Intralipid Infusion: A Possible Solution to Failed Implantations and Early Miscarriages

After my last miscarriage, my doctor tested me for blood clotting problems. The tests came out negative. That was not necessarily good news because we still had no explanation for the failed pregnancy. Implanting a perfect, genetically tested embryo in a healthy uterus did give me the best possible chance of getting pregnant, but it did not help me stay pregnant. I had officially joined the list of women with multiple unexplained miscarriages.

Natural Miscarriage

When my reproductive endocrinologist discovered no fetal heartbeat at one of our regular appointments, he gave me the option to either have a dilation and curettage (D&C) or wait for the miscarriage to happen naturally. Though the decision was up to me, he did recommend the latter approach. I was too preoccupied with the sad news to ask why.

Cramps and Bleeding: A Miscarriage? (Updated Post)

On Thursday afternoon, while I was at work, I started feeling some abdominal discomfort. My first thought was that my lunch was causing me the problem. But we had had a company lunch, and no one else seemed to be affected. So I continued working, not really worried--that is, not until the bleeding started.

hCG Levels: What Do They Tell Us, and Why Should We Care

If you are doing infertility treatments, chances are your doctor will have you test your human chorionic gonadotropin (hCG) hormone levels about 12 days after your procedure to determine if you are pregnant. hCG can be detected in one’s urine or blood, but a home pregnancy test will not show you the amount of this hormone, only whether you have enough of it to be considered pregnant. Knowing the actual level on a given date, however, is important if you want to be sure that the pregnancy is going well in its early stages.

Endometrial Scratching

Your in vitro fertilization (IVF) cycle has failed, and you do not know why. You had diligently followed your IVF protocol, had several eggs successfully retrieved and fertilized, then screened the embryos for chromosomal abnormalities and had at least one normal embryo. You also have no anatomical anomalies, your uterine lining was triple-layered and thick enough, and the embryo transfer procedure had gone smoothly. Still, your pregnancy test came out negative. What do you do? Repeat the same steps and hope for better luck? If the answer is yes, you might also want to consider endometrial scratching. It could help tilt the scales in the other direction.

My Preimplantation Genetic Screening (PGS) Results (UPDATED)

As a follow-up to my post called “Preimplantation Genetic Screening (PGS): Why You Should Do It,” I decided to publish the results of my two PGS tests. I hope the information is useful to anyone who wishes to compare her results or get a better idea of how maternal age may affect the quality of embryos.

IVF Milestone: Egg Retrieval

Egg retrieval is one of the key phases of in vitro fertilization (IVF). After multiple follicles in the ovaries have matured sufficiently (i.e., have reached at least 15 mm in diameter), your doctor will instruct you on when to have the ovulation trigger shot. (The timing needs to be precise.) The egg retrieval takes place about 35 hours after this shot.

How to Eliminate Stretch Marks

Permanent or not, stretch marks are an unpleasant yet inevitable side effect of pregnancy. While almost all expecting mothers get them, some are luckier than others and lose theirs faster, with little or no intervention. The rest of us, the genetically not-so-lucky lot, must do some extra work to minimize the appearance of stretch marks.

Trisomy 13 (Patau Syndrome)

A trisomy is a type of aneuploidy (chromosomal abnormality) in which the cells of the body contain an extra copy of a chromosome. While most aneuploidies result in miscarriage, fetal development can progress to live birth in the case of trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome), trisomy 13 (Patau syndrome), and a few other, less common chromosomal abnormalities. Of the three most common trisomies, Patau syndrome is the rarest; it also has the most severe clinical presentation.

Male Infertility No Longer a Taboo

Many of you had probably heard that June is the national male heath month, but did you know that male infertility is a leading cause in about one-third of infertility cases?

How Many Embryos Should One Transfer: The IVF Dilemma

It is common knowledge that assisted reproduction methods, such as intrauterine insemination (IUI) and in vitro fertilization (IVF), when successful, often result in multiple pregnancy. Some wonna-be-moms, in fact, want to have twins or triplets, especially those who have tried to conceive for a long time—after all, having more than one baby at the same time seems to compensate for the many months or years lost in waiting. Doctors, however, frown at such possibilities. The optimal outcome of an assisted reproduction, they say, is a singleton pregnancy.

Preimplantation Genetic Screening (PGS):

Why You Should Do It

Many factors can sabotage the success of infertility treatments, such as in vitro fertilization (IVF). A woman might respond poorly to ovarian stimulation, develop eggs that fail to fertilize, or produce embryos that are chromosomally abnormal. Her uterine lining might not be thick enough to support implantation, or there might be some other cause of failed implantation, such as damage to oocyte/embryo during unfreezing or transfer. The egg retrieval and embryo transfer procedure too can fail—sometimes due to the doctor’s lack of experience but more often due to uterine contractility. Of all of these factors, however, chromosomal abnormality is the one that controls the success of the majority of cases.

