So, you've picked your doctor and have likely done lots of internet research. You're likely to see about 1,000 different terms & acronyms on websites & discussion boards. Some will be obvious & some not so much... So I'm going to try to make a list of the ones I have encountered to hopefully help you out... I know I'm not going to think of all of these right at the get-go so I'll come back & edit this post as I think of more. Also, feel free to add your own!
Acronyms
AF - Aunt Flo
BCP - Birth Control Pills
BFP or BFN - Big Fat Positive or a Big Fat Negative
BW - Bloodwork
CD - Cycle Day
CM - Cervical Mucus
DE - Donor Eggs
DH - Darling Husband
DPR - Days Post Retrieval
DPT - Days Post Transfer
DS - Donor Sperm
DX - Diagnosis
ED - Egg Donor
FET - Frozen Embryo Transfer
FSH - Follicle-Stimulating Hormone
GS - Gestational Syrrogate
HCG - Human Chorionic Gonadotropin
HPT - Home Pregnancy Test
ICSI = Intracytoplasmic Sperm Injection
IUI - Intrauterine Insemination
IVF - Invitro Fertilization
M/C - Miscarriage
MF - Male Factor
OHSS - Ovarian Hyperstimulation Syndrome
OPK - Ovulation Predictor Kit
PCOS - Polycystic Ovarian Syndrome
POAS - Peeing on a Stick
POF - Premature Ovarian Failure
PGD- Preimplantation Genetic Diagnosis
Prog or P4 - Progesterone
PUPO - Pregnant Until Proven Otherwise
RE - Reproductive Endocrinologist
SA - Semen Analysis
TTC - Trying to Conceive
U/S - Ultrasound
Terms
Beta - The blood test used to test for pregnancy
Protocol - Fancy word for this is what we're going to do this IVF cycle...
And if you see this 5dp3dt... and it looks like Greek, it means someone is 5 days past a 3 day transfer. LOL! You'll see that a lot!
Monday, March 15, 2010
Thursday, March 11, 2010
Choosing your Doctor
So, your choice of doctor will be a very important one. You need to find a Reproductive Endocronoligist (RE) you are really happy with. Now, every RE will not do IVF. IVF is very specialized. Depending on your proximity to an IVF clinic you are happy with, your RE may be your IVF doctor or not. For instance, I live in a medium-sized city with a couple different RE's. However, to my knowledge, there isn't a RE in the area who does IVF. The closest IVF clinic is about 2 hours away. So, I see my local RE for monitoring & tests... then I drive to the clinic for the actual procedures. If you're lucky enough to be near a clinic you are happy with, that's all that much better.
Side note here. If you've been unsuccessfully trying to conceive for over a year, get thee to an RE!!! Really. Run... don't walk to the nearest RE. Well, ok so maybe you don't want to go to the closest one, but you get my drift. RE's specialize in infertility. They have all sorts of sophisticated tests that can make all the difference in the world. I wasted 3 years with my gynecologist saying, "I'm sure next time I see you you'll be pregnant! I don't see any reason why not!" Once I stepped in the RE's office with the same test results my gynecologist had been looking at for 3 years, the first thing I was told was, "Well, you're not going to get pregnant on your own." Sheesh! Had I known that 3 years ago, I would have been a lot better off!
So, back to picking the RE that's right for you...
I would start by asking your gynecologist for a recommendation. He or she will know who has a good reputation in your area. Also, if they do IVF, consult the CDC's ART report to see their success rates. Set up an initial consultation & see how you like them. Not every patient is right for every RE. You need to understand this. Just because they are great on paper doesn't make them great for you. You will be spending amazing amounts of money and time with this person & their staff. Make sure you are comfortable with them. Every patient is different & every RE is different. Make sure you are a good fit. You will be amazed at how much time you're going to spend in the office & on the phone with your RE & your RE's nurse. Funny side story here... one of the girls I know that is doing IVF said she developed an almost Pavlovian response to all doctors. If they walked in wearing a white coat, she immediately felt the need to strip from the waist down for an exam. That makes me laugh to this day, but it has a bit of truth behind it. You're going to be having a LOT of exams. Make sure you can tolerate the person giving them to you!
