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The 10 Questions Everyone Should Ask When a Fertility Cycle Fails

A negative pregnancy test can be hard for anyone to bear, particularly individuals and couples who are going through fertility treatment. It’s like studying for weeks and weeks for an exam, thinking you know the material, and then getting an F. “Disappointing” doesn’t even begin to describe how you feel. And while the first place you usually go is your significant other’s shoulders for a good cry (and for a glass of wine and a bite of unpasteurized cheese), the second should be to your fertility doctor to break down why this cycle didn’t = baby.

Here are our suggestions on what should be on your list:

  1. Why didn’t it work?

Hands down, this is the most frequently asked question when a fertility cycle is not successful. And while it is a good place to start, in order to get concrete answers, it’s better to break it down into little pieces (a.k.a. your reproductive parts). When you chat with your doctor, make sure to be specific in your line of questioning; the narrower the question, the more useful the answer. And bring a pen and paper!

  1. Did I make a bad egg?

While we are never fans of finger pointing, in many cases the culprit is an abnormal egg, which resulted in an abnormal embryo, which = no pregnancy (especially if this was an IVF cycle where the embryo did not undergo genetic screening). Unfortunately, barring genetic testing of the embryo, there is not much that we can do to predict if the egg you ovulated or we extracted was normal. While we use hormonal assays (think FSH and AMH) and female age to help guide our treatment plans and analysis of the outcome, they are limited in their abilities to predict the future. This is why we are huge advocates of embryo screening. While it can’t tell us if the extra chromosomes came from the egg or the sperm, it gives us a lot of data about where the “damage” may have started. And while it is nearly impossible to change egg quality, by analyzing the embryos that are produced by those eggs, we can find the good egg (s).

  1. Was my partner’s sperm only so so?

Although men are often sperm-making machines for years longer than we are egg-making machines, as time ticks away, so does sperm quality and quantity. Furthermore, certain medical conditions or recreational habits can hamper your other half’s sperm production. Make sure that your partner has had a semen analysis, and if the results were only so so, your fertility doctor should refer your partner to a urologist. There are procedures, techniques, and medications that can help improve sperm quantity and quality.

  1. Are things not flowing freely through my tubes?

Think of the tubes like any major New York City tunnel—they can get blocked up anytime and for any reason. And while there are certain things in one’s medical and gynecologic history that would predict a tubal closure (a.k.a. a history of pelvic inflammatory disease or multiple abdominal surgeries), in many cases they are just closed for no clear reason. Therefore, before any fertility treatment is initiated, it’s a good idea to have your “tunnels” checked. If there is a problem, you will need to take an alternate route to achieve a pregnancy—and learning this before you set out on your fertility journey will save you a lot of time!

  1. Was my uterus not ready for a guest?

Although the uterus is infrequently the primary or solo cause of infertility or a failed fertility cycle, it should be looked at from a few angles. Routine ultrasounds depict the uterus in two dimensions. And while it can look good in this mirror, it’s important to have a 3D study or a test (HSG or hysteroscopy) that shows the inside of the uterus. Unwanted guests (e.g., fibroids, polyps, or scar tissue) that can interfere with implantation can be lurking!

  1. Should I repeat the same treatment, and if I do, what is the chance it will work?

Yes and no and maybe. (Well, that was helpful advice!) But all kidding aside, the reality is that most fertility treatments doesn’t work the first time you try them. You often must try a few attempts before you see success. However, you should 1,000% speak with your doctor between every attempt and ensure he or she breaks down what happened and how he or she can make things happen next time. Additionally, make sure you have an end point. While this road can be long, it shouldn’t be endless. Make sure there is a stop and you know where and when that will be.

  1. When is it time to move on to the next step?

Unfortunately, this one doesn’t have an easy answer. However, we added it to the list to make sure you ask it. And to ensure that you know that there are options, both in what you do and where you do it. You aren’t tied to one type of treatment or one treatment center. Ask, look, and listen. There are many good resources out there with lots of information (#trulyMD).

  1. Do you have paper and pen?

Write things down! Whether it be the questions you want to ask or the questions that you had answered, remembering everything can be hard. Jotting down what you want to say and what has been said will serve you well in the future.

  1. Can I have my records?

You are your best advocate (and your best record keeper). Asking for your records and speaking up on your behalf does not make you annoying. It makes you smart. And while you don’t need to become a bookkeeper, keep track of what goes into and out of your body. It can ensure that you stay balanced!