Can Stress Contribute to Infertility?

Stress has become an everyday constant for many individuals. Work, personal life, and other responsibilities keep us awake at night, force us to develop unhealthy habits, and disturb our moods. Add to these the anxieties of trying to get pregnant, and you will see a fair portrayal of many women today. Could this stress affect one’s ability to conceive? In my experience, the answer is: quite possibly so. Many researchers, however, disagree.

What Doctors Don't Tell You About Fertility Medications

Before you started your first intrauterine insemination (IUI) or in vitro fertilization (IVF) cycle, did you know that you would most likely end up injecting yourself with hormones several times a day for as many as three months? I didn’t. Possibly so as not to discourage potential patients, reproductive endocrinologists do not go into detail regarding your medication schedule until you are already emotionally involved and committed to complete the treatment.

Prenatal Multivitamins

Most pregnant women strive for healthy diet and lifestyle, but sometimes nutritional gaps still exist, and supplements need to be added. Rich on folic acid, iron, and calcium, prenatal multivitamins can be key for supporting fetal development and a healthy pregnancy. Many brands are marketed to this effect, but are they all equal in their purported benefits? What prenatal multivitamin do you use? Could you tell us why?

Insurance Coverage for Infertility Treatments

For many infertile couples in the United States, the cost of infertility treatment is prohibitive. While many foreign countries, especially those with declining birthrates, subsidize in vitro fertilization (IVF), the United States government has not yet recognized infertility as a disability that warrants greater scrutiny. Luckily for some, however, legislature in 15 states mandates insurers to offer coverage for certain procedures, making infertility treatments more affordable for thousands of families.

Infertility Defined

Unlike sterility, which implies a physiological inability to conceive, infertility is associated with one’s lessened or lost ability to get pregnant and/or stay pregnant and can be either temporary or permanent. One can become infertile even after having produced one or more children. Similarly, a person can conceive and give birth even after years of unsuccessful attempts. It is also possible for a person to never get pregnant or give birth, despite the absence of physiological causes.

IVF Cost

The first thought that comes to mind when most people consider in vitro fertilization (IVF) is not about its complexity or even its success rate. It’s about cost. Undeniably, IVF costs significantly more per attempt than alternative approaches such as intrauterine insemination (IUI) or a Clomid cycle with timed intercourse. However, although it may seem like a good idea to keep expenses low, one needs to consider the cumulative cost of having to repeat a low-cost procedure multiple times due to its lower success rates compared with IVF. (See my post “IUI vs. IVF: Cost Factor Revisited.”)

My IUI Medications

Intrauterine insemination (IUI), like most other fertility treatments, typically relies on medications to stimulate the production and release of eggs. Usually, Clomid (or its generic version clomiphene citrate) is the first drug prescribed to women who do not ovulate regularly. It is inexpensive and often effective. However, not everyone responds to it or can tolerate its side effects. In such cases, Clomid can be replaced with injectable medications to encourage the formation and ovulation of eggs.

My IVF Schedule

In vitro fertilization (IVF) schedules are highly personalized and often adjusted. The length of the ovarian stimulation phase can vary significantly from one patient to another (based on one’s response to medications). The type of medications will differ as well (based on physician’s preference and/or patient’s circumstances). The timing of the transfer too can vary (depending on the development of the embryos and whether genetic/chromosomal testing is performed). All IVF schedules, however, contain seven distinct stages: (1) preparation of the ovaries for stimulation, (2) ovarian stimulation, (3) ovulation trigger, (4) egg retrieval, (5) monitoring of the development of the embryos, (6) embryo transfer, and (7) pregnancy test.

My IVF Medications

In vitro fertilization (IVF) protocols in the United States typically utilize three main types of medication with the following distinct purposes: to suppress ovulation, to stimulate the growth of multiple eggs, and to trigger the final maturation of the eggs. In addition, IVF is often followed by medications that aid the thickening of the uterine lining to support implantation.

Lessons Learned After Four IUIs

Within the span of one year, I underwent four intrauterine inseminations (IUIs) in an attempt to become pregnant. The reproductive endocrinologist who treated me had all the right credentials, plus a high success rate in making many couples happy. More importantly, my uterus appeared healthy, and so did my ovaries. The only thing I had going against me was my age. I was in my late 30s, and the quality of my eggs proved to be the one unknown that made all the difference.

