Fertility used to be shrouded in secrecy and shame.  Although it is typically a medical condition, it is one of the few medical conditions that hardly anybody discusses.  This secrecy leaves people feeling as though fertility is something to be ashamed of, that others will view us differently if they know we are having fertility problems.  Thankfully this is beginning to change, but it is still slow to change.  As I began to gather information on how views of fertility changed over the years, I found some interesting things about how fertility problems were “fixed” in the past.

Even though approximately 1/3 of the fertility problems are a result of male fertility issues, 1/3 of the fertility problems are a result of female fertility issues and 1/3 of the fertility problems are a result of both male and female fertility issues together, in the not so distant past, it was all blamed on the woman.  Without the extensive tests that we have today, society assumed that a couple did not have any children because the woman “could not have” children.  There was no support for her and she carried this around with her almost as though she was branded with a scarlet “I” for “Infertility”.

Because a “childfree lifestyle” was unheard of at that time, couples would adopt in secrecy.  Women would feign pregnancy.  They would feign morning sickness and being tired.  They would buy maternity clothes and stuff them with pillows.  As they got close to nine months, they would go away for a few weeks and come back with a baby.  The descriptions I read state that nobody knew that they weren’t pregnant, but I find that hard to believe.  I think at that time it was just something that nobody talked about but at least a few other people knew.

As fertility tests began to be more readily available, couples were able to find out answers.  In the beginning though, there were no fertility clinics and no fertility specialists.  That would have been too controversial for the times.  Couples would typically go to their OB/GYN and in some cases just a family doctor to get simple fertility tests.

As society has changed, the secrecy surrounding fertility has changed.  Fertility clinics and fertility specialists began to show up.  At first clinics were only seeing a handful of patients, but this quickly changed.  Advanced testing and a host of procedures that were helping couples to get pregnant drew more couples to seek medical help from fertility specialists.

Thankfully, by the time my husband and I began our journey, things had drastically changed.  So many other couples had pioneered the way.  It is to them that I am grateful.  They helped open the doors for us.  They faced controversy so that others would be able to have the chance to be parents.

When going through our fertility journey, we were able to share our story if we wanted.  We didn’t feel like we HAD to keep it a secret.  I started a fertility support group with a friend.  We met weekly with 5-15 other women and talked about what was working, what wasn’t and shared joy and sorrow.  I did not have to carry the pain in secrecy.  I didn’t have to feel ashamed about what we were going through.

As you are going through your own process, I hope that this gives you a glimpse of the way things were and could still be if society had not begun to lift the veil of fertility secrecy.  I hope that you are able to find others to share in your joy and sorrows.  I hope that we will continue to help men and women going through the fertility process by paving the way for even more advanced testing, advanced procedures and by making a positive advancement in the way society views the fertility process.

(I wrote this article in the afternoon.  When I went to the mail later that afternoon there was an invitation to a first annual celebration given by the fertility clinic we had used for families that had gone through them.  How is that for progress?)

If you are in the middle of your fertility process, or even if you are just beginning your journey, you know that it is an emotional journey.  It is not just the financial stress that many people feel, but the emotional stress that takes the most toll on individuals and couples.  Counseling is often recommended to help you get through this time.

Many people going through fertility treatments report feeling sad, lonely, hopeless and depressed.  They feel that they are the only ones going through this, even though they see so many people at the clinic who are probably going through the same thing.  They don’t know who to turn to for emotional support.  They might take their stress out on their friends, family or even their spouse.  They don’t know if they should or shouldn’t feel what they are feeling and they begin to second guess all of their feelings.

Fertility counseling can help validate your feelings and what you are going through.  Yes, it is natural to feel alone.  Yes, it is normal to feel sad.  Yes, it is normal to feel angry or jealous when you hear of somebody else’s pregnancy.  Whether you are just having a hard time at the moment or with you are bordering on clinical depression, you can get the help you need.

If you are feeling any of these things, ask your Doctor to recommend a counselor or therapist that specializes in Fertility.  You want someone who is an expert on working with couples or individuals who are going through fertility treatments.  Your clinic might have someone on staff or might no someone in the community.  Even though you aren’t even considering adoption, many adoption agencies will be able to direct you to a therapist to help you.  Most couples that choose to build their families through adoption have gone through their own fertility journey and so this is a contact that the agencies have.

Counseling is different then support that you would get through a support group or online fertility chat group.  For some people, support groups are all they need.  The biggest validation they need for their feelings is having someone else say “I feel the exact same way” and learning how they are getting through it.