Also, it is important for you to make a list of questions before you go in. You will be on information overload & when the RE asks if you've got questions, every one of the 100 you have will fly out of your head. Some clinics are great at giving out every little detail of information. Other clinics it seems like you have to ask every detail. Some clinics have shot clinics where they teach you to do the injections. Some hand you the needles & meds and tell you to have fun. The good news is that you can find just about everything you need to know on the Internet from common questions to injection instructions, but if you're a person that prefers the personal hand-holding, then you need to find a clinic that provides that.
Never be afraid to ask questions!!! Ask all the questions you can think of ... even if you think they're silly. There is no other way you're going to know exactly what your RE is thinking and planning.
And one last note... get to know your RE's nurse. He or she is going to be your lifeline. They will be the one calling with test results, scheduling exams & procedures and sometimes, they will be the one doing the majority of your exams. Get to know them & be on a friendly basis with them. Be sure they know you appreciate all they do. They have a hard job & even though it seems they do all the real work, the RE gets all the glory in the end. Don't forget about the nurses!
Side note here. If you've been unsuccessfully trying to conceive for over a year, get thee to an RE!!! Really. Run... don't walk to the nearest RE. Well, ok so maybe you don't want to go to the closest one, but you get my drift. RE's specialize in infertility. They have all sorts of sophisticated tests that can make all the difference in the world. I wasted 3 years with my gynecologist saying, "I'm sure next time I see you you'll be pregnant! I don't see any reason why not!" Once I stepped in the RE's office with the same test results my gynecologist had been looking at for 3 years, the first thing I was told was, "Well, you're not going to get pregnant on your own." Sheesh! Had I known that 3 years ago, I would have been a lot better off!
So, back to picking the RE that's right for you...
I would start by asking your gynecologist for a recommendation. He or she will know who has a good reputation in your area. Also, if they do IVF, consult the CDC's ART report to see their success rates. Set up an initial consultation & see how you like them. Not every patient is right for every RE. You need to understand this. Just because they are great on paper doesn't make them great for you. You will be spending amazing amounts of money and time with this person & their staff. Make sure you are comfortable with them. Every patient is different & every RE is different. Make sure you are a good fit. You will be amazed at how much time you're going to spend in the office & on the phone with your RE & your RE's nurse. Funny side story here... one of the girls I know that is doing IVF said she developed an almost Pavlovian response to all doctors. If they walked in wearing a white coat, she immediately felt the need to strip from the waist down for an exam. That makes me laugh to this day, but it has a bit of truth behind it. You're going to be having a LOT of exams. Make sure you can tolerate the person giving them to you!
Also, it is important for you to make a list of questions before you go in. You will be on information overload & when the RE asks if you've got questions, every one of the 100 you have will fly out of your head. Some clinics are great at giving out every little detail of information. Other clinics it seems like you have to ask every detail. Some clinics have shot clinics where they teach you to do the injections. Some hand you the needles & meds and tell you to have fun. The good news is that you can find just about everything you need to know on the Internet from common questions to injection instructions, but if you're a person that prefers the personal hand-holding, then you need to find a clinic that provides that.
Never be afraid to ask questions!!! Ask all the questions you can think of ... even if you think they're silly. There is no other way you're going to know exactly what your RE is thinking and planning.
And one last note... get to know your RE's nurse. He or she is going to be your lifeline. They will be the one calling with test results, scheduling exams & procedures and sometimes, they will be the one doing the majority of your exams. Get to know them & be on a friendly basis with them. Be sure they know you appreciate all they do. They have a hard job & even though it seems they do all the real work, the RE gets all the glory in the end. Don't forget about the nurses!
Monday, March 8, 2010
So... you're thinking about IVF
So, you've come to THAT place in your life. You're trying to get pregnant & it's just not happening. It sucks. There's no two ways about it. You're sick of charting your basil body temps & you've peed on enough ovulation sticks that you know exactly to the second that you're ovulating. (ok... not to the second really, but it sure seems like it) You're sure you've timed it right month after month and every month you look at that pregnancy test and only see one line. One stupid, frustrating, single line.