  1. What’s next?

We love plans. Just check out our calendars! But we especially love plans when it comes to our patients. Knowing what you are going to do if your day 1, that is, your period, comes can make dealing with D day somewhat easier. Simply stated, plan for the worst (#period), but hope for the best. That way, you won’t waste any time.

Getting pregnant and having a baby are not easy. Contrary to what we thought in college, you don’t get pregnant every time you have sex! Although people use the word “fails” liberally, remember that you are so not a failure. Doing fertility treatment is hard: emotionally, physically, and financially. Staying in the game when things get hard makes you a success—no matter what that pregnancy test shows.

Where Everybody Knows Your Name

While most of you, particularly those above the age of 35, are now picturing a couple of bar stools, Sam, Cliff, Norm, Woody, and Frasier, our minds are far from a local bar in Boston. Our minds are on the waiting room of your local fertility clinic. The place where “everybody should know your name” (but should not scream it loudly for everyone else there to hear!) but never does. The place we are referring to is the waiting room of your fertility clinic.

Contrary to popular belief, the waiting room should not resemble the subway platform during rush hour! Patients are not cattle, and your lady parts are not pieces on a factory assembly line. And while we, too, are fans of a morning sweat session, it should not be achieved by racing your fellow patients to the front of the ultrasound line.  It adds anxiety to an already stressful process. Fertility treatment is not easy. The process of getting there, getting in, and getting out should not make this process even harder. Simply said, if your blood pressure rises several degrees when you walk through the door, it might be time to walk out.

The desire to have a child can be overwhelming. It can drive even the sanest of us to do crazy things. And although we can’t promise that pineapple core, vitamin supplements, and a gluten-free diet will do the trick, we can promise you that they won’t hurt you. However, allowing yourself to be treated as a number and not as a person can be hurtful. In fact, it can compromise the quality of your care and your chances of conceiving; if nobody really “knows your name,” how can they appropriately treat your infertility?

Let’s face it. You don’t need everyone in the fertility office to be your best friend, but the individual doing your ultrasound should know your name, know why you are there, and know what you might be doing next (and should give you more than 30 seconds of their time!). If you are getting the boot out of the door the moment your bottom hits the exam table, it’s probably about time to find yourself another fertility clinic.

Fertility treatment is often a journey. For some, it can take years. The relationship you form with your doctor and your doctor’s office staff should be a good one. And while you may never find yourself in a bar in Boston talking about baseball, it is important that you feel comfortable with those sitting on the stool in front of you. The fertility clinic should be a place “where everybody knows your name.” You owe it to yourself. Cheers!

Don’t Break My Heart: The Impact of Fertility Treatment on Heart Disease

Be still, my beating heart: Does fertility treatment increase your risk for heart disease? The latest results from a large Canadian study made everyone’s heart skip a beat with its recent findings. The data showed an increased risk in heart disease in women who required fertility treatment to get pregnant. And while this study got a lot of press, before you have a heart attack, here are five things that you should know:

  1. Even with the increased risk reported in the study, the absolute numbers are very low (a.k.a. the number of women who experienced cardiovascular events was pretty small). While we aren’t turning a blind eye or a deaf ear to the results, we are interpreting them with caution.
  2. IVF in the 1990s and IVF in 2017 are VERY different. The treatment protocols and techniques have changed more than the fashion trends (#bellbottoms). Therefore, it’s nearly impossible to study the aftereffects of treatments given then to the aftereffects of treatments given now. Our medications are different, our stimulation styles are different, and our dosages are different. In fact, it’s hard to find anything that’s the same!
  3. When analyzing any research study, it’s important to distinguish between correlation and causation. Although they may sound the same and start with the same letter, they are very different in what they suggest and what they mean for you. When you think of causation, think of cigarettes and lung cancer: We all know cigarettes cause lung cancer. When you think of correlation, think of cigarettes and infertility. Cigarettes do not specifically cause infertility, but they have been associated with infertility. In this study, fertility treatment has been correlated with heart disease (to a modest effect), but fertility treatment has not been demonstrated to cause heart disease. And although the distinction may seem insignificant, it’s actually pretty important!
  4. Anyone who is going to undergo fertility treatment should be in good shape. While you don’t need to join us for regular 5:30AM workouts, you do need to be in good health. Pregnancy is no walk in the park; you want your body to be prepared for those nine months and the many months that follow!
  5. The primary outcome studied was “adverse cardiovascular events.” The authors lumped stroke, TIA (think of it as a temporary stroke), MI (a.k.a. heart attack), and heart failure altogether. And while they all may affect your heart and your brain, they are not all the same. By opening up the floodgates (or adding more diseases to the primary endpoint), you will almost certainly capture more women who fall into the “I got that disease” category. So, while more women who took fertility medications may have gotten the primary outcome, the primary outcome was pretty expansive.

