- It’s go time!
The big day is here. You are filled with anticipation, angst, and probably some fear. To minimize some of the negative thoughts running through your hormone-infused head, we have a suggestion. Before you walk into the operating room, make sure you have spoken with your doctor and have an idea about what to expect. What will the procedure be like, how many eggs do they think you will get, and how many embryos will you ultimately have? Managing expectations (particularly when it comes to the number side of things) will make both walking in to and out of the operating room a whole lot easier.
- Pain is not a part of the process.
No pain, no gain does not apply to the retrieval. We want to minimize the physical (and mental) discomfort you feel in every way possible. There will be an anesthesiologist present during your retrieval whose job is to focus on you, your comfort, and your overall well-being. Their cocktail will ensure that you neither feel pain nor remember a thing (without the calories or the hangover!).
- Don’t be tardy for this party.
We are pretty punctual when it comes to retrieval time (no airport delays here!). The time of the trigger medication and the retrieval are more coordinated than the worst bridezilla’s bridal party’s attire; while clinics vary in how many hours separate the trigger medication and the retrieval (some do 34, some 35, and some 36), what doesn’t vary is their commitment to staying on time. When things run behind schedule, what’s at stake is not your connecting flight but our ability to retrieve those eggs (ovulation can occur). So give yourself plenty of time to face the morning rush hour and the inevitable street closures—you don’t need another thing to stress about.
- All in all, the process is pretty quick.
Retrieving eggs is a fairly simple and fast procedure. In fact, most egg retrievals are no longer than a power nap and take no more than 15–20 minutes. Before you know it, you will be recovering in the recovery room, drinking apple juice, and eating graham crackers!
- Relax—we’ve got you covered!
Most fertility doctors are more comfortable doing retrievals than tying their shoes. As medical procedures go, this is our “bread and butter.” Think of something that you do every day (with ease and with grace): that is how we feel about extracting eggs. So while fear and anxiety are totally normal emotions, take solace in our experience. Close your eyes, enjoy the relaxing medications, and dream of something good. We will see you on the other side.
Does anyone recall sitting in math class and just staring at the blackboard thinking, “Nope, I just don’t get how X + Y * A = B.” Sure, you nodded to get Mr. Novick off your back, but in reality, you had no idea how he arrived at that answer. And while algebra and amusing are rarely used in the same sentence, that guy seemed to be doing some funny math! Much the same can be said about how we fertility doctors date (a.k.a. tell how pregnant you are and when you are due) pregnancies conceived with fertility treatments.
Most pregnancies (ART excluded) are dated based on the first day of a woman’s last menstrual period. And although you are technically not pregnant in the first approximately two weeks of the menstrual cycle (a.k.a. the follicular phase), you are growing the egg that will ultimately become half of your baby. Because the majority of menstrual cycles range between 25–35 days, the math usually works out. But when pregnancies are conceived with fertility treatments, the lead time (a.k.a. egg development) can be VERY variable. Weeks and even months may be added to get an embryo implant ready. For this reason, if you used fertility treatments to conceive, you can’t simply add a few days to your last menstrual period to calculate your due date. You may need some creative counting and a good doctor to get things sorted out.
As much as we love numbers, we can only count so high! Therefore, to make sure we are getting this equation right, we use pregnancy wheels (a fancy way to say pregnancy calculators) to figure out when you should plan to meet your plus one. Whether it be the day you ovulated, the day we performed your IUI, or the day your IVF ET was done, we can figure out exactly how far along you are. Given that the numbers will be less than transparent, it’s important to get a due date calculated by your fertility doctor before posting “We are expecting…coming March 24th” on your Facebook page. Additionally, you want to pass this info on to your OB and any other practitioner that participates in your care—they need to be in the know about when you will be ready to go!
Dates are not only numbers to an OB. We don’t break them, we don’t forget them, and we certainly don’t change them (unless we have a really, really good reason). They not only dictate when pregnancy-specific tests should be run (think genetic screening, diabetes screen, and GBS screening) but also when a fetus has what it takes to take on the world. Fetal lungs weren’t built in a day. In fact, they weren’t even built (for most babies) in nine months. They require those dreaded extra four weeks (remember, pregnancy is actually 40 weeks!) to get fully ready for a deep breath in and a deep breath out.
