Infertility 101

So you’ve been diagnosed with infertility?

First of all I want to say that I’m sorry you are finding yourself here. It’s not easy. But know you’re not alone.

I know when we first figured out we were going to have to walk this journey I was completely clueless as to what that meant emotionally, financially, factually. After 3.5 years of appointments, treatments, googling, and reading forums I kind of sort of have a grasp on it. At least enough to share in hopes to help you understand, whether because you have started this journey yourself, know someone, or are simply curious.

First off there’s a lot of jargon and abbreviations to be familiar with:

RE= Reproductive Endocrinologist
ttc=Trying to conceive. (We’ve been ttc for 2 years)
dpo=Days post ovulation (I’m 9dpo and have noticed…)
cd#= Cycle day (I’m cd3 and my progesterone…)
hpt= Home pregnancy test
pos= Pee on stick
bfp= big fast positive! (pregnancy test)
bfn= big fast negative (what we all hate)
dh= dear husband (dd is dear daughter, ds is dear son)
af= Aunt flow (period)
cm= Cervical mucusĀ (important for cycle tracking)–with this comes the desired “ewm” or egg white mucus. Yup. It gets gross.
bmt= Basal metabolic temperature (important for cycle tracking)
bd= Baby dance (sex)
2ww= Two week wait (the time between ovulation and your period)

These are procedure specific and I’ll go in detail later:
IUI= Intrauterine insemination
IVF= Invitro fertilization
fet= Frozen embryo transfer
trigger= HCG shot

So you might see something like this:
My dh and I have been ttc for 3 years. We’ve done 2 rounds of iui and 3 rounds of ivf with no success. This is our 4th IVF with our fet done on cd12 by our RE. I did an hpt with a bfn 7dpo. I pos every day and I’m currently 2 days before af is due and I got a BFP!!!

It’s almost it’s own language.

What causes infertility?
LOTS of things. Some things are easily fixed via a supplement or diet change. Some things require procedures some are not fixable. Infertility might be that you can get pregnant but can’t maintain pregnancy, or you can’t get the embryo to implant, or perhaps you’re not ovulating at all. Or it’s a male factor cause–infertile sperm. I’ll cover the most common reasons starting with the men.

You’ll learn quickly that there’s actually a lot to know about sperm and all the numbers have to be in the normal range for viable odds of getting pregnant.

Sperm count–how many
Morphology–shape of the sperm
Motility–movement of the sperm

If any of those are low then your chances are also low. There are other factors to consider as well…thickness of semen, how long the sperm live, how fast they swim, etc. If men have low testosterone they will also have low sperm count. Testosterone replacement therapy actually makes the man infertile…so they will raise testosterone using female reproductive medications like HCG (pregnancy hormone) or clomid.

Common causes of female infertility:

Generally speaking the treatment for this is oral contraceptives as they help regulate hormones and make the symptoms better. Symptoms of endo are wacky cycles, abnormally heavy or light cycles, long cycle length, horrible cramps. Endometriosis itself is the growth of the cells lining your uterus outside of the uterus. We don’t know why this causes infertility, we just know that it does.

Since birth control is the opposite of what we want the next step is laproscopic exploration and/or removal. Unfortunately THE ONLY definitive way to diagnose endo is to look at it. You CANNOT diagnose this via an ultrasound or palpation. I’ve had general practitioners tell me they couldn’t feel anything so I didn’t have it. Well. I did. Stage 2 with lots of adhesions and I had it removed. I’ve also heard of women being told they didn’t have it because nothing showed on an ultrasound. Any respectable OB/GYN or RE knows that you cannot diagnose this without laparoscopic exploration. This is where they poke 3 holes in your abdomen and take a camera inside to look around. If anything is found they laser it off.

Polycystic Ovarian Syndrome (PCOS):

PCOS is a nasty disorder to have as it not only affects fertility but it messes with a lot of hormones. Women with PCOS tend to struggle with their weight and have a higher rate of diabetes. There are a lot of other crappy side effects and PCOS is worth an entire post in of itself. Treatment for this is symptomatic–treat symptoms and diet change. Getting pregnant with a PCOS diagnoses is a tough journey and I’m fortunate to not have PCOS though I do have polycystic ovaries.

What’s Normal?

A woman’s normal cycle lasts around 28 days on average. You ovulate around cycle day 12-16–the best time to bd. Next is the dreaded two week wait. If you’re trying to get pregnant you will probably be googling pregnancy symptoms constantly and wondering if there is any possible way to get a positive test so early after ovulation. You’ll be reading about implantation symptoms (which occur around 7-12 dpo). Some women get implantation bleeding which happens shortly before your period so it’s often confused as an early period. Your period marks cycle day 1 by the way. You generally won’t get your BFP until 9-16dpo depending on how much hcg your body is producing. Your HCG doubles every day or two so it’s easy to want to take a pregnancy test a million times.

Insiders tip: Amazon has super cheap pregnancy tests in bulk. They are just as accurate though more annoying. You have to dip them instead of pee on them. When you’re ttc hpts get very expensive because you’re probably going to get obsessive about pos. And ladies, I’ll tell you no matter how many times you go back and check that test won’t magically turn positive.

BEWARE of the pregnancy tests. People will tell you how impossible it is to get a false positive, but you’ll quickly learn within the infertility community how inaccurate that is. Blue dye tests are notorious for having this problem so save yourself heartache and stick with pink dye or digital.

Cycle Tracking

Tracking your cycle is important so you know when that sweet spot of fertility is. There’s a few things you can do.

