Couples at the beginning stages of seeking help at a fertility clinic will generally begin by having some basic testing to try to get to the root of the problem of not being able to conceive.  Women usually begin by having blood work and a hysterosalpingogram. Men usually start their testing by giving a sperm sample for analysis.

When giving a sperm sample, the doctors look at various aspects of the sample including quantity and quality such as mobility and motility.  Men who have a low sperm count will have additional testing to see if they can discover what is causing the sperm count to be low.  Low sperm count can be the result of many things including hormonal reasons and physiological reasons.

A majority of male infertility cases are diagnosed as Vericoceles.  In fact, they are the leading cause of male infertility and male secondary infertility problems.  Vericoceles are essentially varicose veins in the spermatic cords.  When Vericoceles occur, they cause blood to pool in the testes.  This then causes the temperature to increase in the testes.  It is believed that this higher temperature causes sperm production to decrease, leading to fertility problems.

Vericoceles can occur in either the right or left testes, but are typically seen in the left testes.  Fortunately, unlike many other male fertility diagnoses, Vericoceles can be treated by surgery.  Doctors will typically treat Vericoceles by performing a Surgical Varicocelectomy.  This is now mainly done as outpatient surgery with minimal cutting and scarring involved.  Essentially what happens in this surgery is the vein is cut above the Vericocele and is tied.  The blood is then rerouted through healthy veins, thus allowing for good blood flow and keeping the blood from pooling in the testes.

There will be some minor discomfort and pain after this procedure.  Most doctors will prescribe pain medication for a few days after the surgery.  You can expect to be off work for at least 3-4 days so that you can rest and heal.  Some men have said that they needed less time and others said they experienced more pain and actually needed 5-7 days for recovery.  Either way, you should avoid heavy lifting for about one week after the surgery.

Studies show that sperm quantity should improve by four months after the surgery and in some cases sperm quantity has improved greatly in the first month.  Almost 50% of men having the surgery have achieved a pregnancy with their partner.  The percentage is even higher for couples experiencing secondary infertility due to Vericoceles.  There is a chance that you could experience problems with Vericoceles in another vein in the future.  Subsequent surgeries have proven successful for future pregnancies.

When you go to your doctor, be sure to discuss Vericoceles diagnostic testing if they do not offer it first.  Despite research that shows the surgery can be successful to help with male fertility problems, some doctors do not feel that there is enough evidence to support the surgery.  If they aren’t willing to explore it, I would encourage you to get a second opinion and to do more research on your own to give you more information about Vericoceles and Surgical Varicocelectomies.  The more knowledge you have on the subject, the more comfortable you will be with discussing this option with your doctor.

After my husband and I began our journey through the fertility process, I took on a new task at work.  I am a pregnancy and adoption counselor (ironically) and I then became the “expert” speaker for our sessions on moving from fertility treatments to adoption in our home study groups.  I didn’t want to concentrate on the negativity of the treatments.  I feel that whatever you go through, no matter how hard or horrible it is, there is always at least one positive thing that you can find about the situation.

I took this idea and rolled it into the beginning of my part of the session by talking about losses and gains in various situations in our lives, such as graduating from college, marriage and moving.  I end the losses and gains part by having couples talk about the losses and gains they experienced while going through the fertility process.  While the answers to the question about what losses couples have experienced comes easily, they are surprised when they can come up with just about the same amount of gains by the time we are done.  Doing this session actually helped me get through the process because I was able to step back and look at what gains I was experiencing both within myself and with my husband.

For anyone going through the fertility process, the losses are obvious.  There is the loss of spontaneity in your love life because everything is on a schedule.  We have the loss of money for all the treatments we have to pay for because most of our insurances won’t pay for everything.  The loss of freedom and the loss of control go hand in hand.  Everything is in someone else’s hands, in someone else’s timing, in someone else’s opinions, in someone else’s options, in someone else’s expertise.  We don’t have control over anything except for whether or not we want to proceed forward or when we want to stop and look at an alternative method of parenting such as adoption or surrogacy.  We have the loss of time as month after month we wait and experience disappointment, only to lose another 30 days before we go through the same thing again.  The loss of privacy happens because we have to tell doctors and nurses about every detail of our personal life and they are present in the room when we are (hopefully) conceiving through IUI or IVF procedures.