When most of us hear those words “You’re pregnant” (particularly after years of trying), we start to think about the end. And while it’s almost like planning for mile 26 before the race gun has even gone off, your due date is a big deal. But no matter how dynamite it is to know when D-Day is, your due date is NOT dynamic. It’s pretty dead set, especially after doing fertility treatment. IVF, IUI, and all the like leave little to the imagination. There is no questioning when your insemination or transfer was performed. Be mindful of these dates and the difference in how your due date is calculated after doing fertility treatment. While we love the web (#trulyMD), we want you to be careful when searching it for your due date. Make sure to use an IVF or fertility treatment calculator. This will save you a lot of calendar crossouts and changing-of-the-date chaos.
Often, making a decision about what we are going to wear to work, eat for breakfast, or make for dinner can be challenging. We have to admit that even for life’s most basic questions we resort to the pros and cons list! And while resorting to the plus-minus activity to answer the red vs the black shoe debate, imagine how long the list will be when you are deciding on what treatment plan to choose when it comes to your fertility. Timed intercourse vs IUI (intrauterine insemination), Clomid vs letrozole, IVF with a fresh transfer vs IVF with a frozen transfer—the list goes on and on. Like a buffet table in an all-inclusive family resort, it can become overwhelming.
We are not here to recommend that you isolate yourself to “half of the buffet” (a little variety is always good!) but to help you decide how to make the best decision for you and your fertility. As a simple rule, we have found that, when you are faced with a difficult decision, you should remember your ABCs. No, your eyes are not deceiving you, and no, we aren’t recommending that you break out into song…we are recommending that you Ask questions, get Answers, and then weigh the Benefits and the Cons of each option. The more you ask, the more you know, the more you know, the better equipped you are to make the right or the best “right now” decision for you and your partner.
Identifying the ABCs and deciding when, where, and what treatment to embark on can take time and work. We often see women and couples who are in the throes of infertility treatment struggling with these decisions. This “lost in limbo land” phenomenon can be debilitating, depressing, and overwhelming. In many cases, couples/individuals are not only wrestling with what sort of fertility treatment plan to choose, but also simply accepting that they are in our office and are going to need fertility help.
And to make matters worse, imagine that someone might be telling you that you won’t be able to use your own eggs or your partner’s sperm or your own uterus. It can be devastating. While we don’t expect an immediate decision, we do want to help you find the tools and the answers that you need to come to that decision. We promise you: the sooner you make up your mind and can initiate treatment, the sooner you are on the path to what you really want—becoming a parent.
Closing the chapter on any phase, any age, any idea, or any process is no easy task. It takes time; it is a process. There may be denial, there may be anger, and there may be grieving. If you are feeling or have felt any of these emotions when dealing with treatment decisions, we are here to assure you that they are normal. Making peace with what has happened in the past will help you move into the future, forward in the treatment process, and ultimately help you out of the dreaded “limbo land.”
The buffet has many options—fruits, veggies, pasta, pizza, chicken, steak, and fish (and don’t forget dessert!) Where to start, when to end, and how many times you should go back for more is really up to you. Your doctor will be your guide as you navigate your choices, but ultimately you put the food on your plate. Although they will point you towards the healthiest options and tell you when your plate is full, you decide when enough is enough. Listen to your gut, and remember your ABCs. They will help you as you review the menu and decide what’s best to order!
You’re not seeing things…we at Truly, MD, are turning our pens and paper towards the guys. While everything up to this point has been girl (or what you need to know about your plus one if he’s a guy)-related, we are breaking the mold and making this piece about men. Specifically, what happens when you have double the sperm and no eggs (a.k.a. same-sex male couples). And while the options may seem limited or even impossible without two key baby-making ingredients (eggs and uterus), there are ways to work around this.
Where do you find an egg(s)?
Close your eyes, and take a trip back to your childhood—specifically an Easter egg hunt. And while it may be a bit hazy at first, you can probably remember searching and collecting dozens and dozens of eggs. And although your brother, sister, or BFF may have come in at a slightly higher egg count at the end of the day, everyone made out pretty well (and consumed lots of chocolate). Finding an egg donor that is healthy and fertile while also possessing the characteristics (e.g., ethnicity, race) and traits (e.g., artistic, athletic) that you and your partner desire in a donor is just the opposite.
The screening process is intense—physical exam, personal and family history, blood testing, ultrasound, and genetics. Bottom line, there are many hurdles that must be cleared before an egg donor is cleared to give her eggs. Egg donors can be anonymous or directed (a.k.a. known). While most couples opt to go the anonymous route, whom you select is up to you and your partner. However, whomever you pick will need to go through IVF to extract her eggs.
