Whether you’re local to me (San Francisco) or halfway around the world, it doesn’t matter. I’m sharing science-based information with you today so that you don’t have to turn to Google, tarot cards, or your co-worker when it comes to fertility advice.
Your situation is unique. I want you to keep that in mind. What you need may be different than someone else. What you need is based on you.
In a sense, your path to fertility treatment should be as customized as your coffee order.
So this is what I do with my patients. I start by getting to know them, and their fertility health.
Have you been starting with you?
What I mean is, do you know what your diagnosis is? Is there a clear and compelling answer for why you may not be getting pregnant? I don’t believe in “unexplained infertility”. There is an answer and my job is to help you find it.
Know Your Diagnosis
How do you know what treatment to pick if you don’t know the diagnosis? I see time and time again where women who are struggling to get pregnant are given fertility pills by their doctor. Then a year or more goes by and they discover that their tubes are blocked or there’s a problem with the sperm. That’s really disappointing. It means this patient has wasted precious time and energy. I don’t want that to happen to you.
If you’re struggling with your fertility I know that when you get your period it’s a bummer. That may be an understatement. It may even feel like a knife to the heart. When I’m working with a patient, I feel their pain too. In my office, “period” is a bad word. We don’t like them. I tell my patients “when your period starts — think of me because my job is not done”.
How old are you?
How many kids do you want?
I know this sounds super basic, but if you know your diagnosis and factor in your age and desired family size, then you can start formulating a plan.
I have three questions that I like to ask every one of my patients. In fact, these are questions that can apply to just about any area of your life. I’ve been using this as a framework for many, many years. This won’t be the last time you hear me talk about them.
Are you ready for them?
Here they are.
My 3 Questions:
1. What do you want?
2. What is it going to take to get what you want?
3. Are you willing to do it?
If you know the answers to these along with your fertility diagnosis then you can formulate a plan.
This is something that takes work. Talk to a fertility doctor and come up with your prescription for success.
Anne Hathaway shared that her path to pregnancy was not a straight line. Anytime you choose to get pregnant you also are choosing the path of unknown. Things may not work as you intend. You may experience a miscarriage or other things as well.
I want everyone’s path to be a straight line, but the reality is that it just can’t be.
What I do know is that by taking the information you learn in this show you can be as empowered with as much information as you can from start to finish.
After we go through the three questions together, then I ask my patients (and myself) this:
What can I do that is in my control to increase the chances of pregnancy?
You don’t know what that is until you get a diagnosis. Some things may be obvious, but others will become apparent after testing.
However, after you do everything you can possibly do I tell my patients to be like Elsa from Frozen — and to Let it Go.
If you overanalyze things and think you have more control than you do then you’re at risk for stripping joy from your every day.
Get clear on what the pregnancy rates are on the treatments offered to you, and then let what will be, be.
How to Find Out Your Diagnosis
You’ve heard me talk about it before, but this time it is officially trademarked with the U.S. patent office. The TUSHY method (yay!) is a 5-step way to figure out what your fertility diagnosis is. Tubes, Uterus, Sperm, Hormones, and Your Genetics.
Talk to your fertility doctor or OBGYN they can help you go through the process of uncovering these five steps so that you get a proper diagnosis before pursuing a treatment method.
If you don’t have a diagnosis then how will you know which treatment is right for you?
Let’s go through different fertility scenarios.
It’s worth noting that I do not expect you to be able to determine what treatment is right for you from this blog post or show episode. The intention is to equip you with a starting point that will lead to questions you can ask when you meet with a specialist and begin the work of getting a diagnosis.
Scenario 1: Blocked Tubes
First, you want to understand if one tube is blocked or if both are. If one tube is blocked and it’s not dilated or filled with fluid you can still consider trying to get pregnant naturally.
Here’s the catch. Our bodies don’t automatically rotate which side they ovulate from. You could actually ovulate from the blocked side for six months before you ovulate on the unblocked side. Think about doing something like ovulation induction pills (a medication like Femara) to help you ovulate more than one egg. This may help you ovulate one on the open side.
The way to find out if you’re ovulating on the open side is through ultrasound. Ultrasounds are super simple tests that you can have done in the fertility doctor’s office or in some OBGYN offices. Think of it as the most accurate ovulation predictor kit as this tool can help a doctor actually see the size of the follicle and tell you when you’re going to be the most fertile so you can time intercourse or your IUI around that date.
However, if you’re older — let’s say over 37 and you want two kids and you still have one tube that’s open and one that’s blocked, then you may want to consider doing IVF so you can preserve your embryos and not spend so much time figuring out which side is open that you’re ovulating on.
Let’s so that you know you only want one kid. Well, in that scenario then it’s perfectly fine to monitor and see which side you’re ovulating on, especially if your AMH level is healthy and shows a good number of eggs. My counsel is to spend two to three months and then reevaluate doing ovulation induction pills and then ask, “should I keep going? Or, “Should I wait and consider other options?”
