Terms/Acronyms
AMA - advanced maternal age (usually over 35 yrs)
AMH - anti mullerian hormone (link for info)
ART - assisted reproductive technology
AMH - anti mullerian hormone (link for info)
ART - assisted reproductive technology
BBT - basal body temperature/thermometer
BCP - birth control pills
BFN/BFP - big fat negative/positive
b/w- blood work
CD - cycle day
CM - cervical mucous
DOR - diminished ovarian reserve
DOR - diminished ovarian reserve
DPO - days past ovulation
DX - diagnosis
DX - diagnosis
E2 - Estradiol (basically your follie growing hormone)
Endo - endometriosis
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
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)
OOP - out of pocket (aka your insurance company is screwing you royally)
OPK - ovulation predictor (kit)
PCOS - polycystic ovarian syndrome
PUPO - pregnant until proven otherwise (term used after ET)
PUPO - pregnant until proven otherwise (term used after ET)
RE - reproductive endocrinologist (aka a fertility specialist)
SA - semen analysis
SA - semen analysis
SHG - Sonohysterogram
TCOYF - Taking Charge of Your Fertility (an AWESOME book)
TI - Timed intercourse
Triggering - taking a hcg shot that forces ovulation ~36 hours later
Triggering - taking a hcg shot that forces ovulation ~36 hours later
U/S - ultrasound
Testing
Ok, so you think you need to start talking to your doctor about infertility testing. Way to go! It can be really hard to make it to this step. Infertility is defined as: the inability to conceive or carry a pregnancy to term after 12 months of trying to conceive. If you are over the age of 35, the time of trying to conceive is reduced to 6 months (http://www.resolve.org/infertility-overview/what-is-infertility/).
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 (mine went in through my belly button) 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.
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 (mine went in through my belly button) 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 (here's my personal experience: link), 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.
Now what a lot of people are interested in: Costs.
These are general estimates based on my own personal experiences.
Medicated + TI: $500-900
Medicated + IUI: $700-1500
Injects + IUI: $1000-3000
IVF: $8,000+
None of these estimates include the cost of medications. Once you enter the realm of injects, medications can cost hundreds to thousands of dollars extra EACH CYCLE.
For information/training on injections, click here.
Questions to ask at your first appointment:
1. What does your typical monitoring consist of with the treatment plan you have for me?
2. What are your operating hours? Weekend hours? Holiday hours?
3. Will I be seeing you or a nurse usually?
4. How long does it take to get lab results back?
5. Do you repeat tests after a certain amount of time? (some clinic's have patients do repeats of CD3, 7DPO, and SA's every six months or year)
6. Do you have a website with information for patients?
7. What is the best protocol for contacting you/your office after hours? Is there a charge for this if it's not an emergency?
8. Do you have your own surgery center or will surgeries/procedures be done elsewhere?
9. Will I ever meet with the other doctor's in the practice (if there are other's)? If no other doctors in the practice - How do you handle your own personal absences since many IF related appointments are time sensitive?
10. Do you have an email address where I can directly contact you if needed?
11. What are payment options? Is all payment due at time of service or can we do payment plans? Is there a discount for paying in advance?
12. Do you have a list of preferred pharmacies for IF medications?
13. Should I still go see my obgyn for my regular appointments (pap smear, yearly appt, etc) or will you do all these exams?
14. What is your waiting room policy? Can I bring more than one person with me to appointments? For those with children - Do you allow children in your office/waiting room?
15. Can I have a copy of your most recent statistics studies? (typically only for IVF patients)
16. What is your opinion on drinking during treatments? Should I alter my diet? What about caffeine?
17. What is your opinion on chiropractic care? Acupuncture? Herbal remedies?
18. Are OTC prenatals good enough or do you require a rx prenatal while doing treatments?
19. Do you have any letters (or emails) of recommendation?
20. Do you ever have trials/studies done that someone with my diagnosis could participate in? Will I get any compensation for these studies?
Just a reminder: I am not a medical professional. All the info here is based on my own personal experiences, experiences of friends, and research I have done. Please consult with your doctor before making any medical decisions.
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 (here's my personal experience: link), 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.
Now what a lot of people are interested in: Costs.
These are general estimates based on my own personal experiences.
Medicated + TI: $500-900
Medicated + IUI: $700-1500
Injects + IUI: $1000-3000
IVF: $8,000+
None of these estimates include the cost of medications. Once you enter the realm of injects, medications can cost hundreds to thousands of dollars extra EACH CYCLE.
For information/training on injections, click here.
Questions to ask at your first appointment:
1. What does your typical monitoring consist of with the treatment plan you have for me?
2. What are your operating hours? Weekend hours? Holiday hours?
3. Will I be seeing you or a nurse usually?
4. How long does it take to get lab results back?
5. Do you repeat tests after a certain amount of time? (some clinic's have patients do repeats of CD3, 7DPO, and SA's every six months or year)
6. Do you have a website with information for patients?
7. What is the best protocol for contacting you/your office after hours? Is there a charge for this if it's not an emergency?
8. Do you have your own surgery center or will surgeries/procedures be done elsewhere?
9. Will I ever meet with the other doctor's in the practice (if there are other's)? If no other doctors in the practice - How do you handle your own personal absences since many IF related appointments are time sensitive?
10. Do you have an email address where I can directly contact you if needed?
11. What are payment options? Is all payment due at time of service or can we do payment plans? Is there a discount for paying in advance?
12. Do you have a list of preferred pharmacies for IF medications?
13. Should I still go see my obgyn for my regular appointments (pap smear, yearly appt, etc) or will you do all these exams?
14. What is your waiting room policy? Can I bring more than one person with me to appointments? For those with children - Do you allow children in your office/waiting room?
15. Can I have a copy of your most recent statistics studies? (typically only for IVF patients)
16. What is your opinion on drinking during treatments? Should I alter my diet? What about caffeine?
17. What is your opinion on chiropractic care? Acupuncture? Herbal remedies?
18. Are OTC prenatals good enough or do you require a rx prenatal while doing treatments?
19. Do you have any letters (or emails) of recommendation?
20. Do you ever have trials/studies done that someone with my diagnosis could participate in? Will I get any compensation for these studies?
Just a reminder: I am not a medical professional. All the info here is based on my own personal experiences, experiences of friends, and research I have done. Please consult with your doctor before making any medical decisions.
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ReplyDeleteIVF fertility treatment helps in bringing the joy of parenthood to most of the patients’ life. But before proceeding for the treatment, it is always advisable to know basics about the treatment. It will help to know what action/precautions should be taken while moving forward with the IVF treatment.
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