The Process of Fertility Treatments

Many people are not aware of what’s involved in fertility treatments so I thought I’d chronicle my experiences here. (Note that not everyone has the same experience, and I realize that there are others that have been through so much more.)

Tracking temperature – Before even starting treatments, I had to track my temperature every day for several months.  This record assisted in an overall view of my cycle and how my temperature shifted throughout the cycle. Body temperature is typically lower in the first half of the cycle and then dips down for a day around ovulation; then it increases in the second half of the cycle as the hormones shift from estrogen to progesterone.

Medication and more tracking – There is a medication that is typically used for breast cancer patients but it is also starting to be used more in fertility. This medication is intended to suppress the estrogen hormone and is helpful for those with estrogen dominance and PCOS (polycystic ovarian syndrome). I was not officially diagnosed with PCOS but was told there was a good chance that I have it since I have a history of painful ruptured ovarian cysts as well as uterine fibroids. I needed to take this medication within the first few days of my cycle (days 3 through 7). In suppressing the excess estrogen, the medication helps the egg grow to a larger, healthier size which then will help support it as it travels down the fallopian tube.  

Doctor visits and more tracking – With a typical cycle of between 27 and 30 days, mid-cycle would be around the 12- to 15-day mark.  Temperature tracking as well as observing cervical mucous helped to determine when ovulation might occur each month.  I had to estimate when I would reach the middle of my cycle and schedule a visit with my OB/GYN.

Painful procedures – During this visit, a vaginal ultrasound would be performed to see if there is a large healthy follicle (implying a large healthy egg ready for release).  I also had endometriosis resulting in the ovaries being stuck in odd positions withing the abdomen because of the sticky tissue that develops outside the uterus.  Besides the cycle pain of endometriosis, the internal ultrasound was very painful since the doctor had to “dig around” to get a clear image of the ovaries.

More medication and strict procedures – If a healthy follicle was seen on the ultrasound, the doctor would prescribe an injectable medication. This medication is not covered by insurance and costs roughly $100 each time – and I was going doing this each month. This injection is administered by the patient into the lower abdomen and is used to help ensure ovulation. If the follicle is not viewed at the appointment, the medication will not be prescribed. Whether or not the medication is prescribed, we were then instructed to be intimate at least once per day for the next 5 days.  This tended to take the intimacy out of our encounters and many times made it seem more like a chore than an act of intimate love.

Additional tracking – Another method of tracking was done with a digital ovulation monitor. This monitor comes with sticks that get dipped in morning urine (around the same time each morning) and, once dipped, get inserted into the monitor.  The monitor can calculate the hormones in the urine to estimate ‘low’, ‘high’ and ‘peak’ ovulation. This monitor was not covered by insurance and was about $100 for the monitor plus purchasing the test strips each month.  Intercourse is encouraged at any ‘high’ detection and for 5-7 days after ‘peak’ is achieved so I also needed to track what day of my cycle the ‘peak’ occurred.

More medication – I was prescribed another oral medication that I would take on days Peak+3 days through Peak+16 days. My blood was drawn on days Peak+5, Peak+7, and Peak+9 every third month for nine months.  It was determined that the oral medication was not bringing my progesterone high enough so I was started on the vaginal suppositories of the same type of medication. However, since they are inserted vaginally, they absorb more because they do not need to flow through the blood system first. This medication was also not covered by insurance and was expensive, about $120 per month. 

More tracking – The suppositories were typically administered in the evening because they can cause drowsiness and they need to stay in position for a few hours to absorb.  This also meant no intimacy once it’s inserted so timing around intimacy days was important.  At first, I was taking the suppositories on days Peak+3 days through Peak+12 days.  It was later adjusted to days Peak+3 days through Peak+16 days to help reduce false positives (due to taking the test too soon after the injection) and/or possibly another miscarriage.

Fears and stress – I had such a lengthy history of miscarriages (most likely due to low progesterone).  The fact that the injection medication was comprised of HCG (the pregnancy hormone), I would have to wait until the day of my expected next cycle before I could take a pregnancy test.  I was afraid that, by ending the medication cycle at Peak+12 days (two to four days before I could test), I would be off of the medication for those two to four days which could possibly cause another miscarriage. Adjusting it to Peak+16 days helped to relieve some of that stress but then you’re back at day 1 of the next cycle and it starts all over again.

Yet more medications and pain – After my most recent pregnancy was confirmed, my doctor switched me to injections of progesterone since that is more concentrated. These injections were given right into the hip and were painful. Unfortunately, they were not enough. I miscarried once again.

Privacy is basically non-existent – Throughout the whole process, with the vaginal ultrasounds, injections in the hips with the pants down, and every doctor needs to go through everything again so they can properly help, privacy goes out the window. Oy vey!