A post ALL about Infertility. Edumucation time!!!

I'm sure I won't cover it all, but I wanted to do a quick educational post about IF and some of the procedures that me and other IFers are going through. 

If you have additional questions, please comment and ask. 

I will start out with my protocol with my IUI. Remember, every protocol is different and is tailored to each patient based on her/his diagnosis and response to medications. Some women start out at different treatments based on age and length of time TTC. Finances also play a factor in treatment as a great number of women are OOP, out of pocket, since most insurances do not cover treatments or medications.

Typically, patients start with oral medications such as Clomid or Letrozole/Femara. That can be combined with TI, timed intercourse, instructed by ultrasound monitoring and blood tests by the RE. These are my REs success rates for these treatments, so take them with a grain of salt. They vary slightly between doctors offices. For TI and pills, the success rate is low. For pills and IUI, the success rate is 9%. Keep that in mind because the average healthy couple who brings TTC has a success rate of 20% each cycle for the first year, so you can see that even with the basic medicated help, the statistics aren't promising. The general rule is that a healthy female under 35 should TTC naturally for a year before seeking medical help from a reproductive endocrinologist. If a woman is over 35 that time frame is 6 months. IF problems occur in approximately 1 in 8 women. 

Following the pills and TI, the next step is pills and IUI. If the female has good response to the pills and good sperm count this treatment could be used three times before moving onto injectable meds. Some patients skip the pills because of poor response or unfavorable side effects from the pills. Clomid is notorious for causing uterine lining problems, cysts, and over stimulation of the ovaries, a problem known as OHSS, which can cause permanent damage and even death in severe cases. OHSS can also be caused by injects too and this is why it is sooooooo important to be properly monitored by ultrasounds and bloodwork and also why no IF patient should be seen by an OB. REs are for getting you pregnant. OBs are for after you get pregnant. Simple as that. See a real fertility specialist if you have IF issues. 

A specific treatment is used three times before moving on to the next course. Once the three times had passed, the chances of success are low enough that it doesn't make sense to proceed. 

For my injects cycle, I did a hybrid cycle of Femara 25 mg for cd 3-7 and of 37.5 IU of Gonal F, aka Follistim, for cd 7-12, Menopur on cd 13-14, trigger on cd 14 and IUI on cd 16. During the 2ww, I will be on progesterone from cd 18 through the entire 2ww. 

I won't speak to other meds except for mine, so I won't confuse you. Just as a point of reference, this protocol has a success rate of about 25%.

Femara is an oral med in pill form that is actually made to combat breast cancer. In its IF form, it is used to help women ovulate. It causes less problems than Clomid, which has the same basic purpose. 

Gonal F is a stronger form of injectable meds to assist in stimulating the ovaries to make more follies. Inside the follies, really known as follicles, is the egg. When a follie gets to mature size, somewhere above 20 mm, the follicle will burst and release the egg. 

Menopur is basically a supplement for the luteinizing hormone. In a normal cycle, when the LH increases, it tells your ovaries to release the egg. This is the hormone that is detected in OPKs. When you pee on these sticks and you get a positive OPK, otherwise known as an LH surge, then it means your body is about to O. Typically, O will happen 12-24 hours after a positive OPK. Many women get multiple positive OPKs in one cycle. Bodies can have an LH surge but still not O. That's why these little pee sticks can't be depending on to determine O. The only true way of confirming O is by taking your basal body temperature, bbt, or by bloodwork and US monitoring. OPKs are helpful because they can narrow down the days you need to have sex, especially in the time when having sex isn't fun anymore and it becomes a chore, so you're not having sex on days when you're not fertile. The Menopur was prescribed to pump up my LH as a supplement. 

After that I took a trigger shot of HCG. The trigger is used to help time the IUI or even help time sex on a TI cycle. When that shot is given, you will O approximately 36-48 hours following the shot. IUIs are timed about 24-36 hours after the shot so the sperm are in the right spot waiting for the egg when it drops. 

If you've seen women talking about testing out their triggers, here's what that means. Triggers contain HCG, which is the same hormone your body produces when you're pregnant, therefore a trigger will turn an home pregnancy test positive.  The HCG leaves the system as the 2ww progresses so some women have tested it out and see it gone, proven by a negative hpt around 8dpo. However, triggers can remain in the system for longer and if it's not tested out, it can produce a false negative. Sometimes the second line on the hpt never completely disappears if it turns into a BFP, but a true BFP will turn darker each day as the pregnancy progresses. 

Seen above, this is a OPK 1dpt (1 day post trigger) and a hpt at 4dpt and 2dpiui (2 days past IUI).

If my trigger disappears and a second line returns, then it can be assumed that it is a true BFP. 

Theoretically, BFPs can be seen after implantation, which occurs at 7-10 dpo. But, the chance of seeing a BFP at 10dpo is about 35%. Every day you wait to test after that increases the chances that the test answer is valid. You could get a BFN at 11 dpo but then get a BFP at 13 dpo. It doesn't mean the test at 11 dpo is false. It means that you didn't wait long enough for your body to produce enough HCG to register on a hpt. 

Lastly, there's progesterone. It's another hormone that's produced naturally. Bodies produce progesterone during the 2ww. It's the evil hormone that is responsible for all your period symptoms. It makes your boobs sore. It makes you hungry and angry. But it also does good things when you're trying to get pregnant. It helps the embryo implant and helps keep you pregnant. Early miscarriages are sometimes thought to be because of a progesterone deficiency. Progesterone decreases before AF and when it drops, AF comes. The level of progesterone also indicates how strong ovulation was. At 7dpo, a P4 blood test is done. P4 should be above 10 on a natural cycle and above 15 on a medicated cycle. 

Make sense? 

Clear as mud? 

Lordie that was a long lesson based on one person's protocol. Gah, I would hate to even touch the topic of IVF. Quick explanation of difference between IVF and IUI is this. IVF uses eggs and sperm in a medical procedure to put them together. They're transferred back into the body days later after they've fertilized. IUI is when the sperm are put into the uterus to wait on the egg to drop in its natural path. There's much more to IVF but that's a simple explanation. 

Sooooo...if you made it through this ridiculously long post, you get a cookie. I have plenty to share.

For more information about TTC and IF, please visit these sites:

www.resolve.org

www.fertilityfriend.com

www.tcoyf.com

EDITED TO ADD: This 2:30 am post is brought to you by the wonderful world of night shift and by Gonz, who requests that I post earlier in the day. Is this early enough, G? :)