You've talked to your gynecologist. You've done the tests. You may know why it's just not happening for you, or you might not. If you have an answer as to why, even though it may seem like the world threw you a nasty, at least you have an answer as to why. There are just too many that just get the "Unexplained Infertility" label. You've maybe tried an IUI or two or three or twelve... that's not working either. Then your gynecologist says those words... they come in two forms...
Form #1 ... I've taken this as far as I can. It's time to send you to a specialist.
Form #2 ... I think you should think about IVF at this point.
So... you go home & start scouring the internet like a fool. Maybe that's how you found this little blog... Welcome to the world of IVF. Frankly, I wish you weren't here. I wish you could've gotten pregnant on your very first try & you were happily pushing around a baby stroller. But... you're not. You're here with the rest of us. The good news is that there is a "rest of us." You're not alone. You're with a bunch of fun, smart, funny, and sarcastic women who all find their situations sounding freakishly like yours. Embrace these gals. That's the best advice I can give you. The people in your life who love you will try their best to understand & support you, but there's just nothing like talking to someone else who knows exactly what you're dealing with.
I think there are four big questions that are in every gal's mind when she starts thinking about IVF...
#1 ... What is the success rate?
#2 ... What is the cost?
#3 ... Am I going to get pregnant with 10?
#4 ... What about the shots?
Let me answer those the best I can & send you to a couple great resources...
First of all... what is the success rate of IVF? Here is the straight up truth. Ummmm... it depends. What a crappy answer, right? Sorry. The truth is, that every clinic is extremely different. Every age range is extremely different. Every diagnosis has its own difficulties. The best you can do is do lots of research. Unfortunately, it seems that the younger you are, the better chances of success you have. I say unfortunately because many of us find ourselves in this struggle in our 30's and 40's. It ends up that way after several years of "trying." I only wish we were all in our early 20's and knew we needed to just skip the years of trying & move directly to this step... but that's not the reality. Anyways, back to success rates. Check out the government publication at the CDC ART homepage. Did I just throw an acronym at you? It's an important one to know... ART... Assisted Reproductive Technology. The acronym describes it perfectly though. It's important to remember that ART is well, it's an ART form. Some doctors are better at it than others. That website is the data that the doctors are required to file with the government & then the government verifies it for accuracy. You may be bummed that the latest report is older than you'd hoped. The thing is... pregnancy is a 10 month-long process. So, if someone got pregnant in December 2009, they would give birth in late 2010... so they would have to wait until the end of 2010 to report the success of 2009 since the report includes live births... and then it takes time to verify. But the nice thing about this report is that it keeps everyone honest about results. You'll see clinics in there with a 10% success rate... all the way to a 50% success rate & higher.
So... question #2... How much does IVF cost? Are you ready for another crappy answer? Because here it comes again... it depends. Sorry. It really does. If you are lucky enough to have insurance that covers it (and most don't), you should do some dancing & singing in the streets. From what I've seen, most of us that pay out of pocket will end up somewhere around $12,000 a cycle. ARGH. Yuck. Eeeeew. Also, if you need donor eggs or sperm, that will add a couple thousand to that total. Most clinics do not publish their prices on-line & will not hit you with the price total until your initial consultation. But... if you're making this big of an investment, do you really want to go with the cheapest or the best? Here is one thing to keep in mind though... the medicine costs. You will probably see a price at the clinic that does not include medicine... and medicine for IVF is EXPENSIVE. My number above is what it costs me with medicine costs... so you'll probably go to a clinic & see a price tag of $6,000 to $10,000. Your meds are likely to cost you an additional $3,500 - $5,000. There is always the option of if you're in the US, you can go out of country and get IVF done cheaper. The decision is totally yours. Just remember to add in travel costs like airline, hotel, car rental & cost of time off work.