Where do you find a uterus?
Finding a uterus (that is, a gestational carrier or a surrogate) can be laborious (no pun intended)! It is a big decision for any woman to make, and therefore, finding a woman who is willing and able can take a lot of time and a lot of resources. Just as there are for egg donors, there are agencies and attorneys who focus on identifying gestational carriers. Getting hooked up with one shortly after you get hooked up with your plus one is a good way to start the process.
Where do you find sperm?
While this question might seem somewhat misplaced (are they kidding me?), deciding whose sperm to use and when can be a bit complicated. If both partners want to provide a sperm, then you must decide whose embryo(s) will be transferred and when….
Today, parenthood is possible no matter who your partner is and what you are “lacking.” And although you may be missing one or two of the core “necessities” (eggs, uterus, or sperm), you already have the most important core necessity for parenthood—a major desire to be a parent. So don’t worry about the rest. That, we can help take care of!
Long gone are the days of June Cleaver, her dress and pearls, and her white picket fence. Nowadays, the face of families has had a major facelift. Two mothers, two fathers, working mom with a stay-at-home dad…it has all changed. Kudos to choice and change! But while you can mold your family to take whatever shape you want without an egg and sperm source, you will need some outside help manipulating the “clay.” Cue your friend, the fertility doctor.
While all pregnancies require an egg, a sperm, and a uterus, how these three sources meet and where they come from can be quite variable. It is our job (a.k.a. that of the fertility specialist) to help make these necessary introductions and ensure that, from this meeting, comes a baby!
The first order of business when we meet with a same-sex female couple is to figure out preferences and timing. Simply stated, do both partners want to give an egg, do both partners want to give a uterus (a.k.a. carry), and if so, when? And taking it one step further, do both partners want to carry their own genetic child or their partner’s genetic child? (Don’t worry if this sounds confusing; we will explain!) We then use this information to formulate your fertility plan. Here’s how.
Timing is not only everything in relationships but also in family planning. Which partner should go first (#getPREGNANT) is not only based on personal preference but also on medical factors (egg quality, egg quantity, and uterine receptivity). Therefore, before any final decisions are made, it’s a good idea for both partners to visit a fertility specialist and get checked out.
What your MD finds might have a major impact on what fertility options are available and in what order. For example, if you are 35 and your partner is 38 but your ovarian reserve is approaching that cliff (a.k.a. about to take a sharp decline), we may recommend that you go first in the pregnancy process. On the flip side, if your partner is 40 and you are 30 and you were hoping to have your little one before 31, we will probably recommend that you put your baby button on pause and let your partner go first. Nuances like this are not apparent unless you get down to the nitty gritty (blood work, ultrasounds, and a full exam) with a fertility doctor.
After you have been checked out, there are a few options for you to check out. Unbeknownst to most, there are a couple of ways (other than the obvious) to get egg and sperm to meet. These include inseminations (IUI) or IVF.
And the variety doesn’t stop there. When it comes to IUI, you can do it as bare bones as possible (a.k.a. time the inseminations to when you are ovulating) or add medications to boost your fertility (e.g., Clomid, letrozole, gonadotropins). Which route you choose to take is often made after recommendations from your doctor. If IUI isn’t working out, we might recommend that you amp it up a bit (#IVF). If other medical issues exist (low egg reserve, advanced maternal age), we may suggest skipping IUI altogether and going right to IVF.
In many ways, same-sex female couples have the most options on how to make and carry children. Let’s face it: although you may be at a loss for sperm, you have double the eggs and double the uterus. This doubling will come in very handy when mapping out how you want to enter motherhood. The reason is that, if you want, you can switch things up. You can carry the embryo created with your partner’s egg and donor sperm, and she can carry the embryo created with your egg and donor sperm. It’s a unique way to build a family, though it requires IVF, creativity, and cash. (We too believe the lattermost is unfair. We have added our voices to the fight against insurance inequities!).
Think about a cake. While the core ingredients are always the same (think flour, sugar, and butter), there is more than one way to mix it up (add cinnamon, nutmeg, or chocolate chips). The same goes for building a family—although you need those core ingredients (an egg, a sperm, and a uterus), how you combine these three can vary. Today’s family should have the flavor and flair of you and your partner—rigid guidelines are “rotten.” Anyone who tells you otherwise has way passed his or her expiration date.