New to Trouble Trying to Conceive?

lyse2143

Welcome!

The 3T gals would just like to say, we're sorry you have to be here. No one wants to have trouble getting pregnant. However, now that you are here, here are a few things that are commonly asked. Reading this will answer a lot of your questions. If after reading this you still have questions, by all means please ask. We are all at different stages in our journey, and will do our best to help you. Good luck moving forward on your own journey!

 

What is "trouble" trying to conceive?

We all have different thresholds for what we would consider "trouble." Most of us on the board would interpret that to mean that you have a diagnosis, such as PCOS or symptoms, such as irregular cycles that will make getting pregnant more challenging. Some people have no symptoms or diagnosis, but have been trying to conceive for over a year without success, or 6 months if they are over 35 years old. Some people have had multiple miscarriages. And some people have other reasons for being here.

You might want to reconsider joining us if your idea of "trouble" is not getting pregnant after only 3 or 4 months of trying. We all remember being there, and yes, we know that it is incredibly frustrating to get that BFN month after month. But please keep in mind, it can take a normal, healthy couple up to a year to conceive. "Impatience is not a fertility issue." -RG. That being said, many of us had our initial testing done before the year mark. Just know that if it comes back normal, you still have a chance that things will work on their own!

Other resources

Some other sites to check out:

The Bump Glossary--an explanation of all those abbreviations and acronyms everyone is using  https://community.thebump.com/cs/ks/blogs/nest_baby_editors/pages/the-bump-community-glossary.aspx

The Unofficial Bump Glossary--more explanations https://community.thebump.com/cs/ks/forums/thread/13543381.aspx

Resolve--the national infertility association https://www.resolve.org/

Soul Cysters--a great PCOS website https://www.soulcysters.com/

Freedom Fertility--one of the cheaper sources for mail order prescriptions for fertility medications https://www.freedomfertility.com/

999 Reasons to Laugh at Infertility--comic relief https://www.999reasonstolaugh.com/

lyse2143

Testing

Common tests your RE or OB/Gyn will order:

HSG:
When you first go to the RE, s/he will most likely start with 3 tests:
1. SA for your husband
2. CD3 blood-work
3. an HSG for you.

The HSG (hysterosalpingogram) is an x-ray of the uterus and the fallopian tubes. The purpose of an HSG is to find out if there are any blockages in your tubes, and/or if the uterus has a normal shape. It should be scheduled between CD 5 and 10, after AF and before ovulation. Call your insurance to see if they cover it before you schedule. The costs can vary quite a bit. In a recent poll on 3T the prices ranged from $450 to $1500.

About an hour before your appointment you should take some painkillers to reduce the pain/cramps/discomfort during and after the HSG. Most women take 800 mg of Ibuprofen. The appointment will last anywhere from 15 to 30 minutes. The radioopaque dye is put through a thin tube (catheter.) This is put through the vagina into the uterus, from here it will flow into the fallopian tubes. Some women are able to watch on a monitor while the HSG is done. However, this is not always the case. The results are sometimes given right there, but it can also take a couple of days. Take a pad to the appointment to catch any leakage afterwards. The dye will come out at some point!

Some find this procedure very painful (especially when tubes are blocked), some have AF like cramping, and others don?t have any discomfort. It is different for everybody. Cramping and light spotting is common for a few days after the procedure. However, if it?s something that concerns you call your doctor.


Semen Analysis:
Your husband/significant other should have an S/A done during the testing phase, even if you have already been diagnosed with another issue.

The World Health Organization (WHO)?s 2009 report considers the follow results ?normal?:
Volume: 1.5ml or more
Concentration: 15 million or more (per ml)
Motility: 40% or higher
Morphology: 4% or higher* (this depends on the method they use. 15% or more used to be ?normal? but that has been updated in the new report.

