Listen to this conversation on The Egg Whisperer podcast:
Figuring out your fertility diagnosis before you choose a treatment is key to your future success. If I can teach people what it would take to give themselves the highest chance of achieving pregnancy at home, then whatever treatment we do together will hopefully have an even higher rate of success.
What’s the one thing that everyone wants to give folks advice on? Anything related to their fertility. People seem to always be full of advice, and while most of it comes from a place of wanting to be helpful, not all of it is well informed or welcome.
Let’s take a bit of advice, for example: “Relax.”
Let’s be honest: that’s the worst thing that you can tell someone who is all tensed up: to just relax, to go on vacation, or to drink some wine. And yet, fertility patients have all heard these suggestions. And no, they are not fertility treatments.
The key to treatment, first of all, is figuring out your diagnosis, and then addressing that. The other thing I tell people is that if you spend 10% of what you would spend on treatment on figuring out what your fertility diagnosis is, then hopefully you’ll have to do less treatment because you’ll be more successful later.
Fertility treatment options
The treatment options that I want to go through today are fertility pills, fertility shots, IUI, and IVF. Basically, those are the types of treatments that we have to offer patients as fertility doctors.
Let’s talk first about Clomid. Clomid can make you feel like you’re walking right into an oven. You’re going to have hot flashes, possibly mood changes, and changes in your cervical mucus where before it might be egg white and then once you take the Clomid it’s a little bit more like the Sahara Desert. I bring that up because before you take Clomid it’s really important to know what the side effects are. This doesn’t happen to everybody.
If you’re someone who has a lot of headaches, Clomid may not be for you because Clomid can cause headaches. If you’re someone who runs more on the depressed side, and maybe you’re taking an antidepressant, Clomid, in my humble opinion, should not be for you because of the depression side effect of that it might cause.
The good news about Clomid is that for the most part they’re completely out of your system within 7 days. After your last pill, you should feel like you’re out of the oven, and hopefully on your way to a really healthy pregnancy.
Clomid is prescribed in several different doses and it only comes in a pill form. Typically your doctor will give you a schedule. I tell my patients to start on cycle day three. Cycle day three is two days after your period starts. I call cycle day one the day where you see red flow, whereas 11:00 PM marks the starting point of where cycle day one could be.
Sometimes people are confused about what is cycle day one. Cycle day one is typically 11:00 PM or later, or before 11:00 PM . Let’s say it’s 10:00 PM tonight and your period starts. Today is day one. That just makes it really easy. In two days, you’ll start your Clomid and you’ll take it for about five days.
When it comes to Clomid, I want to make sure that patients are being monitored and that they have responded well.
Monitoring the Response
How do we know how a patient is responding to Clomid? By doing a simple ultrasound. Your doctor can do an ultrasound and look at your ovaries, at the follicles inside, and actually measure them. The measurements of the follicles are indicators of the maturity of the egg, your most fertile window, and the number of eggs you’re going to ovulate.
The other thing we also look at is the lining of the uterus. There’s a certain texture and lining thickness that we look for to make sure that you’re going to have the highest chance for pregnancy when doing your fertility treatment cycle.
Check the Fallopian Tubes
When doing your fertility treatment, it is also important to ask your doctor if there’s any reason to check the fallopian tubes. The fallopian tubes are the embryo transport system – where the egg and sperm actually meet.
Do you have to do a hysterosalpingogram? No. But before you start treatment, you want to make sure that you’re doing the right treatment for you, because if your tubes are blocked, doing fertility pills doesn’t make sense, but if your tubes are open it certainly makes sense because the embryo transport system is wide open.
Other Options with Clomid
When you’re taking fertility pills like Clomid, you can also do timed intercourse. Timed intercourse simply means having sex around ovulation. If you’re being monitored while taking Clomid or during your ovulation induction cycle, then you’ll know exactly when to have sex.
The other option is artificial insemination. That always just sounded like the silliest name to me. I looked it up and the definition is, according to the Webster Dictionary: “a medical process in which semen is used to make a woman or female animal pregnant without sexual intercourse.”
That sounds hot. Really hot. Basically, it’s an intrauterine insemination. A catheter goes up to the very top of the uterus and there’s a little syringe at the bottom. I always ask anyone who comes to the office with a partner, to push the end of the catheter, and it’s always a good time for all.
Do you have to do insemination? No. But the reason to do insemination is if potentially the sperm quality is lower, or if timing of intercourse is a little bit off. Let’s say you and your partner are both tired, you’re working swing shifts, and it’s just harder to have sex exactly when you need to to make a baby. Then sometimes insemination is the way to go.
Femara (generic name is letrozole)
The other option besides Clomid is Femara. Femara is also a fertility pill. I actually prefer Femara because of the lower risk of side effects that I talked about compared to Clomid. It’s an FDA approved drug for breast cancer prevention, and fertility doctors use it just like Clomid for their patients.
When it comes to fertility pills the goal is to help a patient ovulate an egg. But depending on your situation, it may make sense to help you ovulate more than one egg. When you take fertility pills, I tell my patients you will ovulate 1.5 eggs. Sometimes it’s going to be one. Most of the time it’s going to be two. When you show up and it’s just one, I don’t want you to feel disappointed, because that’s what happens when you take fertility pills.