We experience the loss of friendships.  This can occur either when others make uncaring or judgmental remarks that cause us to step back from the relationship.  Sometimes we choose to step back from the relationship because we just can’t bear to go to one more baby shower or one more 1st Birthday Party.  We can also experience loss of closeness with our families for the same reasons.

There are also other losses that we experience personally.  The fertility process affects each of us differently and we react to it differently.  Facing the loss of our dream child and the possibility of never being pregnant was hard for me and it was hard for many of the women in my support group.  My husband and I faced the loss of honesty as we did not tell a lot of family members about our problems and month after month I had to tell my Mother-in-law that we were going to wait another 3-5 years to have children because we just weren’t ready yet.  In my job my loss was often thrown in my face as I counseled women facing unplanned pregnancies.

With all those losses, where are the gains?  I found that you have to look deeper, deep within yourself, deep within your relationships to find the gains.  I gained even more closeness in my relationship with my husband.  We went through everything together.  There was no finger pointing at me because, essentially, I was the reason we were going through this.  I loved him deeply before, but because of the process I love him even more.

I gained an inner strength that I didn’t know I had.  The fertility process was hard, harder than I could even imagine, yet I was surviving it.  I gained a sense of humor about the process as well, which is what helped me through.  It was such a heavy thing to go through.  I had to find irony and humor in the process and it helped lighten the load.  I also began to gain a sense of peace, knowing that if it didn’t work I would be able to be a parent through adoption.  I knew I would grieve, but I knew I could heal if that IVF hadn’t worked.

I gained friendships through my fertility support group.  These friendships were what got me through the tough times and they are still going strong as we have all entered new phases in our lives.  I gained confidence through these friends and through starting the fertility support group.

I gained a closeness to God that I had not experienced before.  My faith was strengthened.  Instead of being mad and asking “why me?” I asked for strength to get through everything and to be able to accept whatever outcome we had with the procedures.  This helped me through the hard times along with my husband and my friends.

My husband and I began to gain some control in our lives as well.  At one point we were able to say “we need a break” and we didn’t do any fertility stuff for 8 months before doing our IVF.  We saved some money during that time, but we didn’t keep a time table in our relationship.

Just as we all experience our own personal losses during this process, we all experience our own personal gains.  When you are in the middle of the process it is often hard to see some of these gains.  Take the time to make a list of all the gains that you have experienced so far, even if you have to reach deep, deep down inside just to come up with one.  By doing this, it helped to ease the stress in my own journey as I would pull out that list and read it or add to it when I was having a hard day.  I hope that by doing this it will help you get through the process as well.

When you are beginning the fertility process and are close to age 40 or if you have had unexplained fertility problems and doctors are searching further for answers, you will more than likely do a clomid challenge test (CCT) or clomiphene citrate challenge test (CCCT).  The CCT is used to assess ovarian reserve.  It can be used both as a diagnostic tool as well as a predictor for success in an IVF cycle.

When a woman is born, she is born with a lifetime supply of eggs.  This is kind of like a “what you got is what you get” phenomenon and a woman does not develop, grow, or produce new eggs throughout her lifetime.  Each month a follicle containing an egg will develop to maturity and be released (this is ovulation).

Ovarian reserve essentially describes the quality of the eggs that are being produced.  As a woman ages, her ovarian reserve typically diminishes.  However, even a young woman in her 20s can have a diminished ovarian reserve.  A diminished ovarian reserve indicates that a woman’s chances of getting pregnant decrease and a woman’s chances of having a miscarriage increases.

During the CCT, your Follicle Stimulating Hormone (FSH) levels and estradiol levels are tested on day 3 of your cycle.  You will then take Clomid (usually 100 mg/day) for days 5-9. On day 10 your FSH and estradiol levels will be tested again.

If your FSH levels are less than 10 on both days, then the test indicates that there is not a decreased ovarian reserve and everything appears normal.  If your FSH levels measure anywhere between 10-18 then it indicates that, while you don’t have what is considered a diminished ovarian reserve, your chances of getting pregnant decreases and your chances of having a miscarriage increases.  Any FSH levels over 18 indicate that you have a diminished ovarian reserve.  Your chances of getting pregnant substantially decrease and your chances of having a miscarriage substantially increase.

