Conception FAQ

Medication Guide

Here is a list of commonly prescribed medications related to infertility.  It is not broken down between IUI or IVF, but you can look up medications you may be discussing with your RE.

Click here to see medication guide.

***Pharmacy Coupon for Fertility Meds!***

Schrafts Pharmacy - A Walgreens Specialty Pharmacy - has a special for patients who are paying out of pocket for their fertility medications!

If your order totals $500 or more, you will get a $100 coupon that you can use right away!

This is only for the month of May.  Check it out.  Schrafts generally has great prices on fertility meds, and of course they include all syringes and free overnight shipping!

Click here to go to the Schrafts/Walgreens Pharmacy page.  Call  800-876-4545 for more information on the coupon in May!

To find info on cost comparisons by pharmacy - please click here!

Progesterone in Oil Injection Tips!

PIO Tips!

by Jess (Flying Monkeys)

My introduction to progesterone in oil (PIO) shots was during my first IVF cycle in 2005. I wasn't sure about my husband giving me the shots since he almost passed out when our vet described the surgery he had done to place pins in our dog's leg. The last thing I wanted was to have him pass out and get stuck trying to reach the needle to pull it out, flailing around like a wounded whale, what a sight. I eventually handed over the duty. These are tips that worked for me, they may not work for everyone and some things that didn’t work for me may work for others.

*Ambesol does not numb the injection site. Even after it dries, it stings.
*If you divide your butt/hip into quadrants, the upper and outer most quadrant is the most comfortable and desirable spot. I tried my thigh and thought I was never going to get the cramp out. I suppose you could have your spouse give them in your arm.
*It’s easier to have your spouse do them for you. They drew wonderful circles that we continued to retrace so he couldn’t miss ‘the spot’.
*Slow is not the way to go. Use fast darting motions. I had my husband practice on an orange or an apple to get the darting motion down and more comfortable for him. This tip came from a friend who is a nurse anesthetist. The difference between the previous cycle and the cycle he gave us this tip was enormous. My ass thanks him.
*Warm it up. The oil is pretty viscous so I would fill my syringe, recap it and while my cheek was numbing (explained next) I would stick it in my armpit, if you have breasts that will work too. I have tinies, not cleavage to hold it. Be careful not to depress the plunger. It made the PIO go in more smoothly.
*Ice it. I would take a gallon Ziplock bag, fill it about 1/3 with water and lay it flat in the freezer to freeze. About 20 minutes before the shot I would wrap it in a thin dish towel and stick it in my sweats against the side I was getting that night’s injections. (I’m sure I could have left that part out but you never know.) After the shot I’d put it back in the freezer for the next one.
*Make sure he squeezes up some skin where he’s shooting. The pressure helps needle insertion and discomfort.
*Rubbing the site or a heating pad after the injection helps. After the injection I would firmly rub the area or place some heat on it to help the oil disperse.
*Get up and walk around, you want to keep the blood flowing, that will help you not develop lumps and sore spots, and help distribute the medicine.

The warming and icing helped me survive PIO shots through 17 weeks of my pregnancy (don’t worry, that is not the norm for the duration of shots) and 4 of the 7 cycles it took to get me there. Good luck!

IVF Protocol for Poor Responders

"Stop Lupron Protocol"

This is an excerpt from an article in the online Oxford Medical Journals I read recently.  This is only a portion - there is more good information about poor response and ICSI, poor response and the likelyhood of ovarian failure, etc.
A rational approach to the management of low responders in in-vitro fertilization: Opinion

We prospectively evaluated the `stop-Lupron' protocol (Faber et al., 1998) at our Center (Karande et al., 1997b) Improved pregnancy rate in poor responder patients with cessation of GnRHa down-regulation prior to stimulation with high dosages of gonadotrophins. The study population included 82 consecutive low responders who underwent IVF–embryo transfer between January 1996 and October 1996. Low responders were defined as patients with either a history of a cancelled cycle or low response with standard protocol [peak oestradiol <500 pg/ml (1835.5 pmol/l), or <= 4 mature oocytes retrieved (n = 56)]. However, we also included patients with suspected abnormal ovarian reserve because we prospectively anticipated a low response in such patients. These included patients with an elevated day 3 FSH [>7 but <12 mIU/ml (7 pmol/l), n = 33] and/or elevated day 3 oestradiol concentration [>75 pg/ml (275.3 pmol/l), n = 8] in a non-treatment cycle (Smotrich et al., 1995) and patients' age >= 40 years (n = 24). Some patients had more than one abnormality. Patients with a day 3 FSH >12 mIU/ml [equivalent to a concentration of 25 mIU/ml using the Leeco assay (Scott et al., 1991)] were excluded from the study as, historically, we have not had a single live-birth in this group of patients. Twenty-six cycles (31.6%) were cancelled due to poor ovarian response. Fifty-one low responders reached retrieval and 48 had an embryo transfer. None of the patients had a premature LH surge. Based on a presumed low oocyte quality we were liberal with the number of embryos transferred in the low responder group (4.1 ± 2) and none therefore had any excess embryos for cryopreservation. The clinical pregnancy rate per started cycle was 19.5% (16/82) and per retrieval 31.4% (16/51). Surprisingly, we had a very high incidence of multiple pregnancies (43.8%). Of the 16 pregnancies, seven were singleton, five were twin, two were triplet, and there were two quadruplet pregnancies. This is in contrast to a similar group of patients, which were stimulated with a `flare' protocol where we had a dismal success rate (Karande et al., 1997a). Increasing the number of embryos transferred in low responder patients, therefore, does not seem to be a good strategy. We are currently investigating the role of blastocyst transfer in low responder patients (Gardner et al., 1998).