Here is the link to the WHO report for more detailed information:
https://www.who.int/reproductivehealth/topics/infertility/cooper_et_al_hru.pdf

And here?s a great discussion of the numbers (specifically morphology) from an RE at NYU: https://infertilityblog.blogspot.com/2010/07/sperm-morphology-new-guidelines.html

What do I do if our S/A comes back abnormal?
1. Repeat S/A. Have another S/A done several weeks apart because one test cannot give you a full picture and several lifestyle issues can effect sperm (including temporary illness).
2. See an urologist. Have YH see an urologist who specializes in fertility to see what if, anything can be done to improve the numbers. The urologist should be getting his entire medical history, S/A results and should be doing a physical exam and taking blood to test hormone levels, etc.
3. Consider vitamins/supplements. Some couples have found that vitamins/supplements have helped increase sperm quality/quantity. It is not a magic bullet, but it may help. Fertility Blend for Men is one we recommend (it's available online and at GNC stores). You might also look into: pycnogenol (especially for morphology), CoQ10 and L-arginine (which aren?t in Fertility Blend).
4. Consider lifestyle changes. Again, some couples have seen improvement in numbers when lifestyle changes were made. Quit smoking, decrease drinking, switch to boxer shorts, no hot tubs or hot computers on the lap, healthier diets, increased exercise, etc. Also, some men have seen success with acupuncture.

**Remember, it takes approximately 3 months from the time sperm is "born" to when it's released so any lifestyle/medical/vitamin changes will take three months to show up in a sperm analysis. And if YH was sick 3 months before your S/A, it may affect the results.

lyse2143

Diagnoses

Common causes of trouble TTC:

Irregular Cycles:
Long / irregular cycles can be caused by a number of issues including PCOS, thyroid problems, obesity, diet, and hormonal issues, such as elevated prolactin. It is a very frustrating problem to have as it takes longer to get through your cycle, you never know when you are going to ovulate or start AF, you may not be ovulating (anovulation) or have weak ovulation, and frankly, it means you have fewer tries per year than the average lady with a 28-34 day cycle.

Most likely your RE will try you on Clomid or Femara first to see if that helps and then would move on to injectables. You should always have testing done first so the RE can better help you pick the right protocol. If you are suffering from long cycles (longer than 35 days), or are charting and notice no ovulation (shown by erratic temps or no sustained temp shift) talk to your doctor.  Know you are not alone and this is a problem that can usually be fixed fairly easily.

PCOS:
Polycystic Ovary Syndrome affects an estimated 5-10 percent of women of childbearing age and it is a leading cause of infertility. It is the most common endocrinopathy among reproductive age women. It has been found that up to 30 percent of women have some symptoms of the syndrome.

The symptoms of PCOS include, but are not limited to the following:

• irregular or no menstrual periods (Amenorrhea)
• lack of ovulation (Anovulation)
• acne
• obesity/weight gain/inability to lose weight
• breathing problems while sleeping
• depression
• oily skin
• infertility
• skin discolorations 
• high cholesterol levels
• elevated blood pressure
• excess or abnormal hair growth and distribution (hirsutism)
• pain in the lower abdomen and pelvis
• multiple ovarian cysts (Seen on an u/s as a ?string of pearls?)
• skin tags

Some doctors suggest that at least three of the symptoms must be present to diagnose PCOS. Others may make the diagnosis on the basis of fewer criteria (often emphasizing lack of ovulation.) While others believe that PCOS is a diagnosis of exclusion ? meaning if there are hormonal abnormalities for which no other explanation can be found, PCOS is presumed.

PCOS is generally considered a syndrome rather than a disease, though, it is sometimes called Polycystic Ovary Disease. It manifests itself through a group of signs and symptoms that can occur in any combination, rather than having one known cause or presentation. There is no cure for PCOS. It is a condition that is managed, rather than cured. Treatment of the symptoms of PCOS can help reduce risks of future health problems.

Blood-work for PCOS- A good basic screening would include:

• Fasting comprehensive biochemical and lipid panel
• 2-hour GTT with insulin levels (also called IGTT)
• LH:FSH ratio
• Total testosterone
• DHEAS
• SHBG
• Androstenedione
• Prolactin
• TSH

Polycystic ovary syndrome treatment generally focuses on management of your individual main concerns, such as infertility, hirsutism, acne or obesity.

Your doctor might recommend that you:
Schedule regular checkups: Long-term, managing cardiovascular risks, such as obesity, high blood cholesterol, type 2 diabetes and high blood pressure, is important. To help guide ongoing treatment decisions, your doctor will likely want to see you for regular visits to perform a physical examination, measure your blood pressure, and obtain glucose and lipid levels.

Adjust your lifestyle habits: Making healthy-eating choices and getting regular exercise is the first treatment approach your doctor might recommend, particularly if you're overweight. Obesity makes insulin resistance worse. Weight loss can reduce both insulin and androgen levels, and may restore ovulation. Ask your doctor to recommend a weight-control program, and meet regularly with a dietitian.