Ovulation Predictor Kit (OPK):
These are kits you can by over the counter, or again in bulk online. The first few months you use them it’s wise to start cycle day 1 (when your period starts) until your next period. It works just like a pregnancy test where there are two lines, one dark control line and then a test line. The strips measure an “LH surge”. This is when your body produces the lutenzing hormone at it’s peak and ovulation should follow within the next 24hrs. This will show on the strips when both lines are equal in color or the test line can even be darker than the control line.

Basal Metabolic Temperature (bmt):
Lots of women use the bmt to track their ovulation and it seems to be the best indicator of ovulation. Again, it may take a few months to get a good picture of your cycle. There are many apps you can download that you can use to track your bmt and they can predict when you’ll ovulate the next month. With the bmt you’ll see a dip in temperature before ovulation and the a spike in temperature when you ovulate and will stay higher until your period where it should dip again. If it stays high that’s a good sign you may have conceived. The difficulty tracking bmt is that you have to measure it immediately and at the same time every day. As soon as you get and and move it throws off the temperature. The temperature change also isn’t huge it’s just a fluctuation from 0.5-1 degrees.

Cervical Mucus (CM):
Eww. Yes. Eww. However, it’s a great indicator of fertility. Your cervix produces different types of mucus depending where you are in your cycle. The best cervical mucus is called egg-white cervical mucus (ewcm) due to it’s uncanny appearance to egg whites. Your cm can be anywhere from sticky, to lotiony, watery, or dry. The best environment for sperm is indeed the thinner more slippery types of textures. Sticky and dry are the worst environment. You can check your cm in the shower by doing exactly what you think. Close to ovulation you’ll see a change towards ewcm and closer to your period it gets more sticky. Google images will help clear it up for you if you’re not sure.

All of these things combine will help you hone in on the most fertile days you have. However, even with the most perfect timing you only have at most a 30% chance of conceiving. Right? Totally stupid.

Infertility Treatment

Everyone has heard of IVF. We’ll get there, but there are a few more less invasive steps you can take first.

Fertility tracking is the first thing you can try, by using the stuff mentioned above. The next best thing would be medication.

Find a reproductive endocrinologist. They will run a bunch of tests to make sure your hormones are appropriate, that your ovaries are healthy, and uterus has no blockages or growths that would interfere with pregnancy.

Low progesterone is probably one of the largest hormonal issues. Replacing progesterone is simple–a pill or suppository. Low progesterone can cause a short lutenizing phase of the menstrual cycle–short second half between ovulation and menstruation. Extending that phase gives your embryo a chance to implant.

There are also medications that cause “hyper ovulation”. Letrozole (Femera) or clomid. You’ll have an ultrasound (vaginal) to watch where you are in your cycle and then you’ll take one of those meds for five days. This will stimulate ovulation increasing your chances at ovulating. Clomid is older and has a greater chance at multiples, but it also has a lot more side effects. Letrozole has comparable outcomes, but it a more gentle medication with less of a chance of multiples. I’ve done letrozole twice, but would like to try clomid next time. They will also do what’s called a “trigger shot” where you’ll take a dose of HCG to increase your success of conception.

Intrauterine Insemination (IUI):
With an IUI you’ll go through the medication regimen as above, but when the time comes to have intercourse you’ll actually do it artificially. They will collect a specimen from your partner and then insert it directly into your uterus to give those swimmers a better chance at survival, thus increasing chances of conception. It is said that with 3 cycles your chances can be as high as 80%. That being said, there are many women who have done several IUIs without success.

In Vitro Insemination (IVF):
IVF is much more invasive and costly rounding out to approximately $26,000. There are companies out there that will help finance costs which is helpful. With IVF your ovulation will be over stimulated and then the eggs will be collected. A sample from your partner will also be collected and at this point they can be combined and let things happen on their own or you can do ICSI where they literally inject the sperm into the egg. The embryos are allowed to grow to a certain point and then re-implanted. You can choose to implant 1-3 embryos, though most will strongly advise against more than 2 as each of those embryos have a chance at splitting into twins. Embryos that are left over are then frozen for another round or you can donate them.

Embryo Adoption:
Embryos frozen from IVF rounds can be adopted out to parents who are having difficulty conceiving. You can adopt embryos and they are implanted just like with IVF. You carry them and birth them just like your own babies. Personally, I love this.

That’s A Lot

Yes, there’s a lot of information. A lot to think about and a lot of money. Insurances don’t generally cover fertility treatments or medications which has made this road a bit slower than desired for my husband and I. So far we’ve spent over $10K on trying. It hits your pocket, but it hits your heart harder. Beginning this journey is an emotional roller-coaster and I STRONGLY recommend therapy. People will give you well intended advice and know it comes from a place of love though it is often ill-informed. The advice I hear the most is to stop thinking/worrying about it, because that’s when it will happen.

It’s easy to say this when you haven’t been on this road for years. It’s easy to say if you’ve never experienced it. It’s easy to say when you’re not taking hormone supplements that constantly remind you of why you are taking that pill. We had male factor infertility which required injections…not so easy to just forget that. But if we just “stopped thinking about it”, stopped the injections, then there would have been a 0% chance of pregnancy. It’s not that easy. There are days/months that I can give it up to fate/God. I know that things will happen when they happen how they happen and it will all be ok. I can be at peace with everything. But then I can also find myself in a lot of pain with my heart aching to be able to share Christmas with my child. Being sad that we are dealing with this does not mean we are not hopeful. It does not mean we are not joyful or grateful…believe it or not you can be both. I can mourn another month gone by without conceiving and still be thankful for my husband and my life. I can sob because I’m brokenhearted from feeling the emptiness that should be a child, and I can also find joy in others. Don’t let anyone tell you, you should feel how you’re feeling. Don’t let anyone tell you that it’s not ok to grieve this journey. It is what it is. And you’re not alone.