The mechanism by which the `stop-Lupron' protocol apparently improves ovarian responsiveness is unknown. It is possible that Lupron has a direct inhibitory effect on the ovaries and that, by reducing the dose or stopping it altogether, it removes this suppression and increases ovarian response (Parinaud et al., 1992; Kowalik et al., 1998). The mechanism of continued suppression (despite 11.1 ± 1.5 days of stimulation) of premature LH surges under this protocol is presently also still unknown and needs to be further investigated. Continuous suppression of LH after stopping leuprolide acetate has been reported (Sungurtekin and Jansen, 1995): a brief, 5 day course of GnRHa appeared to suppress endogenous GnRH activity for at least 1 week afterwards. In 19 patients, after stopping leuprolide acetate, LH was often undetectable within 48 h and remained so for at least 7 days.

What is Down Regulation?

Down Reg for IVF

Down regulation aka 'down regging' 'DR' or 'd/r' or "suppression", a LHRH Analogue drug is started on day 21 (CD21) of the menstrual cycle and continued for anything between 1-8 weeks. Down regulation is often used in conjunction with bcp. The drug is available either in a nasal spray or injection and has to be administered by the patient daily. The nasal spray is taken 3 times a day and the injection once into subcutaneous tissue, for example the upper thigh or tummy.

The drug will shut down the ovaries (although not prevent menstruation) so that no eggs can mature or be released - perfect for the IVF consultant to plan a treatment where eggs are harvested and collected all within a certain time frame.

Menstruation will occur at the usual time (approximately 7-9 days later) and the womb lining will shed. The woman can now start the next stage of IVF which involves stimulating the ovaries to produce numerous follicles and (hopefully) several eggs to be collected.

Smoothie Recipe!

Smoothie Recipe

By Amy (Practice Makes Perfect)

I SWEAR by my smoothie recipe.  M (husband) and I started drinking them close to daily back in August.  Since then, my cholesterol has gone down to rock star levels, and his triglycerides went from over 500 to below 200.  And I swear its because of the shakes.  I have only had 2 or 3 cycles of TTC since I started these shakes so I can’t swear there, but I am confident they will help!

 

It is a nice alternative to doing plain Whey Protien shakes, plus it counts as a serving of dairy and 2 servings of fruit.

 

This recipe is for TWO 32 oz shakes
2.5 cups of water 
1 cup of ice cubes 
2 scoops JAY ROBB Vanilla Whey Protein Powder 
2 scoops Samabazon Acai Powder
1 tablespoon Ground Flax seed
2 tablespoons organic creamy Peanut Butter
5 heaping tablespoons organic vanilla yogurt
2 large bananas
handful blueberries (fresh or frozen)
8 whole strawberries (fresh or frozen)

Put it in the blender and mix!  Everything can be purchased at Whole Foods or online.  Word of warning – It is absolutely a meal replacement shake calorie wise. 

 

Jay Robb Whey Protein Powder is awesome stuff too.  It is about $45 for 24 ounces - so NOT cheap - but it is seriously yummy and organic. 

Be sure to see the other posts about protein!

IVF/IUI Medication Costs - Comparison by Pharmacy

A very organized and helpful woman named Heather put this comparison together several months back.  I snagged it, knowing I would refer to it often. 

I have not checked to see if any of the prices need to be updated.  Even if you are using different meds and/or different dosages, seeing a price comparison is still pretty helpful!  I so appreciate that Heather put this together.

Freedom Pharmacy is not on the list.  However, they consistently have lower prices, especially on Gonal-F.  I have found some things at a lower price at other pharmacies, so it still pays to call/investigate.  Here is a link to their prices!