Some studies have shown that hormone treatments using progesterone and estrogen can decrease your chances of a miscarriage.  Only a few studies have even indicated that hormones can affect your chances of getting pregnant.

Some clinics will not proceed with IVF if you have a decreased ovarian reserve.  Most of them will discuss the odds of success with you and allow you to decide whether or not to proceed.  At that point you really have to weigh the odds and decide if you want to attempt an IVF, try IVF with hormone therapy or if you want to begin to explore your other options.

You essentially have two other options to choose from if you don’t want to proceed with IVF due to diminished ovarian reserve.  You could either try IVF with an egg donor or explore adoption as a way to build your family.  It is a feeling of being at a crossroads when you are faced with such a decision.  I would encourage you to take the time to explore every option, weigh the pros and cons and decide which route would be the best for you and your family.

If you are one of the many couples experiencing secondary infertility, you know how hard this can be.  It is a mixture of emotions.  You are happy for the child/children you have yet you long for more.  You feel guilty for wanting more.  You are like a member of two clubs.  On one side you are a Mom and on the other side you are longing to be an expectant Mom again.  People don’t understand why you are sad.

People say unpleasant, ignorant or hurtful things as it is when you are having fertility problems.  Secondary infertility brings out a whole new host of comments.  “Don’t you want any more children?”  “You don’t want him to be an only child, do you?”  “You already have one child, you should feel blessed.”  Even friends that you have that are going through their own fertility problems might not lend you an sympathetic ear, often pointing out that you should be happy with the child you have.

The thing is, you do feel blessed.  But, at the same time, you still have the longing for another child, the longing for a brother or sister for your child.  Because of all these conflicting messages and feelings you end up feeling all alone, as though you have no one to talk to who will truly understand what you are going through.  You need someone to empathize not to offer “helpful” comments that just end up making you feel even more guilty and alone.

First of all, I want to say that experiencing secondary infertility is just as hard, just as emotional as having fertility problems and no children.  In fact, it is more difficult in some senses.  On top of the grief, sadness and loss associated with fertility problems, you have the guilt of wanting what you already have again and the sense that you should not feel sad because you have what so many others don’t.  Many couples experiencing secondary infertility tend to stuff these feelings and emotions deep down inside because there is nobody to share them with.

Anytime you are experiencing grief and loss, hiding or ignoring your emotions doesn’t make them go away.  You just keep storing them until you finally can’t hold them in anymore.  Before you get to that point, you need to find a way to express what you are going through.

Consult with your fertility doctor to see if there is a counselor in the area that specializes in fertility issues.  Search out a local fertility support group.  If you don’t feel comfortable with either of these options, I would highly encourage you to join an online support group or network of women experiencing secondary infertility.  It is a way for you to finally connect with someone who can validate every thought and emotion you are having now.

You need to realize that you are not alone, that there are other women and couples going through the same thing that you are.  It might take you reaching out a little to get the help, encouragement and support that you need.  Secondary infertility is a difficult place to be and you should never let anyone tell you that you shouldn’t feel the way you do for whatever reason.  Feelings, pain, loss and sadness are all real emotions.  Don’t let anyone make you feel differently.

“Absolutely not” was the response a good friend of mine and her husband had when their doctor first approached them with the idea of using donor eggs for an IVF cycle.  I first met my friend when she and her husband were considering adoption.  She then joined my fertility support group and we were able to follow her through the process that brought her to using donor eggs.  She now has a three-year-old son and one-year-old twin girls.

The decision to use donor egg or sperm is a very personal choice.  Once you come to the decision that you want to do use a donor program, most clinics will even require that you talk to a counselor surrounding the emotional aspects of using donated eggs or sperm.  It is not counseling to determine if you are a “fit” person, it is counseling to discuss how having a child that will be genetically related to only one parent might affect you and your relationship with that child in the future.

As my friend was going through the counseling to make the decision, she finally came to the terms that biologically the children are hers.  It was her biology, her body that was providing nourishment for her children to grow.  She began to recognize the difference between genetics and biology.  She would still be her child’s birthmother and that was important to her.

Once they decided to pursue an egg donor program and went through some counseling, they began the next step of choosing a donor.  When choosing an egg donor or sperm donor, you are actually able to read through background information on the donors to pick a donor that matches your needs.  This background information is not just height, weight and eye color, it is an extensive social and medical history on the donor and his family, typically going back to grandparents.  You will get information about any mental health or medical issues that are recurring in their family.  All of the information you receive is non-identifying and donations are done anonymously.

