Monday, November 3, 2014

Fertility Treatments 101


Hello Little Momma, and again, Happy National Adoption Month! 

 Like I said in this weekend’s post, adoption and infertility have a special place in my heart, so you can expect them to be common threads throughout this parenting blog. In honor of National Adoption Month, there will be an increased concentration of Adoption information this month in particular, however in order to keep my families story chronological, I will actually begin this month talking about infertility and then bridging into what we learned in our journey in regards to Adoption. This RESEARCH piece in particular, will specifically address fertility treatments.
(Just to be clear, this post is about fertility treatments which mean the content is regarding reproductive health.)

Since high school sex education might be a distant memory, let me start by reminding you a bit about pregnancy. On average a women without fertility issues will ovulate one egg a month. In other words one of her ovaries will release the most mature egg into the fallopian tube where it will travel to the uterus. The exact moment of ovulation refers to the 12-18 hours {sometimes up to 24 hours} that the egg is available for fertilization. This small window of ovulation is the only time during the entire month that the egg can be fertilized. It’s amazing anyone ever gets pregnant, right?!? Well, an interesting fact is that sperm can survive in the female reproductive system for 3-5 days {sometimes up to 8 days} and wait for ovulation to occur in order to produce a fertilized egg. Fertilization is however only part of the journey. Now the fertilized egg, or embryo, must finish its trek through the fallopian tube and nuzzle itself into the uterine lining {this is called implantation} in order to allow for the continued development into a beautiful baby!

There are many different reasons why couples experience infertility, but basically one of the above steps is just not lining up. Fertility treatments are thus designed to…

a.)    Assist the couple in creating an ideal meeting between an ovulating egg and a healthy sperm.

and/or

b.)    Assist the female body in creating an ideal environment for the embryo to implant and continue to develop.

(Fertility treatments are administered by doctor’s and trained medical staff. It is important that you trust your doctor as it is his/her job to design a treatment plan and prescribe a medication regimen individualized to your case. The following is designed to be informative, but cannot, and should not be viewed as a treatment plan.)

Clomid

Clomid is a mildly aggressive form of fertility treatment. It is a small pill used to stimulate the ovaries to prepare more eggs for ovulation.  This is clearly a valuable tool for women whose ovaries are not releasing any eggs as it increases the chance that there will be at least one egg available for fertilization. It is also used for women who are ovulating, but are for some other reason is not conceiving. In this case Clomid is used to increase the opportunity for fertilization by encouraging the body to release approximately 2 -5 eggs, give or take.  Clomid can be prescribed independently, or it can be used alongside other treatments. A doctor will instruct the patient when to start taking Clomid and how much to take, but generally speaking a women taking Clomid will start on day three or five of her period and will take 1-2 pills for 5 days.

Human chorionic Gonadotropin (Hcg) or Trigger Shot

If a doctor prescribes an HCG trigger shot, he/she will first use an ultrasound to identify when the egg(s) that are maturing in the ovary’s follicles are nearing full maturation. This will help them determine when the best time for the patient to take the HCG. The HCG will cause the final maturation of the egg(s) and prepares it(them) to leave the ovary. This is incredibly useful because it allows the patient and her medical team to control when the ovulation window occurs. This information is crucial in IUI & IVF (see below) because it sets the timeline for each step thereafter. This alone can also benefit women who are not ovulating regularly. (Common generic names for HCG are Profasi, Pregnyl, or Noveral)

Video I Used: **
How to Self-Administer Fertility Treatment HCG (Noveral)

(**Your medical team will demonstrate how to use all of the medications you are being prescribed. Personally, I liked to use videos just to help me keep everything straight. I would search for instruction videos for the exact name on the medication I was prescribed. Please do everything your medical staff tells you to do weather or not it is the same as you see in these demonstration videos. These videos are simply tools, NOT medical advice!)

Intrauterine Insemination or IUI

IUI is a moderately aggressive fertility treatment that I lightheartedly refer too as the “turkey baster” procedure. The male partner provides his sample, semen, which they “clean” until only the sperm remain. The doctor will then insert the sperm into the uterus via the vaginal canal using a syringe & catheter. Because this is typically done with an HCG trigger shot, the idea is that IUI puts everything where it should be at exactly the right time, as ovulation occurs. IUI can also be pared with an ovarian stimulator in order to increase the chances that a mature egg will be available for fertilization. (Clomid, as explained above, is an ovarian stimulator. Plus we will address even more aggressive ovarian stimulators in the IVF section.)

Progesterone

Progesterone injections can be given with any level of fertility treatment, with Clomid, IUI or IVF. Its goal is to help sustain a pregnancy by maintaining an ideal environment within the uterus for implantation and continued development.

Conventional In Vitro Fertilization or IVF

IVF is the most aggressive fertility treatment. With the exception of implantation, nearly every part of the conception process is controlled. This process includes several medications plus several scheduled internal ultrasounds and several blood tests used to monitor the stages of the process.

(The exact medications, dosages, and length of time they are to be administered vary based on the patient’s age, test results and the stimulation protocol they are undergoing. Again, the following is designed to be informative, but cannot, and should not be viewed as a treatment plan.)

There are five basic steps to IVF:

1.)    Ovarian Stimulation

·         Often times this process begins with a month of birth control pills. I know that sounds counter intuitive, but this step helps control the cycle and promotes resting of the ovaries.

