Not Quite IVF… but Not Quite the Good Ol’ Fashioned Way

After finding out that my husband had a low sperm count of 10 million as well as low motility, doctors recommended that we try Intrauterine Insemination (IUI) to increase our chances of being able to conceive.  I really didn’t know much about it, but I was excited to feel like we were at least taking a step in the right direction! 

As my doctor explained, the IUI is a procedure that places the semen directly into the uterus so they get a head start.  It is typically done when there is low sperm counts and motility so the little swimmers have a better chance of making it to nd attaching itself to the egg.  As it turns out, I was in the perfect place during my cycle to begin treatment right away. That, to me, was a blessing because it was one of the first times in a while that it didn’t feel like our future was on hold!       

As soon as my period started, I called up my doctor and the process began.  I took clomid on days three through seven, waited for the mid-cycle ultrasound on day 11 to find out I had THREE good-sized follicles around 18 mm.  The mid-cycle ultrasound is a transvaginal ultrasound that you become very accustomed to during infertility treatments.  Not the most comfortable thing, but definitely not the worst either! After the ultrasound, the nurse called to talk with me about deciding whether to continue with this cycle as there was an increased chance for multiples.  The idea of twins was pretty fun to think about… triplets was a little scary.  However, either way, I felt good about continuing and was pretty excited.  Three times the chance of it working, right? Around this time, I also began using the Clearblue ovulation kit I had purchased from Walgreens, waiting for that smiley face to show up and give the go ahead for the procedure.

Thirty-four hours later the smiley face came and we arrived at the doctor’s office.  Clinics usually give you the option to collect the semen sample at home, or in a private room at the office.  There are positives and negatives to both.  Collecting at the office is just a little awkward… actually really awkward, to say the least, but collecting at home doesn’t always give enough time to get back to the lab within the limited 30-45 minute window you have.  We chose to do the collection at the office because we were not about to take any chances!  My husband is a trooper.   It was then washed and evaluated, and the numbers came back looking great (can’t remember the exact numbers now, but the doctors were thrilled and so were we!). 

As soon as everything was ready, they directed us back to the room and instructed me to undress from the waist down, giving me a “disposable blanket” to cover up with (as I’m sure you can tell, there is not a whole lot that’s comfortable or invulnerable about tests and treatments with infertility).  The technician then gave another quick overview of the procedure.   The speculum was then inserted, followed by the catheter during which I felt mild cramping, then millions of sperm were injected into my uterus. This caused a little more quick, mild cramping. Then the procedure was done!  They recommend that I lay flat for the next 10-15 minutes. I, of course, chose to stay there for the full 15 minutes in hopes of increasing our chances for success as much as possible. 

After, we were sent home with a paper that literally prescribed sex.  Least expensive part of the whole process, and the best by far.  Different clinics give different reasons for this, but I for one loved having intimacy brought back into the process of trying to conceive, rather than just making conception a purely medical procedure. 

And so began the progesterone suppositories every night and the much dreaded two-week wait.  Unfortunately, at the end of the two weeks, we did not get the positive result we were hoping for.

We repeated the IUI two more times, the next two times we included letrozole, gonal-f (a follicle stimulating hormone that’s injected), and Ovidrel (an ovulation trigger shot).  I was pretty darn nervous for the shots (yes, the whole two of them), but luckily for me, Shauni (the President of Bundled Blessings) had already gone through IVF and was a pro! My husband was also kind enough to do the shots for me, because there was no way I was sticking a needle through my own stomach. 

In the end, the whole process was pretty simple, not too complicated, very little pain, and we had wonderful doctors to support us through the whole thing! 

-Rachel

Male Factor Infertility

Male Factor Infertility

            Male factor infertility can be attributed to approximately one-third of infertility cases.[1] There are many different factors that can cause male factor infertility. These include: azoospermia (absence of sperm cells), oligospermia (presence of only a few sperm cells), improper shape, slow motility, or sperm cells dying prior to reaching the egg. 2

In October of 2013, my husband was diagnosed with oligospermia and slow motility. When our doctor called to inform us of our test results, I honestly knew absolutely NOTHING about infertility, besides the fact that it existed. All of a sudden, our doctor was giving us all of these medical diagnoses that seemed pretty serious and letting us know that he was not really sure who we needed to see next for assistance. He informed us that it would probably be beneficial to see a urologist and that, if he could not help us, it might be helpful to see a reproductive endocrinologist. Umm… Who?? I had never even heard of these doctors before!