Regulate your menstrual cycle: If you're not trying to become pregnant, your doctor may prescribe low-dose birth control pills that contain a combination of synthetic estrogen and progesterone. They decrease androgen production and give your body a break from the effects of continuous estrogen. This decreases your risk of endometrial cancer and corrects abnormal bleeding. An alternative approach is taking progesterone for 10 to 14 days each month. This regulates your periods and offers protection against endometrial cancer. However, it does not improve androgen levels.

Prescribe Metformin (Glucophage, Glucophage XR), an oral medication for type 2 diabetes that lowers insulin levels. This drug improves ovulation and leads to regular menstrual cycles. Metformin also slows the progression to type-2 diabetes. If you already have pre-diabetes, you are at an increased risk for developing type-2 diabetes. Metformin can aid in weight loss if you follow a diet and exercise program.

Reduce excessive hair growth: your doctor may recommend birth control pills to decrease androgen production, or another medication called spironolactone (Aldactone) that blocks the effects of androgens on the skin. Because spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended if you're pregnant or planning to become pregnant. Eflornithine(Vaniqa) is another medication possibility; the cream slows facial hair growth in women. Shaving, waxing and depilatory creams are nonprescription hair removal options. Results may last several weeks, and then you need to repeat treatment. For longer lasting hair removal, your doctor might recommend a procedure that uses electric current (electrolysis) or laser energy to destroy hair follicles and control unwanted new hair growth.

Use medication to induce ovulation: If you're trying to become pregnant, you may need a medication to induce ovulation. Clomiphene citrate (Clomid, Serophene) is an oral anti-estrogen medication that you take in the first part of your menstrual cycle. If clomiphene citrate alone isn't effective, your doctor may add metformin to help induce ovulation. If you don't become pregnant using clomiphene and metformin, your doctor may recommend using gonadotropins ? follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection.

Endometriosis and Laparoscopies
Endometriosis is a condition in which cells from the endometrium - or uterine lining - grow outside the uterus and adhere to other structures in the pelvis, most commonly the ovaries, bowel, fallopian tubes or bladder. Like the endometrium itself, the transplanted tissue responds to the hormones estrogen and progesterone by thickening and may bleed every month. But because the transplanted tissue is embedded in other tissues, the blood it produces cannot escape. This causes irritation of the surrounding tissue which in turn causes cysts, scars, and the fusing of body tissues.

Symptoms may include:

• Pain, which can be: Pelvic pain, severe menstrual cramps, low backache 1 or 2 days before the start of the menstrual period (or earlier), pain during intercourse, rectal pain, pain before/during bowel movements.
• Infertility (which may be the only sign that you have endometriosis)
• Abnormal bleeding. This can include: Blood in the urine or stool, Spotting throughout the cycle, and vaginal bleeding after intercourse.

The only way to confirm a diagnosis of endometriosis is to have a laparoscopy. In this procedure, your doctor will make 2-3 small incisions in your lower abdomen and will look for adhesions. If they are present, s/he can remove them, usually burning them off with a laser. Recovery varies depending on a few factors, including the severity of the endometriosis. Some women report being able to return to work in a day or two, while others find it can take up to a week.

Endometriosis is not curable and may return numerous times. The main treatments are continuous use of progesterone only birth control pills to prevent periods, as this helps prevent the growth of endometrial implants. Infertility is thought to affect approximately 40% of women with endometriosis. So just because you have endometriosis, this doesn?t necessarily mean you will have difficulty conceiving.

Fallopian Tube Abnormalities:
The HSG may show that your tubes are blocked or filled with fluid (hydrosalpinx). This interferes with the ability of the egg to get from the ovary to meet the sperm, so makes conception difficult. Common causes include prior STD, endometriosis, previous abdominal surgery or congenital problems (only one tube failed to form, abnormally shaped uterus, etc). Often the cause is unknown. Surgery can sometimes help correct this, or some women may need to proceed directly with IVF.

Diminished Ovarian Reserve:
If your day 3 labs come back abnormal (elevated FSH, low estradiol and/or low anti-mullerian hormone) you may have what is known as diminished ovarian reserve. This means you have fewer follicles, and may have poorer quality eggs. Many of these women still ovulate regularly, but have trouble conceiving due to egg quality issues. If this is your diagnosis, your doctor will likely want to treat you more aggressively. Medications such as Clomid do not typically work well for these patients, so if you choose to do IUI, you may want to use injectable medications. Some patients will also choose to move directly to IVF.