Click on the image to make it bigger!  I'm sorry that the links are not clickable.

Foot Baths and IUI/IVF

What are foot baths for?

Soaking your feet in a warm bath can't be bad, can it?  I don't think so.  Several women that are seeing acupuncturists or TCM practitioners have relayed the recommendation to soak the feet in warm water especially during stims.

On this holistic clinic's website, it says, "Heat is another wonderful method that can easily be applied at home if cold is an issue.  Soaking you feet in a warm foot bath is excellent for increasing circulation throughout the body, including the reproductive organs.  This method is especially useful if the person suffers from cold hands and feet."

Every time I've read about this (from other women doing IVF) the wisdom is - frequent warm foot baths helps to increase blood flow to the mid-section, especially the uterus and ovaries, and should be done during stims and up to embryo transfer.

If nothing else, it helps you slow down and relax!

Acupuncture and Infertility

Does acupuncture help infertility?  Does it help you prepare for IUI/IVF?

I have tried acupuncture.  I really enjoyed it, although I really can't be sure that my acu doctor actually specializes in fertility.  He doesn't speak English very well (which I take as a benefit, he is actually Asian!), but I know he understood what I was asking for because he asked me if I had ever been pregnant, etc. 

His treatment centered on "balancing me" and that sounds good to me.  He said, though, that I would need to buy certain herbal mixtures that would actually help me to get pregnant.  Unfortunately, the herbal mixtures were just way out of my budget.  So, I continued to go to him for awhile, just for acu - mainly because it was so relaxing. 

Ideally, I would continue to go to acupuncture if I could be sure I was seeing someone who specialized in fertility.  I don't think that it can hurt, and it is very relaxing for most people, and it might even help!

I found some interesting information about acupuncture and IVF online.  The website includes synopsis of 4 trials involving acupuncture and IVF.  What I found interesting was that in most of the studies, the IVF success rates were higher with acupuncture!  But, the studies weren't conclusive, because they didn't prove statistically positive - it could have just as likely been chance that resulted in the IVF success rates.

Here is a link to the information on IVF and Infertility. 

This website from a holistic clinic in Nova Scotia explains the acupuncture points used to treat infertility and has a lot of information on herbs as well.  There is almost too much information on this website!  It is not easy to self-treat, but you might be able to get some insight about what your practitioner is recommending for you.

First Visit with RE

When you are ready to meet with an RE, or a new RE, its hard to think of all the questions you might want to ask. 

I found this list on Fertility Friend - but I don't know who posted it originally!  Nevertheless, it is a good list, so I want to share it!  If you made this list, let me know so I can give you credit!

I just want to add, that in my experience, listening to what the doctor says BEFORE you even start asking questions is very effective as well.  Sometimes, just letting them lead at first will tell you volumes.  For example, do they ask you a million questions or immediately launch into their "plans" without knowing anything about you?

Here are the questions!

Approximately how many office visits per cycle?

Who does morning ultrasounds? What are the hours for labs/monitoring? How long should I expect to be here each morning for monitoring?

What drugs do you use and what are the side effects?

How often do you perform ICSI? Blastocyst transfers? Frozen embryo transfers?

How many embryos do you typically transfer per cycle?

Do you typically do 3 day transfers or 5 day transfers?

How do you feel about utilizing supplemental forms of treatment along with medications? (Vitamins, acupuncture, hypnosis, therapeutic massage, herbs, etc.)

What kind of protocol might you suggest to reduce the risk of OHSS? What percentage of your patients experience OHSS?

How much does it cost to store embryos and how long can we store them?

Is it possible to setup payment plans for things not covered by insurance?

What is your pregnancy ratio per embryo transfer?

What is your pregnancy rate for couples in our age group and with our fertility problem?

What is the live birth rate for all couples who undergo this procedure each year at your facility?

How will I communicate with you during this whole process?

Will I see you all the way through my treatment?

Will you give me a print out of the number of follicles I have produced each time I go for a scan?

Will you tell me precisely how many follicles were aspirated from each ovary when I have my egg collection and what happened to each one of them?

Will I be able to stay lying down for half an hour to an hour at the clinic straight after my egg transfer?

How long do blood tests and other test results take to receive? What is the procedure for getting the results? (Expect a call from nurse, call clinic after certain hour.)

How open are you to discussing information and protocols I may learn about from other sources? (The Internet, Resolve support groups, etc.)

I understand that many of my questions can be answered with a callback from a nurse, but if I need to speak with a doctor how do I make that clear?

What do I need to know about scheduling weekend procedures?

Number of patients cycling each month? How many retrievals and transfers do you do each week?

Are there any times when they don't do cycles (holidays, etc.)?