“Dr. Aimee, how soon will I be able to get pregnant?”
This is the most common question I get from my patients. I get it. By the time you come to see me you’ve been preparing for pregnancy for a year, three, sometimes longer. I appreciate how emotional and tiring it can be to have a dream to start a family and encounter roadblocks to making it a reality. It’s one of the reasons I do what I do as I love helping people create the family of their dreams.
With pregnancy and getting pregnant there are simply no guarantees. The reality is it can be very hard for a lot of people. No matter what happens……I want you to remember that it’s going to be okay.
That said, I do want to share with you my strategies for giving my patients the best chance at pregnancy. I want you to know about the The Egg Whisperer D.I.E.T (Diagnosis, IVF, Endometrial Testing, and Transfer) and the importance of self-care and assembling your Fertility T.E.A.M. This includes finding trusted resources for Therapy, Exercise and eating, Acupuncture, and Mind body support through mindfulness, and meditation. Patients have the option to do acupuncture throughout this process. And my patients who do acupuncture report less side effects from the hormones compared to patients who don’t.
I want to share the daily things I do with my patients. My hope is that no matter where you live in the world you can learn from me and make the decision to apply this strategy to your situation.
With these 5 simple steps it doesn’t matter who you are, where you live, or who your doctor is, you can get these tests done. Understanding your fertility issues is key to a successful treatment plan.
How does this look on a calendar?
Your period starts. Call me and I’ll put in an order for your Hysterosalpingogram (x-ray study of the fallopian tubes). Imaging centers like to do this around cycle day 6 to 10. Make sure you know what the rules or parameters are for the imaging center you’ll be using.
If you’re seeing me as a new patient and you haven’t had your TUSHY checked, then we’ll always do an ultrasound of your uterus on the day of your first visit with me.
On day three of your cycle I’d want to check your hormones: FSH, Estradiol, and AMH. They tell us more about your egg quality. A preconception panel makes sure you don’t have a thyroid disorder, low vitamin D, or abnormal prolactin. We also want to screen for anemia and make sure you’re still immune to chicken pox, measles, mumps, and rubella.
When I look at Y (your genetic profile), I want to uncover a few different things. I’m looking for variants related to miscarriage, blood circulation, and immune response regulation to name a few. I also look at genes related to cancer and other genetic diseases like cystic fibrosis and heart disease.
I do all of these tests and get the results within a couple of weeks. Once results come in, I review the results with my patient and we talk about what we are going to do next and when. I also discuss other tests that could be helpful.
For example, should we look more closely at the uterus and do a hysteroscopy? Should we be do a sperm DNA fragmentation test to look more closely at sperm health?
I ask questions like:
Should we be taking supplements to improve egg and sperm quality like coq10? Should we be preparing for IVF treatment using drugs like HGH ahead of time?
These are the topics I like to discuss with patients after doing a TUSHY check. I like to also answer the following question: What does the fertility diagnosis tell me about the treatment I should offer my patient and what are the associated pregnancy rates? I make sure my patients know the answers to these questions because a more informed patient is a more successful patient.
If you use the strategies that I’m teaching you here it’s my hope that you have an increased chance of success. Your pregnancy rate and live birth rate can be over 70%.
What I’m sharing right now (see above) is something I’d make in advance. This is a mock calendar so you can see what your life would look like from the time your period starts to the day of a transfer.
At the baseline appointment (scheduled to occur cycle day 1 or 2 or even a few days earlier), we’ll review the protocol I’ve individualized for you and why. From start to egg retrieval there are 5 total visits:
- Baseline Visit: One hour visit to check hormone levels and make sure there isn’t a cyst. If there is a cyst then we wait a month, they are normal and can go away in a month. Some patients use IVF readiness pills (birth control) as they help patients schedule their visits ahead of time.
- Three Monitoring Visits: There are three of them, each 15 minutes long. Using an ultrasound I will look at your follicles to see how fast the eggs are developing. I’ll also give you a better idea of how many eggs we are expecting and when the egg retreival will be scheduled. We look to your ovaries to schedule the egg retrieval?—?they guide us.
- Egg Retrieval Day: You are asleep via IV sedation. You’ll check in 45 minutes before the scheduled retrieval. You’ll get prepared for the procedure with the help of a nurse. When I meet you, I will review the timeline, when to expect updates and answer any questions. We will go into the operating room together. I’ll place an ultrasound in the vagina and retrieve the eggs. By the time you wake up you’ll know how many eggs we were able to retrieve. At the same time your partner will be in the semen collection room.
Once you get home you’ll be wanting to take it easy, but 95% of my patients are ready to go back to work the next day.
After the egg retrieval day we’re able to learn how many mature eggs we retrieved, the fertilization rate, and sometimes we do a procedure called ICSI or PICSI where we can screen the sperm for the most viable swimmers.