Question #3... and a better answer than the last two... Am I going to get pregnant with 10? NO WAY JOSE!!! And if you do, it would be completely your decision & what doctor did you go to anyways? Most reputable clinics will only transfer 1 or 2 embryos. Some (in some cases where there have been multiple failures) will occasionally transfer 3. That said, it is always discussed with you the patient way before the transfer & you will know exactly how many you're transferring. Now, I know that if you really want to get pregnant with 10, you can find a clinic that will transfer a bunch, but is that really in your best interest or the 10 babies' best interest? Now, there is always a possibility that if you put in 1, you could end up with identical twins... or two could split into 4. But ... listen carefully, the chances of that happening are the same as if you got pregnant naturally & had identical twins. Very remote. I'm not saying it can't or won't happen, but I'm saying that's the same chance you would have if you got pregnant naturally. Now, if twins run in your family, that may be something to take into consideration & discuss with your doctor. All that to say, you need to discuss with your doctor what you are comfortable with. And the biggest thing to remember is even if you transfer 2 or 3, the likelyhood of all of them turning into viable pregnancies, is low... But it is a possibility you need to be prepared for.
Last question... and for some of us dedicated wimps... one of the really important ones... What about the shots? The answer is.... LOTS of SHOTS! You read on websites that there are generally two phases to IVF. There is supression & then you do stimulation. I was naive to think that meant a shot a day for supression and then another shot during stimulation. I think I just about passed out when a virtual pharmacy showed up on my doorstep with a sharps container & multiple packages of needles. Here's the truth. Lots of shots. It will all depend on the IVF Protocol that your doctor decides to use. A typical protocol will go something like this... 1 shot per day for supression before your period starts for about 2 weeks. After your period starts, you will do 2 shots in the morning & then 2 or 3 shots in the evening for about 10-12 days. These shots are all sub-q shots meaning little tiny needles that you put in your stomach or thigh. Then you will go in for egg retrieval. Then you start the BIG shots that are inter-muscular... meaning the needles are 1 1/2 inches typically and they go into your hip. You will continue these until you go for a pregnancy test. If it's negative, you'll stop them & if it's positive, depending on your doctor, you could continue them for another 6-8 weeks. Ok... so while your head is swirling around all this, let me say, I'm the head dedicated wimp & I managed to do it... and survive it. You can do it too. I'll do another entry later with some pointers on shots & lessening the pain.
So, long-winded first post... but IVF is a long process. Welcome to the club.
You've talked to your gynecologist. You've done the tests. You may know why it's just not happening for you, or you might not. If you have an answer as to why, even though it may seem like the world threw you a nasty, at least you have an answer as to why. There are just too many that just get the "Unexplained Infertility" label. You've maybe tried an IUI or two or three or twelve... that's not working either. Then your gynecologist says those words... they come in two forms...
Form #1 ... I've taken this as far as I can. It's time to send you to a specialist.
Form #2 ... I think you should think about IVF at this point.
So... you go home & start scouring the internet like a fool. Maybe that's how you found this little blog... Welcome to the world of IVF. Frankly, I wish you weren't here. I wish you could've gotten pregnant on your very first try & you were happily pushing around a baby stroller. But... you're not. You're here with the rest of us. The good news is that there is a "rest of us." You're not alone. You're with a bunch of fun, smart, funny, and sarcastic women who all find their situations sounding freakishly like yours. Embrace these gals. That's the best advice I can give you. The people in your life who love you will try their best to understand & support you, but there's just nothing like talking to someone else who knows exactly what you're dealing with.
I think there are four big questions that are in every gal's mind when she starts thinking about IVF...
#1 ... What is the success rate?
#2 ... What is the cost?
#3 ... Am I going to get pregnant with 10?
#4 ... What about the shots?
Let me answer those the best I can & send you to a couple great resources...
First of all... what is the success rate of IVF? Here is the straight up truth. Ummmm... it depends. What a crappy answer, right? Sorry. The truth is, that every clinic is extremely different. Every age range is extremely different. Every diagnosis has its own difficulties. The best you can do is do lots of research. Unfortunately, it seems that the younger you are, the better chances of success you have. I say unfortunately because many of us find ourselves in this struggle in our 30's and 40's. It ends up that way after several years of "trying." I only wish we were all in our early 20's and knew we needed to just skip the years of trying & move directly to this step... but that's not the reality. Anyways, back to success rates. Check out the government publication at the CDC ART homepage. Did I just throw an acronym at you? It's an important one to know... ART... Assisted Reproductive Technology. The acronym describes it perfectly though. It's important to remember that ART is well, it's an ART form. Some doctors are better at it than others. That website is the data that the doctors are required to file with the government & then the government verifies it for accuracy. You may be bummed that the latest report is older than you'd hoped. The thing is... pregnancy is a 10 month-long process. So, if someone got pregnant in December 2009, they would give birth in late 2010... so they would have to wait until the end of 2010 to report the success of 2009 since the report includes live births... and then it takes time to verify. But the nice thing about this report is that it keeps everyone honest about results. You'll see clinics in there with a 10% success rate... all the way to a 50% success rate & higher.