Our Diagnostic Testing:

But let’s rewind a little to how we got this diagnosis. At our first appointment, my husband was asked a number of questions such as, “Have you ever been hit really hard in the scrotum?”, “Have you ever had surgery completed in your scrotum area?”, “Have any males on your side been diagnosed with infertility?”, etc. Then, they informed us that they would need to obtain a semen sample, which could be collected at home. Once collected, the sample had to be kept at body temperature and be brought into the lab within twenty minutes. On a good day, we can make it to the lab from our house in about forty-five minutes. So instead, we rented a nearby hotel and practiced driving back and forth to the lab just to make sure that we would make it in time!

The results took about two to three days to come in. A few weeks later, another sample was collected and analyzed and the results were compared. My husband had 4.4 million sperm cells per milliliter on the first sample and 3.6 million sperm cells per milliliter on the second sample, which seemed like a lot if you asked me! But, to our surprise, it actually was not.

So, how many sperm cells are needed in order to become pregnant?

We soon learned that the average male ejaculates around 100 million sperm cells per milliliter! Technically, it only takes one sperm to fertilize one egg in order to achieve pregnancy. However, the process for this to occur is more grueling than expected. Once a sperm cell is released, it must first make the journey from the vagina into the fallopian tubes. This journey is very strenuous and only a few sperm cells are able to survive. For those that do survive, they must get past the thick layer that encompasses the egg in order to fertilize. Due to the high number of sperm cells that don’t reach the egg, men who produce less than 20 million sperm cells per milliliter of semen are at risk of infertility.3

However, the number of sperm cells isn’t the only thing that matters. In addition to this, the sperm cell must also be healthy and have adequate motility and function or it will not be able to make it to or enter into the egg. 4

What does a diagnosis of male factor infertility mean?

Thankfully, a diagnosis of male factor infertility does not always have to stop a couple from being able to conceive a child. Based on your diagnosis and specific circumstance, your doctor will be able to recommend what the best route for you and your partner may be.

-Shauni

Resources:

[1]American Society for Reproductive Medicine. (1996-2015). What causes infertility. Retrieved from http://www.reproductivefacts.org/detail.aspx?id=3018

2 Mayo Clinic Staff. (2015, August 11). Diseases and conditions male infertility.  Retrieved from http://www.mayoclinic.org/diseases-conditions/male-infertility/basics/treatment/con-20033113

3 WebMD Staff. (2005-2015). Sperm FAQ. http://www.webmd.com/infertility-and-reproduction/guide/sperm-and-semen-faq

4 Mayo Clinic Staff

Endometriosis

Endometriosis. We have all heard of it. And since approximately 5 million women within the United States have been diagnosed with it, chances are you probably know someone who has it. Perhaps it is you, your sister, your mother, or your best friend. So, what is this disease and why does it affect fertility like it does?

Endometriosis, according to the Mayo Clinic, is “ an often painful disorder in which tissue that normally lines the inside of your uterus-the endometrium-grows outside of your uterus.”[1] Because this endometrial tissues acts just like it would while growing on the inside of your uterus, it thickens, breaks down, and bleeds with each menstrual cycle. However, since it is inside the abdominal cavity instead of the uterus, it has no way to exit. As it sits and brews in one’s abdominal cavity, it can cause cysts to grow on the ovaries or scar tissue and adhesions to form on the abdominal walls and organs.

            Most women who have Endometriosis experience intense pelvic pain, especially during their menstrual cycle. This pain is often accompanied by excessive bleeding. Some women experience pain during intercourse, bowel movements and urination, while others experience fatigue, diarrhea, constipation and bloating.[2] Each woman’s experience with Endometriosis is unique and different. One thing that is important to remember is that one’s level of pain is not necessarily an indicator of how severe their endometriosis is. One woman may experience severe pain, but only have moderate endometriosis, while another woman may experience little to no pain, but have severe endometriosis.

            Endometriosis is categorized into four different stages created by the American Society of Reproductive Medicine. These stages allow medical professionals to accurately and more consistently diagnose between professionals.