Luteal Phase Defect:
The luteal phase (time from ovulation to start of your next period) should typically last between 12 and 16 days. You can determine the length of your luteal phase (LP) by charting. Your LP will be the number of days your basal body temperature remains elevated following ovulation. If your luteal phase is too short, it may be difficult for you to get pregnant. This is often due to low progesterone. To confirm this, your doctor will want to check a progesterone level 7 days following ovulation. It is important that this is checked 7 days after ovulation (as detected by OPK or charting) and not simply on CD21, as few women have ideal cycles. Unless you ovulate on CD14, the results of CD21 progesterone will not be accurate. LP Defect can be treated with progesterone supplements or Clomid.

Male Factor Infertility:

If your partner has abnormal values on his SA, you will likely have to consider IUI or IVF with or without ICSI, depending on the severity of the abnormalities. Your doctor will discuss your options with you. Also see the section on Semen Analysis, for more things to do when you have an abnormal SA result.

Unexplained Infertility:

Unexplained infertility is the inability to conceive after 12 months of well-timed intercourse (6 months if you are over 35), with non-identifiable medical problem. Twenty percent of couples will have no explanation for their infertility. These couples have had a normal fertility work up including:

• normal semen analysis
• normal FSH/estradiol or AMH indicating good ovarian reserve
• normal prolactin and TSH, ruling out other causes of infertility
• normal progesterone 7 days following ovulation to show you are ovulating
• normal HSG to ensure there is no tubal problem

Some women will undergo testing prior to 12 month cut off noted above, for peace of mind or other reasons. However, it is important to keep in mind that if all your tests come back normal, you still have a good chance of conceiving without intervention within the year. Most physicians (and insurance companies!) will not recommend treatment for women with normal test results before one year.

For more information on unexplained IF (and lots of other great information about infertility), check out the resolve.org website: https://www.resolve.org/diagnosis-management/infertility-diagnosis/unexplained-infertility.html

lyse2143

Treatments

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.

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.

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.

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.

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 https://www.fertilityplus.org/faq/iui.html for more frequently asked questions.

Click here https://www.advancedfertility.com/insem.htm for post-wash success rates.


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

lyse2143

Insurance (US and Canada)

Insurance coverage varies dramatically from none to full coverage for IF treatment (although full coverage is rare).
United States
Canada

US Insurance
It?s probably best to call your insurance company before you even have your consult with a RE. Some insurance companies will make you register with their IF dept. You want to find out what type of IF coverage you have. You could have full, partial, diagnostic only coverage and some ladies will find out they have no IF coverage at all. Ask if any fertility medicines are covered, a lot of fertility medicines may not be covered and you will have to pay out of pocket (OOP).

It?s good to know this information before talking about treatments so you can plan accordingly with your RE. Knowing ahead of time is best! You don?t want to go to the RE and have a surprise bill because you weren?t aware of what was covered. Good Luck!

IF Treatment in Canada
In Western Canada the population is lower, so there are fewer clinics and they are fairly spread out.
In Alberta it takes anywhere from 4 - 10 months to get in to see an R.E., so infertility patients are generally referred to an obgyn first.

Unfortunately, in Alberta it is common-practice for the first course of action (depending on diagnosis) to be 3 cycles of Clomid (unmonitored) with an obgyn. Although this doesn't mean it's mandatory (you can wait to see an R.E. to start Clomid), most R.E.s will have you do 3 months of Clomid (unmonitored) to begin.
The Health Care coverage in each Province is different. Some cover treatment/IUI/IVF, some don't. Some only cover treatment for Public Sector employees, while others only cover if you have a diagnosis of bi-laterally blocked fallopian tubes. In Alberta, none of it is covered (unless you have group benefits through your employer, which is rare.).

Fertility treatments in Canada are income tax deductible (so keep your receipts!!!!).

These are really the only differences I've come across, and I don't particularly like the idea of putting it out there that it is common-practice to prescribe Clomid unmonitored. I think a lot of people will see this and think "If they do it in Alberta, it must be OK.". NOT! We are just so underfunded in our Province that they have no choice. In other Provinces they have proper monitoring and better private funding for ART.

 

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