A friend of mine created a blog about Infertility Basics. I thought I'd share some of her info along with some tips and tricks I've learned in the last 16 months.
First let's start off with some acronyms so that way your not confused by this post and many others.
ART - assisted reproductive technology
BBT - basal body temperature/thermometerBCP - birth control pills
BFN/BFP - big fat negative/positive
b/w- blood work
CD - cycle day
CM - cervical mucous
DPO - days past ovulation
DX - diagnosis
E2 - Estradiol (basically your follie growing hormone)
ED- Erectile Dysfunction
Endo - endometriosis
EOD- Every other day
ER/ET - egg retrieval/transfer
FF - fertiliy friend - www.fertilityfriend.com
FMU - first morning urine
Follie - Follicles (basically your eggs - or what your eggs grow in - kind of...)
FSH - follicle stimulating hormone
HCG - basically the pregnancy hormone - will be given as a trigger for ovulation
HOM - high order multiples
HPT - home pregnancy test
HSG - Hysterosalpingogram
IF - infertility
IUI - intra-uternine insemination
IVF - in vitro fertilization
LAP - laparoscopy
LP/LPD - luteal phase/ LP defect
MFI - male factor infertility
MH- My Husband
O - Ovulation
OBGYN/GYN - Obstetrician/Gyno (aka your girly bits dr)
OHSS - Ovarian hyperstimulation syndrome
OOP - out of pocket (aka your insurance company is screwing you royally)
OPK - ovulation predictor (kit)
PCOS - polycystic ovarian syndrome
PN- Prenatal Vitamin
RE - reproductive endocrinologist (aka a fertility specialist)
SA - semen analysis
SHG - Sonohysterogram
TCOYF - Taking Charge of Your Fertility (an AWESOME book)
TI - Timed intercourse
U/S - ultrasound
Trying to Conceive Tips
(Obvs I am not pregnant yet so these are not get pregnant quick tips but just some things to help you understand your fertility, and some helpful advice I've learned a long the way.)
When I started TTC I started taking a prenatal vitamin, I think a multi-vitamin is always a good idea so just change your Multi to a PN.
Find out when you are ovulating
- Chart your Basal Body Temperature (you can purchase a cheap BB Thermometer from Walmart) Make sure you take your temperature at the same time every morning and after at least 3 hours of solid sleep. My favorite website to chart your BBT is Fertility Friend. They make it easy and have lots of lessons to help you understand your body better.
- Use Ovulation predictor tests. You can purchase ovulation tests in bulk online to make it more affordable. Ovulation kits measure the amount of Lutenizing Hormone in your body. Right before you ovulate your body releases a large amount of LH. The test kits are easy to use. They are very similar to a pregnancy test. You will have a reference line and then a sample line to compare that to. Once you show a positive test for ovulation you should have intercourse within twenty-four hours.
- Watching your body's signs of ovulation check your CM and look for EW and Watery CM. FF can help teach you how to check your cervical position as well as your cervical mucus.
- Read TCOYF to learn more about your body, ovulation, and fertility
Sex Timing
- A lot of people suggest every other day sex around ovulation time. Other's say Every day sex. Really as long as you have sex 1+ times around ovulation you have a shot! MH and I have always tried to keep sex fun and not make it about making a baby (even though it really is) so we have sex when we want to. It usually is about EOD anyway so that works for us.
Different things I've heard about
- PreSeed is a great fertility friendly lubricant
- The Husband can eat pineapple core before sex and the wife can eat it after ovulation to help with implantation
- The wife can drink Pomegranate juice or Green Tea
- Remain lying down 20 mins after well TI. Go to the restroom after that! ;)
- I know this is a hard one but try to not stress about TTC
- Another hard one but losing weight (if you need to) can't hurt
- I've read that Wheat germ can help to "normalize" your cycles
- Watch the Great Sperm Race
Testing
If a year or 12 cycles passes (6 months 35+) and you are not pregnant yet you can start testing to see if there is an underlying problem. In our case we knew that I have PCOS, but we did some additional testing to check to see if any other problems were occurring. (Most Testing & Treatment information from Slick)
If you think you need testing, I'd see how much your OBGYN is willing to work with you. I would first ask for CD3 b/w, 7DPO b/w, and an u/s. All of these things can be done within the same cycle. CD3 b/w can typically be done on CD2-4, so if CD3 falls on a weekend, you should be able to work something out. Now with 7DPO b/w, do NOT let your OBGYN or one of the nurses confuse this with CD21 b/w. CD21 b/w is only useful if you O'd on CD14. The only way for you to CONFIRM ovulation is by charting your BBT (www.fertilityfriend.com is a great website for this). OPK's do NOT confirm ovulation and most RE's are not satisfied with only that information. Your blood work will be checking your hormone levels, thyriod, blood sugars, etc. The u/s will check for any major uterine abnormalities and the overall look of your ovaries.