Your heart is as important as your ovaries, your uterus, and your fallopian tubes to us fertility doctors. While we may seem to have a one-track mind (#makingbabies), we are not only focused on your fertility but also your future health. Therefore, we will keep following the latest scientific breakthroughs and bring them to you hot off the press. We cross our hearts!

Round and Round You Go: We Hope It Stops Where You Want to Go!

Unfortunately, it is more the norm for us to see or hear about couples (and individuals) that have undergone years of fertility treatments without success. Month after month, they take medications, inject themselves with hormones, and hold their breath as they wait for the pregnancy test results. For many of these patients, be it for medical reasons, financial reasons, insurance reasons, or misguided reasons, there is little that is changed between the negative cycles. We like to call this the merry-go-round effect: couples/individuals who continue the same ineffective treatments month after month without redirecting or reanalyzing the situation. It’s a bad situation that we want to help you change.

Let’s face it: after the same treatment, be it timed intercourse, oral medications, inseminations, or IVF, has failed continuously, something needs to change. Whether it be moving on to more aggressive treatments (or, as we say, stepping up the ladder!), tweaking the current protocol, or seeking a second opinion, you need to shake things up. There are many available fertility treatments that can be, and likely should be, utilized.

A patient-doctor relationship should be a partnership with give and take, as well as back and forth. Gone are the paternalistic days of medicine where the doctor speaks and the patient listens. Treatment decisions should no longer be dictated, but rather, discussed. If this is not happening for you and you find yourself in the merry-go-round rut, then you need to put the brakes on. Make a phone call, send an email, or sit down with your doctor to review your case. Bring your list of questions, and ask away.

If you don’t like the answers, don’t be afraid to take them and your struggles elsewhere. At some point, you have to either ask the attendant to stop the ride or simply hop off. Eventually, circling in the same direction stops being fun, exciting, or promising; it also makes you nauseous, dizzy, and loopy!

So be your own advocate, and shut this ride down. The park is huge, with so many more rides and adventures to explore.

Acceptance

Weather has a mind, a plan, and a path of its own. No matter how many times we open our weather app, if it’s going to rain, it will rain. We can’t will it away, wish it away, or watch it away (although you can go away and avoid it). It is the ultimate in uncontrollable. For all of us who have planned an outdoor wedding, an outdoor event, or have been derailed at an airport because of weather, you know what we’re talking about. To put it simply, battling uncontrollable elements sucks. Watching and waiting is beyond unnerving. But this is not a piece about the weather; we are for sure no meteorologists. It is about accepting the seemingly unacceptable, making peace with a fate you never dreamed, and learning to work through the discomfort to find a new calm.

On the surface, the connection may be hazy. However, that awful feeling of “I have no control” combined with “I have no idea what will happen” is not dissimilar to what you feel when trying to get pregnant, especially when it isn’t working. And while we are certainly not equating the weather to whether you’ll have a baby (we get how different they are), we are highlighting the similarities in the emotions we feel in situations that we can’t control.

When the pregnancy thing is not coming easily, the first emotion is usually shock. We have heard many a patient say, “I thought I just had sex and it happened. What is going on? Why is this not working?” The reality is that getting pregnant can be really hard. It can be really frustrating, exhausting, and frightening. In this situation, thoughts like “Will I ever be a mother?” run through one’s head on auto-repeat constantly throughout the day.

Additionally, our inabilities to will a baby into our belly can make us angry—angry with yourself, your partner, your friends (especially those that seem to get pregnant when they just look at their partner), and your doctor. These emotions are common and normal. Everything you feel, say, and want to scream is totally legit—for lack of better words, this sh-t sucks.

While we can give you a ton of advice about fertility, a lot of advice about GYN, and a good amount of advice on OB, what we can’t tell you is how to let the anger, frustration, and I-am-so-pissed-off-right-now emotions go. For each of us, it’s different. For some, it’s time. For others, it’s distance; for still others, it’s change. But whatever it is and for whatever amount of time it takes, when you finally arrive, it will be liberating. Acceptance of what previously may have seemed unacceptable will allow you to no longer stand still or move backwards but in fact take a leap forwards. The freedom to let it go is empowering and energizing—with this release, you have the strength to tackle your next steps.

