There are two procedures, in combination with a number of medications used to treat infertility.
Medications:
Metformin
Clomid
Femara
Provera
Procedures:
IUI
IVF
Metformin
Metformin is an oral anti-diabetic drug. It is the first-line drug of choice for the treatment of type 2 diabetes and is also used in the treatment of polycystic ovary syndrome. Evidence is also mounting for its efficacy in gestational diabetes, although safety concerns still preclude its widespread use in this setting.
Metformin is an insulin sensitizer. This means, it helps your body recognize the insulin it already produces, helping your pancreas stop the overproduction. Often your doctor will prescribe 500mgs, taken once daily. It’s recommended that you start off taking it at night to minimize side effects. You should also take it with a small meal or snack. You will often be asked to increase your dose, do so slowly to give your body time to adjust. The dosage your body needs will be determined by your doctor. You should follow the above instructions when upping your dosage gradually.
The most common adverse effect of metformin is gastrointestinal upset, including diarrhea, cramps, nausea, vomiting and increased flatulence; metformin is more commonly associated with gastrointestinal side effects than most other anti-diabetic drugs. Some women notice certain food affect them more than others; greasy food and salad seem to be the most mentioned. Many recommend carrying anti-diarrhea meds (like Imodium) with you until your body adjusts to the medication.
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Clomid
Clomid blocks the effects of estrogen in the brain (specifically at the pituitary), which leads to increased levels of two hormones: LH and FSH. Higher LH and FSH stimulate follicle development in the ovary.
There are several types of patients who are prescribed Clomid:
1. Anovulatory cycles (typically PCOS)
2. Luteal phase defect
3. Unexplained infertility
Before starting Clomid, you should have a full work-up for infertility to ensure Clomid is the appropriate medication. You should discuss this work up with your physician, but it will typically include:
1. Semen analysis to make sure there aren’t any problems there. (What good is ovulation induction if there’s a sperm problem?)
2. HSG, especially if over age 35 to avoid using ineffective treatment when fertility is in decline
3. Day 3 labs, especially FSH since Clomid is less effective in women with high FSH
Your doctor may want to run other tests as well. Once it has been determined that Clomid is an appropriate treatment, it is typically started at a dose of 50 mg per day for 5 days (usually days 3-7 or 5-9). If ovulation is not achieved on this dose, it can be increased to 100 mg, then 150 mg. Your doctor may choose to use different doses depending on your particular case of IF.
Your LH surge will typically occur 5 days after the last dose of Clomid. Depending on your treatment plan, you will want to start using OPK’s 5 days after the last pill. Clomid can cause a false positive OPK if you check too soon, since Clomid artificially increases LH levels, which is what OPK’s measure. Most doctors don’t recommend using Clomid for more than 6 cycles.
Most of us are monitored with our RE’s when on Clomid. This means we get baseline ultrasounds to ensure there are no cysts (you don’t want to stimulate the ovary if you have cysts) and we get mid cycle ultrasounds to monitor response. Not all doctors do ultrasound monitoring because you can often determine whether you are ovulating with a 7 day post-ovulation blood progesterone level, and the risks of Clomid are low. However, the risks are real and it is important that you know what they are. Your physician may be comfortable not doing monitoring, but you need to be comfortable with this decision as well.
The mid-cycle ultrasound is probably the most important. It can tell you some very important information. First, it will determine whether you are responding to the Clomid. If there are no follicles, your doctor can adjust your treatment plan appropriately, and you don’t waste time taking a medication that doesn’t work for you. Second, it can determine if you are responding *too* well to the Clomid. The risk of multiples is higher with Clomid, and while most of that risk is for twins (7-9%), the risks of triplets (1 in 200 pregnancies), quads (1 in 300), and quintuplets (1 in 800) are also increased. If you don’t know how many follies you have, you can’t know your risk of multiples.
Rarely, people will have more serious side effects. While these are very rare, they do happen and you should know this when you agree to take Clomid without ultrasound monitoring.
If you read the information sheet that comes with the prescription, you will find that all of those side effects have been experienced by someone on this board. Most common is hot flashes and night sweats. Other common complaints are bloating, mood swings and headaches. Some people find the side effects are easier to tolerate if they take Clomid at night. Some people don’t notice any side effects from the Clomid.
In addition to the common side effects, Clomid can thin the endometrial lining, making it difficult (if not impossible) for implantation and pregnancy to occur. Mid-cycle ultrasound monitoring will show whether your lining is being affected by the Clomid, and your doctor can change your treatment plan accordingly. You also have higher risk for multiples, but mid-cycle ultrasound can show if there are more than 3 follicles, and you can discuss with your physician whether you are comfortable moving forward in that situation.
For every 100 women treated with Clomid, 70 will ovulate and about 25 will have a successful pregnancy. The efficacy will depend on your diagnosis.
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Femara
Femara is commonly known as a drug to help treat breast cancer. It is used "off-label" by some REs instead of Clomid, or if Clomid didn't work previously. It basically does the same thing as Clomid but usually with fewer side effects such as little to no CM and thin lining. As with Clomid, your Dr. (preferably an RE) will need to monitor you to make sure you respond and you don't have any ill side effects.
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Provera
Amenorrhoea, is the absence of a menstrual period in a woman of reproductive age. To cause the on start of a period, most OBGYNs will prescribe Provera. Provera, (Medroxyprogesterone) is a progestin, a synthetic variant of the human hormone progesterone. It is used as a contraceptive, in hormone replacement therapy and for the treatment of endometriosis as well as several other indications. It is often prescribed for 10 days. You can expect the onset of your cycle to start 2-5 days after you finish the last dose.