When choosing a donor, some couples look for a donor that matches as closely to their spouse’s social and medical history as possible.  Other couples choose a donor based on good medical and mental health history, which might be a better medical background than their own.

When choosing a sperm donor, you will more than likely be choosing from sperm that has already been donated and frozen.  When choosing donor eggs, you will actually go through the IVF process along with the donor.  Whereas she will be taking medications to stimulate egg production, you will be taking medications to prepare your body for transfer of the embryos when they are ready to be transferred.

IVF or IUIs using a sperm donor do not typically cost much more than going through the process without a sperm donor.  IVF with an egg donor typically costs between $8,000-$15,000 more than IVF without an egg donor.

Before choosing to do a donor program, you need to weigh the pros and cons of using a donor with your spouse versus the pros and cons of other options such as adoption.  It needs to be a decision that you come to together instead of a decision that one of you gives into in order to appease your spouse.  It was to be done with peace and acceptance in order for you to fully accept and love your child.

I would encourage you to read more about donor programs and to talk to men or women who have done a donor program.  Nobody knows what you are going through better than someone who has been in your same situation.  You can find support at a local fertility support group or an online fertility support group.  Ask all the questions you need to ask and feel 100% comfortable with your decision before proceeding.  I hope that the information in this article helps you in your journey and decision making process.

If you are just in the beginning stages of the fertility process you are probably at the point where you are trying to figure out what is going on to prevent a pregnancy.  One of the first tests that a woman will have done is a hysterosalpingogram (HSG) to determine whether or not there are any blockages in the fallopian tubes.  Because blocked fallopian tubes account for 20-25% of all female fertility problems it is essential that women start with this test before proceeding with any fertility treatments.

There are many causes of tubal blockages or abnormal fallopian tubes.  These causes include adhesions, infections, infectious or non-infectious pelvic inflammatory diseases, scar tissue, endometriosis and damaged tube ends or damaged fimbria.  The number one cause of blocked tubes is a Chlamydia infection.  Some women have had Chlamydia and not even known it so that the damage has already occurred without a woman even having an idea that any infection was ever there.

A blocked tube hinders a pregnancy by preventing the egg and sperm from meeting.  Many times in blocked tubes, an egg will not even be able to get much past the ovary let alone the whole way to the uterus.  Blocked tubes also increase your risk of an ectopic pregnancy as the egg can become fertilized in the tube but the embryo can not make it back to the uterus, therefore causing it to implant in the tubes.  This is a highly dangerous scenario and can cause infection if the tube bursts.

A blocked tube can also cause fluid to build up in the tube.  This fluid can eventually back up into the uterus.  When there is fluid in the uterus it impedes implantation of the embryo in the uterine lining.  Most clinics will not do an IVF procedure unless a blocked tube is unblocked or removed because of this fluid problem.

A woman with a blocked fallopian tube can have laproscopic surgery to attempt to unblock the tube or remove scar tissue.  The less blockage there is, the more successful the surgery.  Some blockages are just at one end of the tube and they have the highest success rate of becoming unblocked.  If a woman has had a Chlamydia infection, there tends to be more extensive damage and blockages.  Blockages due to Chlamydia have the lowest success rate of becoming unblocked.

Whether or not to have the surgery is a personal decision.  One thing you must realize is that if you have blocked tubes but opt not to have the surgery to unblock them, then you decrease your chances of getting pregnant significantly and increase your risk of an ectopic pregnancy.

You need to weigh the pros and cons of the surgery along with the long term effects of having it verses not having it.  You also can discuss other options with your doctor such as whether or not they will do an IUI or IVF on a patient with a blocked tube.  Their answer to this question may also affect your decision.  In the end, you have to do what is best for you and your spouse.  No one can decide what is best except for you.

In my fertility support group we started a new tradition about three years ago.  We decided to give an IVF shower to anyone in the group who was getting ready to go through the IVF process.  It was a wonderful way to celebrate hope and bring comfort and friendship to the recipient as they prepared for retrieval, transfer and bed rest time.

