Placenta Previa

I am generally healthy, but I am now 40 years old, have had three failed pregnancies, and have now conceived via in vitro fertilization (IVF). All of these factors qualify my pregnancy as high risk, so when I graduated from the fertility clinic, my reproductive endocrinologist urged me to find an OB-GYN who specialized in high-risk pregnancies. I had no idea how difficult my quest would be.

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.

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.

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 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.

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.

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.

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 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.

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).