IUI #4: Final Attempt

With two almost successful pregnancies, I knew that intrauterine insemination (IUI) could work for me. The question was how many more attempts would I need before I managed to have a truly successful pregnancy. Since my insurance covered most of the cost of my IUIs, I decided to give the procedure another chance.

IUI #3: Chemical Pregnancy

Even though my second intrauterine insemination (IUI) attempt did not make me a mother, it did prove that I was able to get pregnant and stay pregnant during the most critical months. To the reproductive endocrinologist who treated my infertility, this was encouraging; the aneuploidy was merely bad luck. Surely, my age had a lot to do with the unfortunate diagnosis, but since the chances of having another fetus with trisomy 13 were close to nil, I was eager to try to get pregnant again, hoping that the odds would now be in my favor.

IUI #2: Quasi Success

Seventeen days after my unsuccessful first intrauterine insemination (IUI), I began preparing for my next attempt. Since I had experienced rare but severe adverse reaction to Clomid, this time I had to order an injectable medication (Menopur), which was significantly more expensive but presumably had milder side effects. At this point, the cost didn’t matter. I just wanted results.

IUI #1: The Clomid Experience

I was 38 when I first heard about reproductive endocrinologists and how they could help me. After nearly a decade of unsuccessful attempts to conceive, I was relieved to learn that I no longer had to resort to regular OB/GYN doctors, whose experiments with birth control pills never did make me fertile. I was also surprised to find out that both OB/GYN doctors and reproductive endocrinologists like to start a patient’s treatment conservatively—with a pill.

Special Fertility Diet

The link between body weight and hormonal imbalance has proven key to understanding and treating many couple’s fertility problems. But what if a woman’s weight is well within the normal limits and her infertility still cannot be explained? Perhaps it is time for her to reexamine her diet. Specific dietary restrictions have demonstrated a powerful effect on regulating male and female hormones and increasing women’s chances of achieving pregnancy.

Body Weight and Fertility

Are you overweight/underweight and suffering from irregular periods? Have you tried to conceive for months or years with no luck? The link between body mass index (BMI) and fertility should not be ignored. Even though exceptions can always be found, your chances for a successful pregnancy strongly correlate with your BMI.

What Is IUI?

Intrauterine insemination (IUI) is an assisted reproduction method that improves a woman’s chance to achieve pregnancy by placing sperm directly inside her uterine cavity. Albeit simple, this concept can be an effective way of circumventing male fertility problems such impotence, premature ejaculation, or low sperm count or motility. It is also widely used in cases of unexplained infertility, polycystic ovary syndrome (PCOS), anovulation, or absence of a male partner.

IUI Cost

Many couples who choose to pursue assisted reproduction opt for intrauterine insemination (IUI) first. Their physicians have informed them that the procedure is relatively simple and fast and would require lower doses of medication (if any). These are undeniably true statements, but they are typically followed by a much fuzzier claim regarding IUI cost. Here are some points to consider.

IUI vs. IVF: Cost Factor Revisited

When we are faced with multiple options, we typically consider not only their efficacy but also their cost. This is especially true with regard to assisted reproduction. Although the efficacy of a procedure can never be guaranteed, the cost can be substantial and, for many of us, even prohibitive. But is the least expensive option necessarily the first line of action you should pursue? The answer often depends on your age.

Years of Infertility

When I was officially diagnosed with primary amenorrhea in my late teens, I was also told I would likely have a problem with fertility. For many years, that was not a concern. By my early thirties, however, I had already decided that I wanted to be a mother. That’s when I learned how true the doctor’s words were.

Reproductive Endocrinologists:

Infertility Specialists Who Might Have an Answer for You

Have you and your partner tried to conceive for over a year with no success? Are you over 35? Do you have a known medical problem that affects your ability to become pregnant or stay pregnant? A regular OB/GYN doctor might be able to help. However, if you are in your late thirties or older, or if no factors can be identified as contributing to your infertility and you are tired of dragging yourself from one OB/GYN office to another in the hopes of finding an answer, it might be time to turn to the experts. Pick up the phone and schedule a consultation with a reproductive endocrinology and infertility specialist. It might very well be the best decision you’d make in a lifetime.

Care to Compare?

I have been trying to conceive since I was 30 years old. Eight years had quickly rolled by with no result before I finally decided to consult a reproductive endocrinologist and seek alternative methods. In the span of a year, I underwent four intrauterine insemination (IUI) procedures. Two resulted in pregnancy, neither of which lasted. I am now in the process of attempting my first in vitro fertilization (IVF).