When a doctor prescribes fertility shots, it’s also to help a patient ovulate an egg, but sometimes the goal would be to ovulate more than two eggs, and sometimes even three. Depending on your age or situation, ovulating more eggs will give the sperm a higher chance of penetrating, fertilizing and creating a healthy embryo.
We continue to look at the ovaries and we monitor fertility shot cycles. You start the shots in the same way as you would start Clomid, at the beginning of your cycle. You may have two, three, four, maybe even five ultrasounds during a fertility shot cycle.
Then, just like I talked about IUI or artificial insemination, also known as the turkey baster approach (no turkey basters in my office), you will be able to time your intercourse, do insemination, and sometimes I recommend a double IUI. That doesn’t mean two collections in one day, although I have done that before, but that typically means, let’s say today is Wednesday and I think your most fertile peak window is going to be between Thursday and Friday, I might do two inseminations, one on Thursday and one on Friday.
The way I can determine the most fertile window can also be with a trigger shot. I like to think of it as the love shot. That sounds a lot better than a trigger shot. What the trigger shot refers to is an injection to induce ovulation. The sperm can wait in the tube for three, maybe even six days, but the eggs are quite picky. They’re going to sit in the fallopian tube for six hours, 18 hours, 24 hours, tops. So, you may want to have sperm waiting for the eggs before you do the insemination. Talk to your doctor about the absolute best window for you.
Next time I’m going to wear a shirt that says, “If your ovaries are working, so am I,” because it doesn’t matter if it’s a Friday, a Saturday, or a Sunday. If the time is right for your eggs and sperm to meet, I’ll see you in my office. Read this article about the 7 things you didn’t know about the trigger shot.
I want to talk now about IVF. IVF stands for “Is Very Fun.” No, it doesn’t. It stands for in vitro fertilization. It’s probably the most efficient way that we can help patients get pregnant.
What I mean by efficient is the pregnancy rate, that’s the one thing we didn’t talk about when talking about fertility pills or fertility shots. Typically with fertility pills you’re looking at about an 8–10% chance of pregnancy. When you add insemination, maybe close to a 15% chance. When we look at fertility shots, you’re looking at potentially a 15–20% chance for pregnancy, which also involves higher medication costs.
When you do IVF, you’re actually putting patients on the shots, and there are more natural ways of doing it where you don’t necessarily have to take shots. When you meet with your doctor you have to talk to them about what’s important to you, the side effects that you’re worried about, your previous treatment, so you can figure out exactly what the best treatment is for you. That’s what I do. It’s not a one-size-fits-all approach for everybody.
This is a great blog, a great website written by someone who did IVF with me. Indeed, she called it “is very fun.” I hope you like the blog and think it’s super fun.
I want this show to be super informative. I know that there are millions of people out there who don’t have access to a fertility doctor, who don’t even have access to treatment. If I can help one person just get information that’s going to be helpful to them, I would say that’s mission accomplished for me, my producer Paula, and director John. So, I came up with this list of things that I want every patient to know. It’s a list of about 10 things that IVF doesn’t for you.
You’re watching this show and you want to know the best fertility treatment for you. It might be IVF. This list is something that you can go through before you’ve gone through the cycle.
I think the first most important thing is this: Why are you doing IVF? I see patients from all over the world and they’ve done IVF, and I ask them that question. They look at me like, “I don’t know.” I say if you knew the answer to that question, the why, maybe you could do things to make things even better.
I’ll give you an example. Let’s say the sperm quality is low and that’s why you’re doing IVF. Maybe if you improved the testosterone, took supplements, made sure there wasn’t a varicocele, potentially the next cycle would be more successful.
Get a Diagnosis First
I want to do those things before you even do that first cycle. Knowing your diagnosis is key. Doing a fertility gene test is available for both men and women now so that you can learn about the right protocol for you. We’re learning so much about our DNA and how it affects our fertility every single day. There are patients that I can help that I couldn’t have helped in the same way maybe even six months ago. It’s pretty incredible. If you’re a patient out there that maybe did treatment two or three years ago and you’re thinking, “I thought I did everything,” it may not be a bad idea to re explore seeing a doctor, telling your story, and running some new tests to see if there is something that we can do to help you.
Learn from Past Cycles
Other questions to ask your doctor are why they think that the cycle didn’t work or why you didn’t get pregnant. Then really look at the protocol. Look at the medications used. If you haven’t done IVF before, be sure to ask your doctor why they are choosing those medications. Is there anything that they would add or take away?
For example, HGH (human-derived growth hormone) is a drug that many bodybuilders abuse, and which Lance Armstrong is famous for taking, but it can potentially improve the quality of a woman’s eggs in IVF. If let’s say you have a high FSH, a low egg count, age over 40, maybe it’s for you. I would want you to know about that medication before you even did a cycle so that you knew that you could add it upfront and you can ask for it if your doctor hasn’t brought it up yet.
How Many Eggs?