If you want a SA (semen analysis) can also be done this cycle. I would make sure to do this before any more invasive tests are ordered for you as this test is SOOOO easy and relatively cheap OOP.
Ok, so those tests came back. Now, if you're still not pregnant (and if it's been a year of well timed sex), then get thee to a RE!!! Once there, they'll probably take the reigns but if not, ask for a HSG or SHG next.(have you noticed that I haven't mentioned treatments yet...yes, that was on purpose - no treatments should have been ordered yet) This will show a more in depth look of your uterus and check to see if your tubes are all clear.
If this comes back clear, then it's likely treatments will start... (see next section for more info)
The next step in testing is a LAP. This is a diagnostic surgery. It's very simple in surgery terms and most women have easy recoveries. Little cameras will be inserted through small incisions in your belly and they'll look around. This is the only way to definitively diagnose endo and other issues. It will also give them a look at other organs around the uterus and inside.
Sometimes your doctor, whether new or old, might order repeats of tests. This is especially true of shady SA's. If you get bad results with those a repeat will almost always be ordered a few months down the road.
Treatment
Now you're in the treatment phase. Treatment will depend greatly on your diagnosis. Some people only require simple treatments and some will skip straight to IVF. It really just depends.
One of the most simple treatments is a medicated cycle with TI. Common medications for first cycles are Clomid and Femara. Here is the protocol that should be followed for almost any medicated cycle:
CD3: baseline u/s and b/w - this will be a check to make sure you don't have any cysts, your lining is appropriately thin, your blood flow to your uterus is good and your hormone levels are where they should be.
CD10-12: Follie check & b/w - this will check to see how and if your follies are growing and to make sure you aren't over responding (OHSS)
Then you'll go in every few days or so until you have mature follies. Then your RE will either instruct you on when to have sex or give you a trigger shot (to give yourself at home) so you'll O 36 hours later and know when exactly to have sex.
7DPO: this will be to check your progesterone levels. If your progesterone is too low, then you cannot sustain a pregnancy and then you might be put onto prog. supplements.
This monitoring might seem extreme but it is so so SOOOOO important. I don't know why anyone would want to risk their reproductive health when there are options to help. Many fertility medications (like Clomid) can be very dangerous. It can cause horrible cysts, thinned uterine lining which may be permanent, HOM (wanna be the next Kate+8?) and other awful side effects.
Ok, so you tried a few cycles of TI and it didn't work. The next step would be medicated cycle + IUI. You will follow the same protocol up until the sex part and then instead your husband will go give a sample about an hour before you go in to be sperminated. May the sperm be with you. There are varying levels of IUI protocol's. After Clomid/Femara there are then FSH injects. These increase the odds of pregnancy but then also increase the odds of HOM. They're also like liquid gold as the medications can cost thousands of dollars each cycle.
Next, if you and your RE feel that IUI isn't working and they want to go to the next step, that would be IVF. IVF is very invasive and very expensive. You will inject yourself at home (with similar drugs or the same drugs) as you used in an injects cycle. When your follies are ready you'll then go in for an egg retrieval. This is where your RE goes in and removes your eggs - as many mature ones as they can. This might be 20 or it might be 3. Of course higher numbers mean more chances but there are no guarantees. After the eggs are retrieved, they will be sperminated by your RE with your husband's sperm. They will then closely monitor your new embryos. Depending on the quality of your embryos that were fertilized (if any) they will transfer them back in 3 or 5 days after (I've also heard of day 6 transfers). Now, make sure you have a responsible doctor and only transfer 1 or 2 (mayyyybe 3). Don't go Octomom on us and transfer 10, mmmkay?
Now, that was an extremely sugarcoated version of IVF. It's painful, emotional, expensive, and hard. I've never been in that situation but know a few people that have been through it.
Costs.
These are general estimates based on my own personal experiences as well what I've heard from friends and patients Medicated + TI: $500-1,000
Medicated + IUI: $700-1500
Injects + IUI: $1000-3000
IVF: $9,000+ (each time)
FET: 3,000+
I hope this information was helpful to someone, and at least informative to any others wanting to learn more about Fertility.