Over the course of the next five days, we watch these embryos grow and I give my patients reports describing what we have and how we feel about it. What I also remind my patients is that it’s not over until it’s over. It’s easy to feel like you are losing eggs when for example 18 eggs turns into two embryos. I remind patients that it just takes one embryo for a healthy pregnancy down the road and that we had to grow 18 eggs to get the one or two strong ones.
5 to 7 days after the egg retrieval we do something called an embryo biopsy and freeze. The embryos stay in the lab after they are frozen. The genetic testing company will send us a report. In the near future there may be ways to test embryos without doing a biopsy and I look forward to that day.
We then wait a week for the genetic testing report. Once I receive the report (approximately 2 weeks after the retrieval) we’ll review the embryo quality, how many are normal and which one we want to transfer first. Do we have enough embryos for the family size you want? Yes or no?I like to review this in person as there is a lot of data to understand.
It may make sense to do another cycle depending on your desired family size. There are a number of ways to help a family reach the family size goals they want, including IUI. Another round of IVF may not make sense immediately. I may suggest to try and get pregnant naturally, or to let your body heal a bit from IVF before trying again.
Back to the Egg Whisperer D.I.E.T.
The D is going through the TUSHY method to uncover your fertility Diagnosis. The I is IVF designed to address your diagnosis. E is for endometrial testing (ERA and Receptivadx testing among other things), and T is for Transfer. Endometrial testing is what I call a mock cycle or a rehearsal cycle. I want to go to sleep at night with no regrets about how I’m approaching a Transfer of embryos.
If I have a patient with 5 normal embryos we may skip this extra testing, but it may make sense if they have a history of previous negative pregnancy tests after embryo transfers or endometriosis.
I like to test how you react on the fertility medication. Live your life normally. Start estrogen tablets twice daily (I suggest taking the pills at 8 Am and 8 PM)along with aspirin 81mg and a prenatal vitamin (not time sensitive). Two weeks later I’ll have you come in for a blood draw to look at estrogen and progesterone and measure the lining of the uterus. Then we do a biopsy (which is like an endometrial scratch) and it can be painful. The catheter placement is also known as a mock embryo transfer except instead of pushing a microscopic embryo in, we are removing a small amount of cells. We take cells from your uterus to understand exactly how many hours of progesterone your body needs for implantation to occur (endometrial receptivity assay) and to diagnose inflammation, endometritis (infection of the lining of the uterus), or the presence of microscopic polyps (through the receptivadx test). With this information I can then tell the patient what the best protocol is for them, and when they need to start progesterone relative to the transfer date for the highest pregnancy rate.
After the lining check, I have patients start progesterone 6 nights before the biopsy. Depending on your protocol, you will take either a vaginal suppository like endometrin three times a day (8AM 2PM and 8PM) or an injection (progesterone in oil) every night between 7 to 9 PM. I prefer progesterone in ethyl oleate 100 mg daily for the injection. The shot is just as effective as the vaginal suppositories however people who forget a suppository could cause a pregnancy to stop growing. If you don’t think you can stay on a strict medication schedule to place an insert vaginally three times a day definitely choose the injection.
On the day of the biopsy I have my patients eat normally and take a Valium and Tylenol with codeine thirty minutes prior. A full bladder also helps lean the uterus back and allows ultrasound visualization of the uterus transabdominally if needed. This is a similar protocol you will follow on transfer day. Feeling comfortable in my office and not experiencing severe pain is important to me. I sometimes do a saline infusion sonogram or a hysteroscopy on the endometrial biopsy day and this plan is discussed in advance.
Patients will take medications up until the biopsy day, and then stop. Once the period starts I begin getting results back and use the results to guide me. The mock cycle takes a month start to finish is about one month. Once the next period starts (about 3–5 days after the biopsy), patients will start medicine again. The receptivadx results about 5 days after the biopsy so assuming no changes need to be made based on what we learned, we continue as we did for the mock cycle, but this time for real! The endometrial receptivity assay (ERA) test takes about two weeks result which is perfect because that’s about the time for the lining check for the real transfer. The official transfer day gets scheduled and the pregnancy test follows 8 days later.
As a recap:
March 6 the IVF cycle starts (Step 1) including all of the elements of the Egg Whisperer DIET: Diagnosis, Embryo Creation, Implantation Testing (Step 2), then Transfer (Step 3). The transfer day is May 17th and pregnancy test is May 25th.
What I described in this article is no doubt a lot of work, but in my humble opinion it is worth it. It’s worth it to do the work you need to create the number of embryos required for the family size you want.
I hope this was helpful, and as always please reach out if you have any questions or topic suggestions for future shows.
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