In my prior blog about infertility/pregnancy loss (PL), I shared my story and what to expect emotionally when you’re experiencing infertility/PL. In this segment, we will explore what to expect if you pursue treatment from a fertility specialist.
During a discussion with Dr. Stephanie Gustin, a fertility specialist at the Heartland Center for Reproductive Medicine and partner of Dr. Victoria Maclin, she educated me on what couples experience when embarking on their journey towards building a family.
Initially, it’s important to know when it makes sense to be concerned.
For the healthy couple younger than 35, most physicians recommend attempting natural conception for one year. If you are a female over the age of 35, this is shortened to six months. For females 40+, fertility specialists recommend an early evaluation of maternal health before attempting to conceive. Early evaluations can help couples decide the best course of action to build their family, even attempting in vitro fertilization (IVF) from the get-go. This also allows couples to decide if they would like to freeze embryos should they wish to have more kids years down the line.
Health concerns that may allow you to seek early assistance include irregular cycles/unknown ovulation, severely painful periods, known history of conditions causing damage to the fallopian tubes, or a male knowing he may have a sperm issue.
So you’ve scheduled your consult with a fertility specialist, now what?
Before your appointment, you and your partner will fill out a health and reproductive history, including menstrual patterns/conception efforts, medical issues, and family/social habits. Be sure you’ve allotted at least one hour for this appointment. You will meet with a doctor in an office environment to discuss your file, broach concerns, and begin exploring treatment options. Be sure to have your list of questions so this consultation can give you the knowledge you need to move forward.
It is typical to begin bloodwork at this appointment. Bloodwork assists to create a foundation for the female’s hormonal access. Then, in an ultrasound done the same day, your ovarian reserve health (i.e., reproductive potential based on number and quality of eggs) will be assessed. You may expect multiple rounds of bloodwork in the future as well.
The two initial key focuses confirm that the female is ovulating, and the male has active sperm.
Don’t forget the swimmers. If you have a male partner, make sure he realizes the importance of his part in the fertility equation. Most doctors recommend two to five days of abstinence before semen analysis.
After you get poked (no pun intended) and speak with a doctor, you will meet with a financial specialist to discuss insurance options. Fertility science is a treatment for a medical issue; however, you will want to be sure to check with your insurance to see what they cover and discuss out of pocket expenses. For the most successful route to conceive (IVF), you might expect to spend $10,000-$12,000 per attempt. Other methods, such as intrauterine insemination (IUI), are cheaper. At the same time, their success rate is lower.
During a follow-up, mama, you can expect to undergo a hysterosalpingogram (HSG). This is when the dye is injected into the uterus to assess the uterine cavity and see how fallopian tubes function. Take ibuprofen, expect discomfort, and sit back so your fertility specialist can make magic happen.
Image by Darko Stojanovic from Pixabay
Now that you’ve been poked, prodded, and empathetically interrogated, what can you do?
Most patients are interested in hearing about lifestyle modifications that may impact their fertility. Let’s say you’ve decided to try IUI and/or IVF treatments. The first recommendation is to check your mindset. Yes, not conceiving is stressful in more ways than one. Yes, the process can cause anxiety and depression long before you get to this point.
So HOW ARE YOU?
Let’s chat statistics.
You’ve been copulating, met with a doctor, know without a doubt she or he will help you have a child. At the same time, doctors are human and can only control so much. So what’s a fair expectation?
The best odds for treatment, including IUI, fall between 20-25% per attempt. Before you begin this process, be sure to set yourself up with a strong support system and acknowledge that there will be ups and downs. This is rarely a one and done kind of thing. While IVF has higher success rates, it is more invasive and requires more diligent effort on behalf of the mother.
So if you and your partner are healthy with no known issues, you may choose to start with IUI with your fertility specialist.
IUIs are a milder form of IVF with intermittent ultrasounds/bloodwork to see what is developing egg wise and an ovulation stimulating medication, such as Clomid, may be on board. Once your follicles (egg houses) are large enough, mamas take a human chorionic gonadotropin (HCG) shot and complete the process 24-36 hours later. How does one complete an IUI? Well, the doc makes it a little easier for your guy’s swimmers to travel. A tube is inserted into the cervix, with the very best of the swimmers released directly into your uterus, giving them less ground to travel to the queen egg. With this method, you will find out if you’re pregnant in two weeks.
Ok. So we’ve shagged, done IUI, what about IVF?
The purpose of IVF is to persuade the ovary into developing follicles that will carry your eggs. Injections of the follicle-stimulating hormone (FSH), as well as the luteinizing hormone (LH – take home ovulation predictor kits, anyone?), encourage your body to make as many follicles as possible. These are completed on a daily or twice daily basis. As humans, we typically do not have litters of children—how animals do it, I’ll never know. However, for this process, the fertility doctors want to encourage many eggs to get ready for fertilization to give you the optimal chance of conceiving. Outside of giving yourself shots, you’ll be visiting your specialist for ultrasounds and bloodwork to monitor your response to the hormones.
Then the HCG trigger shot! Over 10-12 days, the shots you’ve taken have prepped your eggs for fertilization. The shot tells those eggs, get turned on, ladies, it’s time to meet your other half! Technically, the HCG shot triggers ovulation; however, your doc will retrieve your jet-set eggs before ovulation occurs. Egg retrieval is done approximately 36 hours after the trigger shot and completed under sedation. So be comforted, mamas. The process may send you on a hormonal rollercoaster, and shots may bruise your bum, BUT you get to sleep through the down and dirty part. I’ll spare you the details of what you’ll be sleeping through.
The morning of your egg retrieval, your partner (if they’re male) will provide your doc with a sample of swimmers. Then the petri-dish magic happens. Sperm and egg combine to become one, and the following day the melding of genes is revealed to see how many embryo cohorts you now have the option of carrying for the next 40 weeks. Once your embryos reach soccer ball status (six to seven days post-retrieval), they are ready to transfer or freeze.
Today, many fertility specialists do not prefer to insert more than one embryo as this can oftentimes result in women carrying multiple children, which may result in a high-risk pregnancy. However, you can freeze the rest of your babes for future use or donation!
After your soccer ball is transferred into your belly, you can expect to know whether you’re pregnant within a week!
As women, we generally carry the weight of infertility treatments, both emotionally and physically.
Let me try to take some of that burden off of your shoulders, mama.
Statistically and remarkably, infertility issues are equally spread across the board as far as root causes are concerned. Approximately one-third of known issues lie within the mama, one third within the papa, and one third are legitimately unknown! Don’t let this discourage you—be sure to meet with your local fertility specialist so that they can help you today.