·         An antibiotic, such as Doxyxyline, is prescribed for both the male and female patients in order to decrease the chance of infection during the IVF process. This will likely be taken up until the evening of the Embryo transfer

·         When doing IVF there is a need for ovarian stimulation beyond the scope of Clomid’s ability.  With IVF,  injectable medications that fall into the FSH or follicle stimulating hormone are used. Gonal-F, Follistim, and/or menopur are often used for IVF. This will likely be taken up until the HCG trigger shot.
VIDEOS I USED- **

·         In addition to FSH medications patients may also be prescribed Human Growth Hormone in order to improve the quality of the eggs retrieved. (This may be called Tev Tropin) This will likely be taken up until the HCG trigger shot.

·         Patients will also be prescribed an injectable medications used to stop your body from naturally ovulating in order to allow the IVF process to assume control the cycle. (This will likely be named Cetrotide, or Antagon) Antagon is a prefilled syringe which is nice because it does not require you to mix anything prior to injecting the medication.  This will likely be taken up until the evening of the Embryo transfer

·         Aspirin 81 (baby aspirin) may or may not be prescribed. Some doctors believe it helps achieve necessary blood flow levels to the reproductive system. This will likely be taken until the pregnancy test.

2.)    Egg Retrieval or (Oocyte Retrieval)

Once the ultrasounds and blood work show that several eggs have matured, the doctor will order the patient to take an HCG trigger shot (see above). Within 36 hours of the shot the patient will be taken into an operating room, under conscious sedation, for the egg retrieval procedure. The eggs are retrieved by ultrasound guided transvaginal needle aspiration. In other words a hollow needle which is equipped with an ultrasound is guided through the vaginal canal, out the wall of the vaginal canal, into the women’s body until it reaches an ovary’s  follicles to retrieve the eggs. The number of eggs retrieved varies based on the patient’s age and their response to the ovarian stimulation. While some eggs retrieved will likely be immature or even degenerate, most are expected to be mature.

On this day, the male partner will need to provide his sample, semen, which they “clean” until only the sperm remain.

In order to prepare for the transfer, Progesterone will now be prescribed to create an ideal environment for implantation (as explained above). This will likely be taken up until the pregnancy test, and if the patient is pregnant it will likely be taken through week 10 of the pregnancy.

3.)    In Vitro Fertilization

This is where the embryologist comes in to work his/her magic. The eggs will be placed in a culture medium and incubated for several hours. Than the sperm that was collected will then be placed in the culture along with the retrieved eggs. The sperm are than allowed to naturally fertilize the eggs. About 12-18 hours later the embryologist will examine them for evidence of fertilization which typically occurs in approximately 70% of mature eggs. Once confirmed, the Embryo transfer will be scheduled for approximately 3-5 days after the egg retrieval. Between the time of the scheduling phone call and transfer day, the embryologist will keep a constant eye on the fertilized eggs, or embryos, to track their development. Unfortunately some will experience arrested development and will no longer be viable for transfer. The doctor, embryologis,t the patient and the patient’s partner will determine how many of the viable embryos will be transferred, typically 2. If there are remaining embryo’s the patient will need to decide to either have them frozen for later use, discarded, or donated to another couple in need.

4.)    Embryo Transfer

The embryo transfer is done exactly like the IUI, except that instead of using the syringe and catheter to inject sperm, the doctor will be injecting the predetermined number of embryos. At this point the patient will be prescribed Estrace tablets to be taken about 3 times a day to help build and maintain the endometrium lining in the uterus. This lining will be where an embryo will implant in the event of a pregnancy. This will likely be taken up until the pregnancy test, and if the patient is pregnant it will likely be taken through week 6 of the pregnancy.

5.)    Blood Draw for Pregnancy Test

The big day! The blood will be drawn and analyzed. Patients will likely be given the option of waiting in the waiting room until the results are ready, or leaving the office and thus receiving the results by telephone.

In Vitro Fertilization with Intracytoplasmic Sperm Injection or IVF with ICSI

This procedure is identical as conventional IVF with one exception in the 3rd step. In conventional IVF the sperm were placed in the culture with the eggs and left to fertilize the eggs naturally. When a patient opts for ICSI, an individual sperm is injected directly into each mature egg. This form of fertilization can result in up to 80% of the eggs being fertilized. This is particularly beneficial to those patients who have a partner with male factor fertility problems.  (He may have too few sperm, the sperm may not be shaped correctly or move in the typical fashion, or the sperm may have trouble breaching the eggs outer layer.)

Assisted Hatching

An embryo has a protective layer called the zona pellucida. In order for implantation to occur, the embryo must “hatch” out of this protective layer. If a patient opts for Assisted Hatching, a tiny hole will be made in the zona Pellucida to assist the embryo in its hatching process, thus encouraging implantation.

***VIDEO
The following video is a great visual explanation of IVF’s 3 central steps, ICSI, Assisted Hatching, and the freezing of embryos. This is a video I watched several times, and had those close to me watch several times, in order to fully grasp these treatment processes. I hope it adds to the picture I have painted for you in this research piece.

 

Fertility treatments are riddled with very personal choices that must be made by each individual patient and her partner. If you have any specific questions that are not answered in this research piece, please feel free to ask me in a comment here on the blog, on the blog’s facebook or via email at littlemommamoments@gmail.com. I hope this piece was clear and informative. Please know I pray for my readers and I specifically say a special prayer for those who are living through infertility. Please don’t ever lose sight of hope! Subscribe via email to Little Momma Moments in order to hear about my personal journey through infertility.

Love,
Little Momma, April Faith

1 comment:

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