The Stages are as follows:

·      Stage 1- Minimal

·      Stage 2- Mild

·      Stage 3- Moderate

·      Stage 4- Severe

The stage of Endometriosis one has is determined by the location, depth, amount, and size of the endometrial implants.[3]

            So, how does Endometriosis affect infertility? Endometriosis is considered to be one of the top three major causes of female infertility.[4] For some women who have mild cases of endometriosis, the infertility may be temporary and is often solved with surgery to remove adhesions. In other more severe cases, the woman may remain infertile. This is often thought to be due to scar tissue impairing the release of an egg from the ovary or preventing pickup from the fallopian tube.

            Although Endometriosis can be a scary thing, it can often be treated and there are many ways to help women manage the pain that may come with it. In addition, with the help of professionals, many women who struggle to conceive due to Endometriosis are still able to find ways to have a family.

-Kamryn

Sources:

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[1] Mayo Clinic Staff. (2013, April 2). Definition. Retrieved from http://www.mayoclinic.org/diseases-conditions/endometriosis/basics/definition/con-20013968

[2] Mayo Clinic Staff.

[3] Mayo Clinic Staff.

[4] Mayo Clinic Staff.

PCOS (Polycystic Ovarian Syndrome)

PCOS is an endocrine system disorder that can be difficult to diagnose at times, and is common for women who are within the reproductive ages to have. ¹ It’s estimated that between 8-10% of women are affected by PCOS, and among those affected by it, there is a high rate of infertility. Many women with PCOS have to turn towards various medical treatments in order to improve their chances at being able to conceive. ²

How do you know if you have PCOS?

Here are some symptoms that are commonly associated with PCOS:

           

·      Irregular cycles

·      Difficulty ovulating

·      Infertility

·      Excess level of androgens

·      Excess of facial and body hair

·      Acne

·      Male-pattern baldness

·      Polycystic Ovaries (Fluid-filled sacs/cysts)

·      Obesity (Not only a possible symptom, but can increase other symptoms as well)

·      Depression and Anxiety ³

Although PCOS has MANY unwanted and embarrassing symptoms that women are often ashamed of, the worst of them all for me was experiencing infertility and feeling as though my body was/is incapable of doing something so simple and yet so complex and miraculous as conceiving and maintaining a healthy pregnancy. Never have I felt so little control over something in my life than I have while trying to start a family with my husband. 

Diagnostic Testing:

For me, getting diagnosed with PCOS was quite the process!  I don’t present with all of the “typical” symptoms of a woman with PCOS, so many doctors I saw would simply say, “It looks like you could have PCOS”, but it seemed as though no one wanted to be the one to confirm it.  It took about two years of self-advocating to have tests done, to finally get some answers.   It’s a little unusual to feel relief for receiving a diagnosis, but that’s exactly what I felt!  I could finally move forward with this information and figure out the next steps to take. 

Some of the diagnostic testing included:

·      A transvaginal ultrasound (looking for enlarged ovaries and cysts)

·      Blood tests (looking at hormone levels such as testosterone levels, Anti-Mullerian Hormone, FSH, Thyroid, etc.)

·      Physical exams

·      Glucose/Insulin testing

·      Hysterosalpinography (HSG)

What can cause PCOS?

Although the cause for PCOS isn’t known for sure, it’s thought to be a combination of a few factors including genetics, insulin resistance, and diet.   Insulin resistance impairs a woman’s ability to use glucose (sugar) and causes the pancreas to create more. In addition, an unhealthy diet adds to the problem, as the body doesn’t know what to do with the extra sugars and unhealthy carbs that are added to the equation. ⁴

Taking the next step:         

Being diagnosed with PCOS can be overwhelming, as well as having any other infertility diagnosis, but fortunately there are plenty of resources online and doctors who specialize in infertility that can help inform us of different treatments and give us better knowledge on how to live a healthy lifestyle in order to greatly improve our chances of starting a family. 

-Rachel

           

References

¹ Mayo Clinic Staff. (2014, September 3).  Definition.  Retrieved from http://www.mayoclinic.org/diseases-conditions/pcos/basics/definition/con-20028841

² Sherbahn, Richard.  Polycystic Ovarian Syndrome, PCOS and Infertility and Pregnancy What is PCOS Syndrome? Retrieved from http://www.advancedfertility.com/pcos.htm

³ Mayo Clinic Staff.

⁴ Mayo Clinic Staff.