Most women struggling with infertility probably never wanted to undergo fertility treatments, let alone talk to their GYN about why things were not working out. They never imagined doing IVF, let alone something like egg donation or a gestational carrier. The realization of where you are in relation to where you wanted to be can be mind-boggling.

And while we are certainly not minimizing your emotions or making light or your situation, we are hoping to push you forward. As your pacers, we know what awaits you at the finish line. We can see the end way sooner than you can because we have run this race alongside many other women many other times. We have some serious experience on this course and know its ins and outs, turns and curves. We want to guide you to the finish and achieve the dream of parenthood.

There may be no bigger control freaks than us at Truly, MD. Admittedly, we too are type A++++ women who like to check, double check, and then triple check. Gambling is not our thing, and we almost never leave anything up to chance. It’s just not our style. But through years of both professional and personal trials and tribulations, we have had to learn to let go—to give in to the unknown and to say okay to the previously unacceptable.

While we are certainly not recommending that you just go along for the ride on your fertility treatment merry-go-round (we want nothing more than to empower you to ask questions and participate actively in your treatment), we do want to help you close that weather app and accept what’s going on outside. You may not get pregnant on a bed of roses listening to Sade…it may be in an operating room with bright lights and a speculum. It doesn’t mean you failed or are any less of a woman. In fact, most would say you are even more of a warrior woman and will make an even better mom because of all you went through to become a parent.

Although the weather forecast may look bleak, remember, things can change as the days and time get closer. And even if it doesn’t, even if it rains or snows or hails in April, you can get through it. You may need to go to Plan B or Plan C, but at the end of the day, if you hang in there, you will be a parent. You will have a family, and you will reach the end of the fertility journey.
If you can find a way to accept your forecast, the skies will be bright on the other side; you may just get wet on the way.

Do I Have to Put My Gym Membership on Hold While Doing Fertility Treatments? Exercise during IVF

From Twitter to Instagram and Facebook to Google, we are constantly surrounded by other people’s thoughts, opinions, and advice (with the latter often being unsolicited). Do this; don’t do that. Eat this; don’t eat that. Wear this; don’t wear that. It’s overwhelming. One of the most hashtagged topics is what a woman should and should not do while she is either pregnant or trying to get pregnant. And while most advisors are well intentioned, their advice is often not well researched. This can not only be frustrating but also confusing; deciding whom to listen to can add to an already stressful process. Exercise and fitness top the list of hotly debated topics when it comes to preconception and pregnancy. But we are here to tell you to lace up, because your daily gym routine is unlikely to be the one to blame for your fertility struggles.

Exercise has taken quite the negative rap when it comes to preconception and conception. It has been blamed as the culprit for infertility, failed IVF cycles, miscarriage, early delivery, and everything in between. Keep your heart rate below 140. Don’t lift greater than X number of pounds. Don’t run more than three miles…the list goes on and on. But the science behind these data is weak, making them more fiction than fact. While there are times during fertility treatment where you may need to modify your regimen, it actually has less to do with the impending pregnancy and more to do with the size of your ovaries.

Fertility treatments, specifically IVF, cause the ovaries to grow in size. Bigger ovaries have a bigger chance of twisting (medical term = ovarian torsion); this is a medical emergency and requires surgery to correct. To reduce the chance of this happening, old-school fertility recommendations included a blanket recommendation: “Don’t exercise.” However, with more modern treatment protocols and a slew of exercise regimens, this is no longer the case. While you may not be able to run the New York City marathon three days before your IVF retrieval, you can certainly participate. The key is modification (and moderation!)—just as you would modify regimens and activities when pregnant, you can do the same while trying to get pregnant. But you don’t have to stop. It is likely what makes you feel good about you and what makes you sane. The medications can mess with you (both mentally and physically), and we want to help you maintain every aspect of what makes you YOU.

No one regimen, routine, or practice has been demonstrated to be the best. You should always share with your doctor what you are doing and let them referee your activity level. Additionally, if exercise is a big part of your life, then pick a doctor who gets it and your needs. Being avid exercisers ourselves, we get the yen for a good sweat. We have ways to alter your IVF treatment plan so that we can keep you moving throughout the entire process.  There will most certainly be a brief pause to any impact exercise at some point in the process, but the resume button can be hit pretty quickly!

You may not be a world-class athlete or make the next Olympic team, but if exercise is important to you, then you should not have to stop. Motivating yourself to move can be hard. We commend you for wanting to keep “moving it,” no matter what the season, the occasion, or the situation. Although you may have to move slower or lift lower, we can find something that you can do to keep that blood moving and the endorphins flowing, even when you might be growing!