Thursday, August 20, 2009

Our New TTC Protocol, Part One: Yes, Women ARE Complicated!

I’ve often heard men say that women are complicated. Men, you have no idea! So read on.

There are basically four levels of assisted reproductive therapy ("ART"): (1) a medicated cycle, (2) intra-uterine insemination (“IUI”), (3) in-vitro fertilization (“IVF”), and (4) intra-cytoplasmic sperm injection (“ICSI”). Because timing, and everything after intercourse, relies so much on the woman’s body, medicated cycles alone can help women who have unexplained infertility, irregular, or unpredictable cycles. The medication also has a higher occurrence of more then one egg being released, increasing the opportunity for a sperm to fertilize an egg.

The average woman’s menstrual cycle is 28 days long, and she will ovulate (“O”) usually on cycle day (“CD”) 14. Ovulation refers to the release of a mature egg from an ovary. Cycle day one is the first day of a woman’s full-flow menstruation. These are the dates that conception, and therefore assisted reproductive therapies, are based on.

My cycles are rather predictable, with O arriving on CD 14 like clockwork (unless I get sick earlier in my cycle). They are a little on the shorter end, at 24-25 days long, but this is not short enough to be diagnosed with a defect because of it. Since we have moderate male-factor infertility (“MFI”), the least-invasive step that could help for my husband and I is IUI. In proceeding with IUI, many fertility specialists like to have the woman on medications also to make her cycle extremely predictable, stable, increase the number of eggs released to increase the odds, and make her as fertile as possible. It made me feel like a bionic baby-making machine!

Anyhow, I liken IUI to the turkey-baster method. This seems to be a working metaphor, and it sticks in my friends’ and family members’ heads so I don’t have to repeat the descriptions over and over again! It also contrasts nicely with the next step, which is IVF, or what I refer to as the petrie dish method. A quick description of IVF and ICSI: For IVF, the sperm are donated and treated as in an IUI, and mature eggs are extracted from the woman’s body, then the two are put in a container together, and hopefully, sperm meets egg there. ICSI is IVF with the sperm being injected into the egg(s). We have been told that if IUI doesn’t work for us after about three times, ICSI would be the next step.

So, back to our current cycle, new protocol and IUI. It all starts with me taking Clomid on CDs 3-7. As it was explained to me, Clomid acts like a little general in your brain telling it to stop listening to certain hormones and to listen to the Clomid instead, which mainly tells it to mature extra follicles (in which eggs are maturing). Side effects that I had from it included hot flashes, bloating, headaches, and blind spots (like stars you see when you get a concussion or a migraine). I have heard from other gals that modd swings are also very common, and the doctor warned me that the Clomid could thin out the uterine lining and decrease cervical mucus (which is an important fluid present around O that helps the sperm swim through the cervix and into the uterus). Because of the last couple of side effects from Clomid, the next drug is Estrogen, or Estradiol, which I took on CDs 8-12. The bloating continued, but the other side effects subsided. Starting on CD 11, I had to use an ovulation predictor kit (“OPK”) first thing in the morning, and as soon as we had a positive, call the clinic and go in for an intra-vaginal ultrasound (“IVUS”) to see how big my mature follicles are and how thick my uterine lining is, and from that, predict how close I am to O. We also had to abstain starting on CD 9 until the insemination, so that my husband could build up a good store of soldiers before making his deposit! They start you on CD 9 in case you have to get the IUI on CD 12, so that you have three days of storage, but I didn’t O until CD 14 (as usual), so it was a long time, I tell ya! And mind you, those days are your most fertile, so for the last two years, that’s been baby-dancing time! What a switch…

Next post will continue at CD 13 when we went in for my IVUS to check out the follies. Make sure to check back!


Monday, August 3, 2009

Misconceptions about Infertility (no pun intended)

Please let my lawyer-self come out for a moment and make this disclaimer: I am not a doctor or any sort of medical professional. The information I share in this blog is from my reading, experience, and layperson opinion. I will try to cite reputable sources as often as possible.

I want to tell you about our new plan/protocol that is now underway, but before I do that there are a few more general issues I’d like to opine about. In particular, I want to dispel some of the more common misconceptions about infertility. One of the reasons I think this is important to do is because I know I may have some friends and family members reading this who are unfamiliar with infertility.

Infertility is not rare. In the United States, ten to 15 percent of couples are infertile. (Mayo Clinic, at According to the Mayo Clinic, infertility is the inability to get pregnant despite having frequent, unprotected intercourse for at least a year. (Ibid.) Several papers I have read from various clinics and sources define infertility more specifically as the inability to get pregnant despite having regular, unprotected intercourse for at least a year under the age of 35, or for at least six months if 35 or older. If the man or woman is diagnosed with a fertility-impairing condition prior to that time, they also may be considered infertile. I have noted that the population usually tested consists of married couples in which the woman is of “child-bearing age”, or 15-44 years of age.

In my experience, people often blow off infertility as insignificant, something that only rarely happens, and not to them. But if ten to 15 percent of couples are infertile, that means that more than 1 in 10 of the couples you know have, are, or will be struggling to bear a child. Infertility has been a taboo subject for far too long, leaving these people feeling isolated, unsupported, and misjudged.

Another broadly misunderstood aspect of infertility is that “it’s a woman’s problem.” In this day and age, I haven’t heard anyone actually use this phrase, but it is inherent in the assumption that people make that if a couple is infertile, there is something wrong with the woman.

Numbers vary on the exact percentages of the frequency that infertility is caused by a woman’s problem, a man’s problem, both, or is unexplained. Personally, I believe part of this problem in getting an accurate representation is simply that, if a couple is having trouble getting pregnant, the woman is far more likely to go see the doctor about it and get tested. Also, many symptoms or signs of infertility in women are more easily noticeable than in men. The National Women’s Health Information Center stated: “About one-third of infertility cases are caused by women’s problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.” (

The third misconception I want to mention here about MFI (male factor infertility), is that a man’s fertility depends simply on his sexual performance, such that, if he has a fertility problem, he must not be a great performer in bed. On the contrary, all the stories I know about MFI entail men between the ages of 24 and 50, who have low sperm counts, morphology or motility, and are stallions in bed! (Their wives or partners have provided me with this data.) This includes my own husband. Enough said about that.

Watch for my next entry, which I plan on being about our new protocol.