The other question is asking the doctor how many eggs they’re expecting. If you already did IVF, how many eggs did you get, how many were mature, was that a surprise to them, is there anything that they would do differently knowing this number. This is the thing; you want to go into your IVF cycle with the right expectations. I’ll just give you another example.
Let’s say you’re starting your IVF cycle and you’re told that you have three follicles. You should be sure to know before you continue your treatment that three doesn’t turn into six, doesn’t turn into 12. Fertility doctors can only rescue eggs that exist. For now. Maybe one day I can help a patient grow more eggs than she already has. Right now, all I can do is help the three eggs that a patient has and help those three grow.
If you show up on egg retrieval day and the doctor says, “I got one or two eggs,” and you were expecting six, that’s going to be extremely disappointing. What I tell patients who have less than five follicles is that there’s a chance that we may not get any viable eggs. Those are the kinds of things that you really want to know before you even start treatment.
Other Key Questions for IVF
A few other things to know. How many eggs were fertilized? Is that what you expected? Did you do ICSI? Should you maybe even consider PICSI or Zymot? You should know the quality of the embryos that were transferred and what it means. Maybe you should consider genetic testing. Is that for you? Maybe you should consider switching the day of transfer. If you transferred day three, consider day five. Maybe a frozen embryo transfer is for you.
Again, writing things down, having a log. I tell my patients to keep everything in a binder, keep all of your labs there, everything that we talk about, so that you always are on top of everything that’s going on.
Keep Asking Questions
A few other questions to bring up, and these are things that I do for my patients. If a cycle doesn’t work, I always want my patients to know everything possible, including everything about the embryology part. If you have questions about what went on in the lab, ask to speak to the embryologist. Embryologists, at least the ones that I work with, love talking to patients about their case and telling them what they saw, so that you can learn as much as possible about your DNA, your eggs and sperm, and how things looked when the embryos came together.
More Treatment Tips
A few other tips. Checking out the fallopian tubes. Looking at the uterine cavity. Consider doing not just a cavity evaluation, like a saline sonogram or a hysterosalpingogram, but maybe also a genetic test on the lining of the uterus called EndomeTRIO. Looking to see which day is ideal for embryo transfer during your IVF cycle.
The last thing to talk about is if there are any other things that you can do; acupuncture, working with a nutritionist, changing your diet. These are the things that I talk to my patients about before their cycle. I want them to know why they’re doing IVF, what their fertility diagnosis is, and if there is anything else that they can be doing on their own to give themselves the highest chance for pregnancy. If my patient is very stressed during their cycle, I may suggest that they reconsider shifting their vacation time or take time off work so that it coincides with their cycle, this way they can be as rested and relaxed as possible.
Self Care and Mental Health Considerations
Certainly, I want people to do whatever they can to reduce stress. I don’t like to use the word stress. There’s just something about that word that seems stressful. I like to talk about what people can do to promote rest and relaxation.
There’s a lot of things that you can do. Just look at the nature around you. Get a pair of sneakers on, go for a walk. The other thing you can do is take care of yourself. Maybe get a spa treatment here and there, get a massage. Another thing you can do is salt float. I talk about that a lot on my show, but I think that patients who want a little bit more rest and relaxation can certainly get that. Just look it up, there’s probably a salt float in every major city now. It’s quite popular.
When it comes to treatment, I actually really want people to get pregnant at home, it’s way more romantic. I promise you that my office is not sexy or romantic. I know this sounds kind of strange because I’m a fertility physician and I went to school for a really long time to figure out that an egg and sperm equal a baby. If I can teach people what it would take for them to give themselves the highest chance for pregnancy at home, then whatever treatment we do together, they’re hopefully going to have a higher rate of success.
Let’s talk about natural treatments.
Living in California, I have a lot of extremely health-conscious patients. They’re really focused on what they’re putting in their body, what the side effects are, and how it might affect them. I do like patients to try to be as natural as possible if that’s what they want.
Some of the natural things that I talk to patients about would be lifestyle changes, like decreasing alcohol and coffee intake. Addressing BMI issues, if your weight is high. Maybe working with someone like Dr. Ban or Dr. Stephanie Fein that we work with remotely, and they work with my patients to help them reduce their BMI and they focuses a lot on nutrition. I mention acupuncture, seeing a nutritionist, and even seeing a hypnotherapist.
There’s actually a hypnotherapist Lucy Yaldezian in my building here and I refer a lot of my patients to her. She really helps them kind of retrain their brains. I think the words we all use matter. Instead of seeing yourself as an “infertility patient,” I like patients to think of themselves as fertility patients, doing fertility treatment. Working with a hypnotherapist, believe it or not, can help you stop smoking if you’re smoking, she can help you with other things, like if you have an eating disorder, but I think the most important thing would be to help retrain your brain into thinking and being more positive when it comes to yourself and how you’re feeling about things. Then also seeing a therapist.
Those are all pretty natural things that you can do. I’ll talk about how you can be more natural in whatever treatment you choose whether it’s IUI or IVF.
If you’re reading this and you have some questions for me, but I don’t live in your area, that’s okay. I can help you by checking your levels and talking to you about what they mean through my website EggWhisperer.com.
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