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.