I can’t remember who came up with the idea first.  It might have come up in passing as we were discussing how much we dreaded baby showers at that time and wondering whether or not we would ever get to have one of our own.  We were all excited about the shower and prepared to give one to one of the girls in the group two weeks later.

When preparing for the shower, we steered clear of any baby related items.  We wanted it to be all about the recipient, a shower to pamper her and comfort her.  Many people in the group are spiritual and I began to look for unique books that either had uplifting stories, inspirational stories or daily thoughts. I wanted it to be a book that would help them pass bed rest time and one that would be appropriate no matter what the IVF results were.

When it came time for my IVF shower, we met at Starbucks. I’m addicted to coffee, but gave up caffeine totally once we started fertility treatments.  I chose a coffee shop though because I love the atmosphere and smells there.  Anyway, it was a wonderful experience to be surrounded by women who knew what I was going through and to feel their love and support.

I was given all sorts of goodies such as lotion, lip gloss and candies.  I got a comedy DVD that I watched my second day of bed rest and it helped keep my mind off of things and made me laugh, which I needed.  My favorite gift was a relaxation CD.  I listened to it the day I came home from my transfer and was on bed rest.  The songs on that CD still invoke so much emotion in me today.  Every time I used any of the items that were given to me it made me feel comforted.  Even after bed rest, as I was awaiting my results, I found my gifts comforting.

If you know someone who is going through the IVF process, you don’t necessarily have to give them a shower, but just give them a book, CD or pampering gift that will let them know you care and are thinking about them.  It will let them know they are not alone.  Even buying a pampering gift can be comforting.  Whatever you can do to help yourself or someone else going through the IVF process is a gift worth giving.

In my fertility support group we started a new tradition about three years ago.  We decided to give an IVF shower to anyone in the group who was getting ready to go through the IVF process.  It was a wonderful way to celebrate hope and bring comfort and friendship to the recipient as they prepared for retrieval, transfer and bed rest time.

I can’t remember who came up with the idea first.  It might have come up in passing as we were discussing how much we dreaded baby showers at that time and wondering whether or not we would ever get to have one of our own.  We were all excited about the shower and prepared to give one to one of the girls in the group two weeks later.

When preparing for the shower, we steered clear of any baby related items.  We wanted it to be all about the recipient, a shower to pamper her and comfort her.  Many people in the group are spiritual and I began to look for unique books that either had uplifting stories, inspirational stories or daily thoughts. I wanted it to be a book that would help them pass bed rest time and one that would be appropriate no matter what the IVF results were.

When it came time for my IVF shower, we met at Starbucks. I’m addicted to coffee, but gave up caffeine totally once we started fertility treatments.  I chose a coffee shop though because I love the atmosphere and smells there.  Anyway, it was a wonderful experience to be surrounded by women who knew what I was going through and to feel their love and support.

I was given all sorts of goodies such as lotion, lip gloss and candies.  I got a comedy DVD that I watched my second day of bed rest and it helped keep my mind off of things and made me laugh, which I needed.  My favorite gift was a relaxation CD.  I listened to it the day I came home from my transfer and was on bed rest.  The songs on that CD still invoke so much emotion in me today.  Every time I used any of the items that were given to me it made me feel comforted.  Even after bed rest, as I was awaiting my results, I found my gifts comforting.

If you know someone who is going through the IVF process, you don’t necessarily have to give them a shower, but just give them a book, CD or pampering gift that will let them know you care and are thinking about them.  It will let them know they are not alone.  Even buying a pampering gift can be comforting.  Whatever you can do to help yourself or someone else going through the IVF process is a gift worth giving.

Let me just begin by stating that I hate the word infertility.  To me, stating that you are “infertile” or going to an “infertility doctor” or even doing “infertility treatments” all has a negative connotation.  Let’s face it; it already isn’t the happiest most stress free point in your life.  You want to start a family, but it isn’t happening like you planned.  You are stressed, EVERYTHING is all about timing and there is no more spontaneity in some of the most intimate parts of your life.  You are sad because the thing you want the most is not happening, so why add another negative component to the whole experience?