In females, the most common adverse effects are acne, changes in menstrual flow, drowsiness, and can cause birth defects if taken by pregnant women. Other common side effects include breast tenderness, increased facial hair, decreased scalp hair, difficulty falling or remaining asleep, stomach pain, and weight loss or gain. To decrease side effects you should take Provera at bedtime.
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IUI (Intrauterine Insemination)Most IUIs are done in conjunction with oral or injectable stims. Monitoring is required on Cycle Day 3 (blood work and ultrasound to check for cysts) and again around Cycle Day 12 (ultrasound to check the progress of follicle growth). When your doctor determines your follicles are ready, a shot will be given that will trigger ovulation approximately 36 hours following. A sperm sample will need to be dropped off a few hours prior to the IUI. It can be done at home or at the clinic as long as it arrives within an hour. The IUI itself feels similar to a PAP smear. Spotting and cramping is common following the procedure.
Click here http://www.fertilityplus.org/faq/iui.html for more frequently asked questions.
Click here http://www.advancedfertility.com/insem.htm for post-wash success rates.
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IVF
IVF (Invitro Fertilization) is where your egg and DH's sperm are put together outside your body, in a controlled lab. It is then monitored between 3-5 days (5 days is the norm if you have a lot of fertilized eggs. They want to see which fertilized egg progresses the most to know which to transfer back into your body.)
Usually your doctor will start you out by putting you on BCPs for 2 1/2 weeks to start to suppress and control your cycle. Then you will begin your protocol, which will involve stim(ulation) shots (shot into your stomach). There are several different med options.
During this time you will be monitored via ultrasound to keep a close eye on your follicles and their growth as well as your estrogen levels. The estrogen is to make sure that you are not going to ovulate on your own. Once the follicles hit the size your RE requires, (usually 18 mm or larger) you will trigger (another shot to bring on ovulation in 36 hours). Then, 36 hours later you will go in for your Egg Retrieval. This is where you are anesthetized your eggs are removed from your uterus, and then placed in the controlled lab. DH will have to submit a sperm specimen as well. There are two options. The sperm can be introduced to the egg(s). Or they can do ICSI which is where the sperm is actually shot directly into the egg. Some RE's will only do ICSI, others only when there is a problem, such as MFI.
The zygotes will be closely monitored with the hope is that they will mature into muti-cell units. Then on Day 3 (or 5) you will return, with a full bladder. They will take the zygote(s) and return it/them to your uterus. This is in hopes that it/they will snuggle in and become a viable pregnancy. Most REs will only return 1 to 2 zygotes depending on the age of the patient and which IVF cycle you are in. Each zygote has the potential to split and become twins. Any remaining zygotes will be frozen (snow babies) for a FET (Frozen Egg Transfer) if your fresh cycle does not work. It is also possible that you will not have any snow babies.
The main benefit of embryo freezing is the option to have frozen embryos thawed and transferred to the woman’s uterus in the future without having to undergo stimulation of the ovaries or egg retrieval. It is also possible that there may be enough frozen embryos for more than one subsequent cycle. If you choose to do this, your doctor will most likely have you on a aggressive protocol, to achieve as many follicles as possible without OHSS. Embryos can be frozen at any stage if they are of good quality. Embryos are stored in batches of one or more embryos depending on the number of embryos that are likely to be transferred into the uterus at a later date.
Not all embryos survive the freezing and thawing process. In a good freezing program, a survival rate of 75-80% should be expected. Therefore, it may be necessary to thaw out several embryos to get two or three good embryos to replace. Damage of embryos does occur as a result of freezing, not during the storage but during the cooling and thawing process. Couples have the right to have their embryos transferred from one center to another. The average cost of Embryo freezing can cost anywhere from $800-$2000.00. This is the typical initial fee for the freezing and first year of storage. After the first year, there are storage fees your clinic will charge as well.
Below is what happens in a 3dt:
1dpt ..embryo is growing and developing
2dpt... Embryo is now a blastocyst
3dpt....Blastocyst hatches out of shell on this day
4dpt.. Blastocyst attaches to a site on the uterine lining
5dpt.. Implantation begins,as the blastocyst begins to bury in the lining
6dpt.. Implantation process continues and morula buries deeper in the lining
7dpt.. Morula is completely inmplanted in the lining and has placenta cells &
fetal cells
8dpt...Placenta cells begin to secret HCG in the blood
9dpt...More HCG is produced as fetus develops
10dpt...More HCG is produced as fetus develops
11dpt...HCG levels are now high enough to be immediately detected on
HPT
===========
This is what happens in a 5dt :
-1dpt ..embryo is growing and developing
0dpt... Embryo is now a blastocyst
1dpt....Blastocyst hatches out of shell on this day
2dpt.. Blastocyst attaches to a site on the uterine lining
3dpt.. Implantation begins,as the blastocyst begins to bury in the lining
4dpt.. Implantation process continues and morula buries deeper in the lining
5dpt.. Morula is completely inmplanted in the lining and has placenta cells &
fetal cells
6dpt...Placenta cells begin to secret HCG in the blood
7dpt...More HCG is produced as fetus develops
8dpt...More HCG is produced as fetus develops
9dpt...HCG levels are now high enough to be immediately detected on
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