directly and appropriately followed after all testing has been done with all results coming back negative . . . meaning unexplained infertility. Through testing, we can gain a better understanding of appropriate treatments and potentially eliminate dead-end paths.

How's the sperm?

Sperm is half the battle and the most often overlooked component – not the case here at CNY Fertility. Knowing the quantity and quality of your sperm is vital. It can either keep your options wide open (pending female evaluation) or make many treatment options completely futile. Remember, sperm have a long way to swim so if they don’t look like they’re entering the Olympics you may want to steer clear of some basic treatment options that require the sperm to do some heavy lifting.

If sperm and female are good – ovulation induction and IUI could be great places to start.

A sperm count of under 10 million motile sperm is counter indicative for these treatments. It may be recommended to jump to IVF (with ICSI). With very little (oligospermia) or no sperm (azoospermia), it may be required to have a testicular sperm extraction or even use donor sperm.

Ovulating?

Not ovulating or having regular cycles? It doesn’t sound good, but it may actually be one of the “best,” diagnoses you could receive as treatment can be incredibly straight forward.  Many with ovulation disorders conceive with simple oral medications and regular intercourse in an ovulation induction cycle.  If that were unsuccessful, treatment would typically progress in line with the map above.

How are the fallopian tubes?

If the fallopian tubes are damaged the real question becomes how much or how bad? With mild damage or damage that is localized to one side then one could potentially proceed with basic treatment options or have surgery to correct the damage. 

If the damage is severe enough that there becomes no hope of the egg ever passing through to meet the sperm than IVF is a great option as it completely bypasses the tubes.

If the woman has had a tubal ligation (tubes tied) they will either need a reversal or go straight to IVF.

How is the uterus?

There are two main questions here . . . are there any gross anatomical issues and how does the lining develop.

Many anatomical abnormalities or pathologies can be surgically corrected and open up most treatment options.

Lining issues can be challenging but can be helped with medications and PRP while still keeping most treatment options open.

Hormone levels . . .

Everything looking good? Great!

Things like a Low AMH, High FSH, High Estradiol, and thyroid disorders may indicate a rapid progression through basic treatments (or skipping straight to IVF).  Donor eggs could also be discussed (although never pushed on you or required).

Other lab values like low vitamin D can have a drastic effect on fertility, but for that, let’s just start by taking some vitamins.

Age . . .

All things being equal, the quality of eggs and sperm decline as we age – and rapidly after the age of 35. Those on the friendly side of 35 can generally take their time progressing through treatments where those nearing 40 should get moving with IVF sooner than later.

Fast Track Continued

Other Common Reasons People Jump to "Advanced" Treatments

  • Trouble Carrying

    From genetics to the immune system, inflammation, and lining issues there’s lots to consider but most paths lead to reproductive immunology with IUI or IVF before moving on to gestational carriers.

  • Genetics

    Sometimes chromosomal abnormalities can lead to incompatibilities with life and cause miscarriage while others simply do not want to pass along a genetically related disease. IVF with genetic testing or donor eggs/sperm can help often help.

  • Sex Selection

    Some people choose to do IVF to choose the sex of their child. Some call this family balancing, others gender selection.  To do this, you will need to do IVF with genetic testing.

The Unfortunate Truth

Insurance Coverage

As bothersome as it is, insurance coverage often dictates how people progress through treatment. Many people have IUI coverage but not IVF coverage so spend a medically unadvised time on IUIs before progressing to IVF or other treatments that appear needed. Others may have no fertility coverage which can similarly alter one’s ability to pursue treatment.

FORTUNATELY, YOU’RE IN THE RIGHT PLACE. CNY IS THE NATION’S MOST AFFORDABLE FERTILITY CLINIC AND COUPLED WITH OUR IN HOUSE PAYMENT PLANS AND TRAVEL TEAM WE ARE HERE TO HELP WHEREVER YOU LIVE.

Learn moar about our Pricing and Plans