So... question #2... How much does IVF cost? Are you ready for another crappy answer? Because here it comes again... it depends. Sorry. It really does. If you are lucky enough to have insurance that covers it (and most don't), you should do some dancing & singing in the streets. From what I've seen, most of us that pay out of pocket will end up somewhere around $12,000 a cycle. ARGH. Yuck. Eeeeew. Also, if you need donor eggs or sperm, that will add a couple thousand to that total. Most clinics do not publish their prices on-line & will not hit you with the price total until your initial consultation. But... if you're making this big of an investment, do you really want to go with the cheapest or the best? Here is one thing to keep in mind though... the medicine costs. You will probably see a price at the clinic that does not include medicine... and medicine for IVF is EXPENSIVE. My number above is what it costs me with medicine costs... so you'll probably go to a clinic & see a price tag of $6,000 to $10,000. Your meds are likely to cost you an additional $3,500 - $5,000. There is always the option of if you're in the US, you can go out of country and get IVF done cheaper. The decision is totally yours. Just remember to add in travel costs like airline, hotel, car rental & cost of time off work.
Question #3... and a better answer than the last two... Am I going to get pregnant with 10? NO WAY JOSE!!! And if you do, it would be completely your decision & what doctor did you go to anyways? Most reputable clinics will only transfer 1 or 2 embryos. Some (in some cases where there have been multiple failures) will occasionally transfer 3. That said, it is always discussed with you the patient way before the transfer & you will know exactly how many you're transferring. Now, I know that if you really want to get pregnant with 10, you can find a clinic that will transfer a bunch, but is that really in your best interest or the 10 babies' best interest? Now, there is always a possibility that if you put in 1, you could end up with identical twins... or two could split into 4. But ... listen carefully, the chances of that happening are the same as if you got pregnant naturally & had identical twins. Very remote. I'm not saying it can't or won't happen, but I'm saying that's the same chance you would have if you got pregnant naturally. Now, if twins run in your family, that may be something to take into consideration & discuss with your doctor. All that to say, you need to discuss with your doctor what you are comfortable with. And the biggest thing to remember is even if you transfer 2 or 3, the likelyhood of all of them turning into viable pregnancies, is low... But it is a possibility you need to be prepared for.
Last question... and for some of us dedicated wimps... one of the really important ones... What about the shots? The answer is.... LOTS of SHOTS! You read on websites that there are generally two phases to IVF. There is supression & then you do stimulation. I was naive to think that meant a shot a day for supression and then another shot during stimulation. I think I just about passed out when a virtual pharmacy showed up on my doorstep with a sharps container & multiple packages of needles. Here's the truth. Lots of shots. It will all depend on the IVF Protocol that your doctor decides to use. A typical protocol will go something like this... 1 shot per day for supression before your period starts for about 2 weeks. After your period starts, you will do 2 shots in the morning & then 2 or 3 shots in the evening for about 10-12 days. These shots are all sub-q shots meaning little tiny needles that you put in your stomach or thigh. Then you will go in for egg retrieval. Then you start the BIG shots that are inter-muscular... meaning the needles are 1 1/2 inches typically and they go into your hip. You will continue these until you go for a pregnancy test. If it's negative, you'll stop them & if it's positive, depending on your doctor, you could continue them for another 6-8 weeks. Ok... so while your head is swirling around all this, let me say, I'm the head dedicated wimp & I managed to do it... and survive it. You can do it too. I'll do another entry later with some pointers on shots & lessening the pain.
So, long-winded first post... but IVF is a long process. Welcome to the club.
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