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