Frequently Asked Infertilty Questions

I had a friend post a FAQ on Adoption and I thought it was a great idea. I have been asked various questions over the last few years and I thought it would be helpful to post some of the answers that you might be wondering about. I would like to start by saying this post might contain some TMI so if you are weary stop reading here. I would also like to say that my degree is in accounting, and I was never premed or nursing, I have learned all of the following from our struggles with infertility. Let's get started with Infertility 101.

1. What does it mean to be infertile? That means that you have had consecutive unprotected sex for at least one year and have not become pregnant.

2. How did you know when to go to the doctor about not getting pregnant? I believe this varies for each and every husband and wife. Some people wait well past a year or two and some just a mere few months. I went to my regular obgyn in March 2008 and he referred me to St. Vincents small infertility clinic, I am now at ART program of AL.

3. What is the first thing doctors suggest when you say you cannot get pregnant? Most doctors recommend a round on blood work on both male and female as well as sperm analysis for the guy. Once the guy is cleared they know they can focus just on the woman.

4. Does your husband have to "collect" at the doctor's office? No, not necessarily. If you can be to your Docs office within 30-45 minutes, you are allowed to "collect" at home.

5. What kind of blood work do they do? Doctors offices typically look at hormone levels for both male and female. The woman always gets tested more often has our hormone levels tend to fluctuate more than a guys. Most likely a woman will have your estrogen, progesterone, prolactin, thyroid, and others evaluated on your first visit. Oh lets not forget they will check and make sure that you don't have HIV or AIDS...I laughed at that testing.

6. What is clomid? Clomid is a pill that is usually prescribed to most infertility patients as a first round of treatment (can be bought at a normal pharmacy). The medicine is administered in dosages of 50, 100, & 150. It is usually recommended to only take for 6 months, after that you should move on to injections. I do know of people who couldn't stand the thought of giving herself a shot every day so the doctors increased beyond 150 and kept trying past the 6 months.

7. What do you do if Clomid doesn't work? Most of the time doctors recommend doing an HSG (hysterosalpingogram). This is where they check to see if you a womans tubes are open by injected dye through your uterine cavity and watching it on an Xray machine. (I would recommend taking a medicine to relax you before this procedure. It tends to hurt while it is going on (about 5 minutes). Also, if you feel like you are going to urinate on the table and you just went to the bathroom, you're not going to go, it's just nerves and the medicine.

8. What if your tubes are blocked? Pretty much if your tubes are blocked, Invitro fertilization is the only option for you. There are some cases where the dye flushes any blockage in the tubes away.

9. If your tubes are clear, you ovulate on clomid and you are still not pregnant, what do you do next? Well most doctors would recommend trying an IUI (interuterine inseminations, basically artificial insemination). An IUI is especially useful if you scored low on the post coital test (looking to see how much cervical fluid you have during ovulation---PS cervical fluid (egg white) is a necessity for fertilization to occur).

10. What is an IUI and is it painful? An IUI is not painful, it feels like you are going for your annual woman appointment. Your husbands specimen will be injected to your uterus by a small catheter. (remember the the home collect kit, if your husband is nervous)

11. How many IUI's should you do before moving on to IVF? My doctor told me that after three rounds of IUIs, that the chance of that type procedure working for me was decreasing drastically. I don't know if this is the case with all doctors.

12. How much does it cost to do an IUI? IUIs can be covered by insurance, but most of the time they are not. The cost can vary depending on the doctors office, usually $200-400.

13. I thought doctors liked to do IVF more then IUIs, is this true? Yes it is true. Doctors have the greatest control on the number of potential embryos through IVF. If you are heavily stimulated in an IUI cycle, the doctors can't tell the swimmies not to fertilize all the eggs. In an IVF cycle you get to choose how many eggs go back in. Also the cost for the doctor is much higher in IVF (see 14)

14. How much does IVF cost? The cost of the procedure is around $8500. This does not include the medicine which can cost anywhere from $3,000 to $7,000. Some insurances will cover portions of the costs associated with IVF. Most of the time, insurances want proof of two years worth of trying and fertility treatment. (I am thankfully blessed with pretty good insurance)

15. What exactly happens in an IVF cycle? Well once you get to the part of stimulation medicine, you go to the doctor every two days. They do bloodwork and an ultrasound. The ultrasounds measure the size of the follicles (eggs are contained in follicles, but not every follicle contains an egg, sometimes it's only fluid--like a cyst). The blood work tells the doctors the most about what's going on. Your estrogen level rises as you approach ovulation. An estrogen level should be around 200 per mature follicle (this is 1.7cm). They also check your progesterone level. Your progesterone level increases in preparation for ovulation and implantation. You want your progesterone level to rise, but not before your follicles are big enough to have mature eggs. Ok back to IVF, once your hormone levels get to the right amount, you do what is called an HCG shot. Yes this is the same hormone that you produce once you actually become pregnant and yes it is also the same thing as the newest weight loss scandal is all about. HCG mimics the Luteinizing Hormone which a normal body produces. The LH tells your body to rupture the follicles and release the egg. 36 hours after HCG injection is egg retrieval. This is when they basically suction the eggs from your body. You are not put asleep for this, but they do give you some happy drugs.

16. What happens after egg retrieval? The eggs are fertilized with the husband's sperm. This can be done one of two ways. Through ICSI (one sperm injected by needle to center of egg) or through sperm penetration in a petri dish. Also, not all eggs retrieved will be of the right size, sometimes they will continue to grow over night (like mine did in June). Some practices monitor eggs for 3 days and some 5 days. In Birmingham the doctors do a 5 day transfer, meaning they let them grow in the incubators for five days before putting them back into a woman's body. Oh and don't forget the progesterone supplements and shots that will begin to help make your uterine lining the best environment, good and strong (this is also done with IUIs). After transfer, you wait...9 days later you get to do a blood pregnancy test (i.e. beta) to see if it worked.

Ok so I think that's all my FAQ or atleast that I could think of... If you have more questions please don't hesitate to leave a comment (you can leave it anonymously if needed).

I hope you all have a great night. I will try and post more tomorrow from my doc visit.

Samantha