By our wonderful friend and TTC warrior, Jay Palumbo
Across the world, the pandemic is (hopefully) phasing out. Well, sort of. Every fertility clinic is navigating how to proceed with fertility care and protect the health of all involved. Pursuing fertility treatment right now is like playing a new board game, and everyone is trying to get to grips with the new rules
“Wait… do we roll the dice or wait a month or two to play?”
“Hang on… I didn’t pass go, and now I’m in IVF Purgatory? That’s not right.”
“What do you mean there is no banker? How about an insurance card?”
“Oh shit… I drew six Clomid cycles!”
Why are you playing this game? As in, do you know why you’re not conceiving? Some fertility roadblocks for women could be irregular periods, any history of sexually transmitted diseases, early menopause or menopause in general (depending on your age), polycystic ovarian syndrome (which can cause irregular periods), or endometriosis just to name a few possible issues. For men, there could be a concern with their sperm, such as low sperm count or perhaps poor morphology. In both cases, a genetic component might be an issue as well.
Getting a thorough fertility examination is an excellent place to start (if you have not done it already). Hopefully, you’ll get a diagnosis that will help provide insight into the best course of action and whether or not fertility treatment is needed just yet. You may have a condition or issue that could help through medication, surgery, lifestyle changes (such as losing weight, quitting smoking, etc.) or some other underlying health issue.
Overall, answers are a good thing when it comes to your reproductive health. No one wants their infertility diagnosis to be like a Magic 8 Ball.
“What do I have?”
“Outlook hazy. Check back later.”
Family Building Options
Now that fertility treatment is starting back up again, let us look at all of the options on the family building menu, shall we? I am not a doctor, nor have I played one on TV so here is my less than medical take on each one:
Intrauterine Insemination (IUI): A catheter gives the sperm a head start by inserting past the cervix and ideally, making its way to an egg during ovulation time.
In Vitro Fertilization (IVF): Eggs are retrieved and combined with her partner or donor’s sperm. After fertilization, ideally, embryos will be created. You can discuss with your doctor how many to transfer or freeze to be transferred later. Similar to IUI, the embryo(s) are put into a catheter where it is transferred to the woman’s uterus (or a gestational carrier) in the hopes that it will implant into the uterine lining.
Intracytoplasmic Sperm Injection (ICSI): I personally think of this as a doctor saying to the sperm, “No, really… go here!” but more clinically speaking, this is when a single sperm is injected directly into your egg, rather than placing many sperm next to the egg.
Freeze All IVF Cycle: IVF cycles described above typically involve the transfer of “fresh” embryos to the uterus within three to five days after the egg retrieval. With a “Freeze All” cycle, any embryos created are frozen using a process called “vitrification,” which is a fast freeze, and the embryos are transferred later. This is recommended either if your doctor feels you could benefit from genetic testing (such as PGT-A or PGT-M) or they want to give a woman’s body time to get back to its normal state after taking hormones to produce the eggs that were retrieved. (I had my last IVF nine years ago and I’m still not sure my body is back to normal)
Donor Egg or Donor Embryo: If you are unable to conceive with your eggs or if you’re in a same-sex male relationship, you can have IVF treatment using donated eggs. The eggs are combined with a partner or donor sperm, and just like the IVF, the resulting embryo(s) is transferred to the intended mother or gestational surrogate’s uterus (see below).
Donor Sperm: This is an option either for LGBTQ+ couples or single women as a means of conceiving, if a male partner has no sperm or a poor semen analysis (azoospermia, low count, poor motility), or when there is a genetic concern that could be inherited from the male.
Surrogacy (gestational carrier): Your bun and her oven. Not at all the medical way of putting it, but it helps everyone get the process. Basically, another woman carries your embryo or donor embryo to term and gives birth to your baby. Note that gestational carriers do not have a biological tie to the child. If they did, it would be called “Traditional Surrogacy,” which isn’t recommended.
Questions to Ask Your Doctor
Clinics are opening again, and you’re about to jump into the trying to conceive game (so to speak). Some clinics may not have paused some treatment, while others now have new protocols in place. Here are some questions you may want to ask to feel comfortable and safe now that you are pursuing treatment:
When attending any clinic appointment, what precautions will the clinic be taking? Are there any precautions you recommend my partner and I take as well?
How are you prioritizing fertility treatment? What would you consider my treatment as?
Is there anything I can do to help expedite treatment?
Will there be any additional paperwork or consent forms to help us best proceed in getting the care we need to build our family?
How to Stay Healthy
You are on the gameboard again. You have your playing pieces ready to go and your game face on. The last question (other than, ‘Will this damn treatment work or not?!?’) is if you need a surgical mask on that game face. These are the recommendations to help keep yourself healthy during treatment:
Wash hands frequently
Yes, this again. Use warm soap and water for at least 20-30 seconds. If you are unable to wash your hands, use an alcohol-based hand sanitizer with at least 60% alcohol. Clean and/or disinfect all surfaces using household cleaning spray and/or wipes. Avoid touching your face, eyes, nose, and mouth.
Continue to avoid exposure
Skip any nonessential travel, use rubber gloves and a mask if it makes you feel more protected and of course, avoid those who sick.
Some Fertility Resources to Turn To
The path to parenthood can take many different routes for everyone, and you need to decide what is best for specifically you and how to feel safe while pursuing this path during COVID-19. Please know that you have at least one Italian American Woman in Brooklyn, New York hoping you win this crazy game!
To read more articles about fertility treatment, written in her brilliant, unique and easy to understand way, click here.