Couples facing infertility treatment are understandably a bit nervous. After all, this isn’t how most people make a baby, and the schedule of drugs, the cost of treatment, and the frequent appointments combined with the fear of the treatment failing can be overwhelming.
Having faced this myself, I thought it might be useful to demystify the world of infertility treatment.
What are they going to test us for? How awful is it?
The specific tests vary, but there are a few common ones:
- Blood tests
- Semen analysis. This might be embarrassing, but it is necessary. Some clinics allow off-site collection, but many do not. But rest assured that the folks at the clinic are more than used to the process.
- The hysterosalpingogram (HSG). Technically, this is just an X-ray of the uterus and tubes to check for blockages. A dye is inserted into the uterus and the doctor watches to see how the dye flows. The HSG is frightening for a lot of women, and of course the question of the day is whether or not it hurts. For many women, it causes some cramping, and taking ibuprofen before the procedure can really help. For a few of us, it’s not really fun at all. The cramping was bearable, but I had a lot of trouble with the cervical clamp. Fortunately, it’s a really fast test.
- The sonohysterogram (SHG). This test is similar to the HSG, but in this case, saline is inserted into the uterus and the doctor watches via ultrasound. I had this one done too. The SHG was essentially painless. Easier than a pap smear. My RE said that it should be painless.
- Ultrasounds. These are also painless, but they are vaginal rather than abdominal, which at first might make some women uncomfortable. Transvaginal ultrasounds are an essential part of infertility treatment, however, and believe it or not, they eventually become routine.
There are other possible tests as well, but the ones above are the most common
Ok, Let’s Talk Drugs
The first-line drug for infertility treatment is commonly Clomid, although Femara is becoming popular as well. Both Clomid and Femara are pills, so taking them is easy enough. Most doctors monitor you while on these drugs, but the degree of monitoring varies. I did 4 rounds of Clomid. Lots of women have no trouble with Clomid, but it made me pretty crazy. I was moody and grouchy. I also got night sweats, which is a common side effect. Nothing unbearable, but still a little annoying.
The Injectables
While Clomid or Femara can be wonder drugs for many women, there are others who need to move on to “injectables.” This can be really disconcerting. I’m terrified of needles (or I was, rather), and the thought of getting daily injections was frankly nauseating.
But what are the shots like?
There are several injectable drugs, and they are administered either subcutaneously or intramuscularly. Before starting these drugs, you’ll take a “shot class” where you and your partner will learn how to give the shots.
The subcutaneous shots:
The subcutaneous ones aren’t that bad, actually. I used Follistim, and it was injected into the skin of my abdomen. You just pinch an inch and inject. At first, my husband had to do it and I had to look away. It made me feel a little ill because I had a lingering needle phobia. But after a while I got used to it, and ultimately I could give myself the injection if needed. These shots did not hurt at all, but sometimes my skin would get a little irritated and itchy at the injection sites.
The intramuscular shots:
Now the real kicker is progesterone. The progesterone is suspended in oil, so the liquid is s l o w to inject. Also, it needs to go in the muscle. There’s no way around it—the needle is long. It’s a little like getting a flu shot. Every day. In the butt (well, hip, really). When we were IVF newbies, the nurse helpfully drew circles on my rear to show the correct shot placement. Because progesterone goes in so slowly, the needle is in there a while. That’s the part I hated. The initial jab was fine, but it grossed me out feeling the oil go in. After the shot, I usually put a heating pad on to help the oil dissipate and I rewarded my fortitude with a giant bowl of ice cream. I could never inject the progesterone shot myself, but I do know women who have successfully done it.
What Happens at the Clinic?
There are a lot of appointments when you are getting injectable drugs, whether for IUI or IVF. The docs need to watch how the follicles grow and mature, and they need to check bloodwork to keep an eye on hormone levels. There is usually a week or so where appointments happen every other day, and sometimes on consecutive days. At the appointments they take blood (it helps to alternate arms to minimize soreness) and do a vaginal ultrasound.
IUI
The actual IUI procedure is fairly simple. Again, it’s really just like a pap smear. The sperm are inserted and you rest for a bit afterwards. It’s quick and painless.
IVF
IVF is the granddaddy of infertility treatments, and when I went into it, I thought I was prepared. After all, I had endured the same drugs with IUI, so how different could IVF be? IVF is different, though. It’s more intense and the stakes seem higher, somehow, because it feels like the end of the line.
Physcially, the first part of an IVF cycle is similar to an IUI cycle.
The real difference comes on retrieval day, when the docs need to go in and get the eggs. For this procedure, I was put into twilight sleep, and I did not have any discomfort although some women do.
The eggs are then mixed with sperm, and left alone to do their thing. Eventually, the clinic will call with a report about how many fertilized and how they are developing. 2-5 days later, an embryo or embryos will be transferred back into the woman’s uterus.
The transfer is a bit more uncomfortable than a pap smear, mostly because it’s done with a full bladder so that the doctors can use ultrasound to guide the embryos to the right spot. Be sure to have that full bladder! I didn’t for one of my transfers and they had to use a catheter to add fluid. Helpfully, I was prescribed a valium before transfer, and that helped me relax considerably.
After transfer, you may or may not have bed rest. It depends on the clinic.
One line or two?
Then, of course, is the pregnancy test. Many women choose to use home pregnancy tests before the actual blood test at the clinic. I did not. I had seen too many negatives in my life and the tests just increased my anxiety. But waiting for that phone call from the clinic was stressful. Every time the phone rang I felt like I was going to throw up.
I did IVF 4 times. One cycle was cancelled so I never made it to the pregnancy test. 2 times, the doctor made the phone call herself. Negative. I always respected her for making those hard calls, though. On the 4th round, the nurse called, and I got the news we had been waiting so long for. I was pregnant.
So overall, how is it?
Although the physical aspects of infertility treatment can seem the most daunting to couples just embarking on it, they really are manageable. The shots become routine, the complicated medication schedule becomes clear, the frequent ultrasounds less intrusive. You just do it. The psychological aspects, however, can be difficult. IVF, for instance, is really a roller-coaster ride that cycles between hope and despair. It can be consuming, to say the least.
Still, couples seeking medical help for infertility do not need to be afraid of treatment. It might be overwhelming at first, but like all things, we learn to cope with it.