IVF was actually invented for people with blocked tubes so you can obviously go right to IVF and then there’s also a treatment called Invocell.
Scenario 2: Endometriosis
Endometriosis is very common. Some people think that maybe up to 40% of women who have fertility problems might have some aspect of endometriosis. If you have it then you likely know what I’m talking about as it can cause lots of pain, heavy bleeding, and may affect your egg quality, block your tubes, and it can also affect implantation rates.
If you’ve been given this diagnosis then I encourage you to think about fertility preservation. Consider making use of your younger eggs — you can do so by getting pregnant earlier then maybe you planned for, or by freezing eggs or embryos to make use later.
You may also want to consider medication treatment to prevent the progression of endometriosis. What could that be? I encourage you to speak with your doctor, but it could be something like taking birth control pills continuously to prevent having your period. Medications like that which prevent your period can also prevent the progression of endometriosis.
The bottom line is to find out your diagnosis. Get a clear answer if your fallopian tubes have been blocked by the scar tissue that endometriosis may have caused. Then ask yourself the questions we’ve already covered — what’s your age and how many kids do you want? What’s it going to take to get the family size you want?
Scenario 3: Fibroids
When patients hear the word fibroids it can sound scary. Many people immediately think of cancer. But what I tell people is that fibroids are super common and as insignificant as a freckle on your face. It all depends on how big the fibroid is and where it’s located. There are many options for removing fibroids that don’t involve surgery or much hospitalization. I ask my patients to see a MIGS surgeon (which stands for Minimally Invasive Gynecologic Surgeon) when it comes to any surgery that requires anesthesia in the hospital. Although please keep in mind that not every fibroid needs to be removed so take a look at where it is. Is it in a cavity? Does it need a hysteroscopy? Before you even have it removed ask yourself the key questions. How old am I? How many kids do I want? What’s my diagnosis?
Here’s why I suggest you ask yourself these questions. Let’s say for example you’re forty-one and finding out you have fibroids for the first time. You may want to preserve your embryos, have them genetically tested, and then remove the fibroids. Don’t do the fibroid surgery first. It can wait. It’s really important before you do a surgery like that to talk to a fertility specialist, get your fertility hormones checked, and decide which order you should do things. I say this as sometimes I meet patients that didn’t have guidance from someone like me and they did things in an order that wasn’t ideal for them. What I mean is, if you have fibroids removed by surgery then your doctor may tell you to wait 9 months before trying to get pregnant again. If you’re 41 years-old then that may be too long to wait as your fertile window may be closed when you’re ready to start trying.
Scenario 4: Vasectomy
What do you do if your partner has had a vasectomy or a vasectomy reversal? Well, surprise, surprise — the same series of questions apply here too. How old are you? How many kids do you want?
If you and your partner are thinking of getting a vasectomy reversal then have him see a urologist that specializes in this. Someone that can test his hormones and understand his health before pursuing this path. Not any urologist can do an excellent vasectomy reversal. It’s kind of like when you see a fertility doctor you want to see someone that did OBGYN training and then did extra training in Reproductive Endocrinology and Infertility. This is what I did and urologists, they do that too.
Even if you do a reversal you may still need to aspirate sperm from the testicle. Many people think that sperm aspirated from the testicle can be used for insemination and it can’t. If you aspirate sperm from the testicle then you have to do IVF.
For example: If I have a patient who is forty years old and her partner has had a vasectomy, then I would recommend doing IVF. I wouldn’t say, “let’s reverse the vasectomy and try IUIs”, because of the woman’s age. These are the kinds of decisions that you want to make with your doctor and conversations to have before going through any procedure. Whatever you do please don’t beat yourself up if you’re not getting pregnant as it takes a healthy embryo and a healthy sperm to make a baby.
Sperm after vasectomy reversal can sometimes be affected by something called anti-sperm antibodies. It’s a simple test a guy can do. We look at the sperm making sure they aren’t wearing “helmets”. This test helps us to guide a patient to consider IUI after a vasectomy reversal or IVF.
One Final Thought: Please be true to yourself.
I know I’m an IVF doctor, but I really don’t want everyone to do IVF. I want everyone to know what their diagnosis is and to be heard. To work with a doctor that’s going to listen to them, and take care of their needs and be honest with what all the side effects are for all of the treatments.
The biggest complication that I worry about when it comes to treatment is when treatment doesn’t work. It’s a sadness that comes and I want my patients to always feel like they’re being empowered with knowledge about their own bodies. This way, regardless of what happens with the treatments, they view it as a learning experience. I know I can’t help everyone that sees me and I can’t guarantee success, but I can guarantee that the experience will be as good as I can possibly make it for them. The way I’d want it to be if I were a patient.
I hope this article serves as a helpful guide so you can ask your doctor the questions that will help you determine the best fertility treatment for you.
If you’re curious about something or have a suggested show topic, please send a note to [email protected] or post a comment here.
You can also catch more of me and topics like this through The Egg Whisperer Show. The episodes are live-streamed onYouTube,Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!