This brings me to the first way to take charge of your fertility and that is to drop the word “infertility” and replace it with the word “fertility”.  I am going to a “fertility doctor”, I am going to a “fertility clinic”, we are going through “fertility treatments”.  To me, this sounds more hopeful and at this point that is what you are looking for: hope.  Wouldn’t you consider “infertile” to sound much worse than “fertile”?  I know it is just psychological, but it is something that has stuck with me and my other friends going through fertility treatments and we refuse to say it any other way

The second way to take charge of your fertility is to ask questions and seek answers.  If you don’t understand something, ask.  If you want to know about a different treatment not mentioned by your doctor, ask.  If something doesn’t feel right to you, ask.  If you still have more questions, join an online chat group, a fertility support group or ask your clinic if they know of someone who might be willing to talk to you.  Don’t just sit back and let things happen to you.  Go to your Doctor armed with a whole list of questions and don’t leave until they are answered.

The last thing that I want you to do is actually the hardest thing to do when you are in the middle of all of this.  That is, don’t let your fertility take charge of you; take charge of your fertility.  This whole process is so consuming.  If you ere on the OCD side like me, it is all that you can think about.  When is my next appointment?  Don’t forget to take that temperature first thing in the morning.  What time do I need to get that shot?  I need to cut out the caffeine just in case it works.  You get so caught up in it all that you lose yourself.  This might mean taking a few months off, starting a hobby that doesn’t involve obsessing about the time of the month or going away for a long weekend with your husband and leaving the basal body thermometer at home.  Don’t lose yourself in your fertility.

So, drop the “I” word, lose “infertility” and start taking up the good “f” word “fertility”.  Make yourself an expert on the subject.  This is your body we are talking about.  You need to know what is happening and why and what each treatment involves and means for you.  The most important thing to do, though, is to take some time out for yourself and your spouse.  Remember who you are and what you enjoy doing and try, as hard as it, to lose yourself in fun things every now and then because everybody needs a break now and then.

A few years back in my fertility support group, the subject of acupuncture came up.  Some studies show a correlation between acupuncture and pregnancy when used in conjunction with fertility treatments.  It is still a somewhat controversial subject among many fertility doctors.  They seem to either really feel it works or really feel that it is a waste of time.  Regardless of how they feel, recent studies do show a positive relationship and it is a decision that you need to research and decide if you feel that it is right for you.

Acupuncture affects the female reproductive system in a number of ways.  From what we have learned from a local Acupuncturist, it increases the circulation of blood in the pelvic cavity and increases the thickness of the uterine lining.  It is also associated with improved ovarian function and helping in follicle production.  Even women without fertility problems have gone to acupuncturists and have had a quicker pregnancy success rate than the general population.

Most acupuncturists will agree that acupuncture is more of an aid in the fertility process than a cure.  They recommend that you use it in conjunction with your fertility treatment to help increase the success rate rather than use it in place of a fertility treatment and the recommendations of your fertility doctor.

Acupuncture can be pricy but, when you put it in the context of a $15,000-$20,000 IVF cycle, it is relatively inexpensive.  On average it costs $75-$100 per treatment and is done 2-3 times per week for one month and then goes down to once a week for three to eight months.  The average cost of Acupuncture in conjunction with IVF is $1500-$2000.

Most acupuncturists recommend that you begin acupuncture treatments 2-3 months before doing any fertility treatments.  This way they have begun to regulate your body and understand your cycle.  It wouldn’t do much good to start acupuncture the same day as you start an IVF cycle and it could hurt the cycle.

I would recommend that you seek an acupuncturist that specializes in fertility issues.  Your fertility clinic might be able to recommend one or you might have to do your own research with local acupuncturists.  Just as you have probably sought a doctor whose sole focus is fertility issues, you should do the same for your acupuncturist.

Two of the women in my support group chose to do acupuncture.  One of the women had had multiple miscarriages in the past.  She used acupuncture throughout her pregnancy and carried her baby girl to term.  Another girl in the group did acupuncture with an IVF cycle and had a successful IVF cycle after having 3 failed cycles.  That was enough to convince me that there was a connection.

Whether or not to use acupuncture in conjunction with your fertility treatments is, of course, a personal decision.  In writing this article, I just wanted to give you another option and another avenue to explore.  I encourage you to do more research online, discuss acupuncture with your fertility doctor and interview an acupuncturist in your area.  I believe that all decisions you make in your process should be informed decisions.  I hope that the information I gave you helps give you to begin to make an informed decision about acupuncture and fertility treatments.