The most important thing for you to know is that you are not alone.  There is help out there for you, all you have to do is ask.  So, whether you go to a counselor, support group, or join an online chat group, you are encouraged to talk about what you are going through and get help the need to go through your own emotional fertility journey.

If you are in the middle of your fertility process, or even if you are just beginning your journey, you know that it is an emotional journey.  It is not just the financial stress that many people feel, but the emotional stress that takes the most toll on individuals and couples.  Counseling is often recommended to help you get through this time.

Many people going through fertility treatments report feeling sad, lonely, hopeless and depressed.  They feel that they are the only ones going through this, even though they see so many people at the clinic who are probably going through the same thing.  They don’t know who to turn to for emotional support.  They might take their stress out on their friends, family or even their spouse.  They don’t know if they should or shouldn’t feel what they are feeling and they begin to second guess all of their feelings.

Fertility counseling can help validate your feelings and what you are going through.  Yes, it is natural to feel alone.  Yes, it is normal to feel sad.  Yes, it is normal to feel angry or jealous when you hear of somebody else’s pregnancy.  Whether you are just having a hard time at the moment or with you are bordering on clinical depression, you can get the help you need.

If you are feeling any of these things, ask your Doctor to recommend a counselor or therapist that specializes in Fertility.  You want someone who is an expert on working with couples or individuals who are going through fertility treatments.  Your clinic might have someone on staff or might no someone in the community.  Even though you aren’t even considering adoption, many adoption agencies will be able to direct you to a therapist to help you.  Most couples that choose to build their families through adoption have gone through their own fertility journey and so this is a contact that the agencies have.

Counseling is different then support that you would get through a support group or online fertility chat group.  For some people, support groups are all they need.  The biggest validation they need for their feelings is having someone else say “I feel the exact same way” and learning how they are getting through it.

The most important thing for you to know is that you are not alone.  There is help out there for you, all you have to do is ask.  So, whether you go to a counselor, support group, or join an online chat group, you are encouraged to talk about what you are going through and get help the need to go through your own emotional fertility journey.

After months of trying to get pregnant and not having success, you begin to look for answers as to why nothing is happening.  One of the first steps to take before even consulting with a Doctor is to start charting your Ovulation Cycle by taking your Basal Body Temperature every morning.  Once you do that, you may begin to notice that you don’t ovulate on a regular basis.  It might also appear that you are ovulating, but your Doctor can actually do a test to see if you are and what your monthly cycle is like.

If you aren’t ovulating at all or at least not on a predictable basis, your Doctor might recommend that you take a drug, such as Clomid to help stimulate your ovulation or help regulate your ovulation.  Clomid is generally initially used by itself, without any other procedure or drugs involved.  Most Doctors recommend trying this for about six months before trying any other procedures or diagnostic testing.  So, if your first diagnosis is an ovulation problem, then Clomid is a logical first step for you during your Fertility process.

If, however, Clomid doesn’t work within six months, then they will begin diagnostic testing to see what else might be causing fertility problems.  They will look at such things as sperm quality, mobility and motility and they will most likely perform a test called a hysterosalpinogram in which they check to see if a woman’s fallopian tubes are blocked.

If both of these tests show no problems, then the next likely procedure that the Doctor will recommend is Intrauterine Insemination (IUI).  You will take Clomid once again to help with ovulation, possibly a higher dose to produce more eggs.  The Clinic will give you an injection of Human Chorionic Gonadotropin Hormone (HCG) to induce ovulation and then they will do the IUI.

Clomid is also used for IVF cycles as well.  Many clinics will perform what is called a Clomid Challenge Test before doing IVF to test your ovarian reserve.  They do this before doing IVF to help ensure that you have the best possibility for a successful treatment.

So, as you can see, as you are beginning your fertility journey, Clomid is a drug that you might come to know as you do different procedures.  If you don’t have any known fertility issues other than ovulation, it is probably the first step, and the right step, for you to take to help achieve pregnancy.

If you are just beginning the fertility process at your clinic, one of the first tests that they will likely perform is a Hysterosalpingogram or HSG.  One of the least invasive of fertility testing procedures, the HSG gives you instant results.  It is typically used to see whether or not you have blocked tubes, but will also show uterus abnormalities and fibroids.

The exam is typically done at your fertility clinic or in the hospital’s surgical/surgery center.  It is a quick test, usually taking less than 15 minutes from beginning to end.  You will lie on your back and the doctor will inject contrast die into your uterus through your cervix while simultaneously taking an x-ray.  The contrast die will spread throughout your uterus or tubes, almost instantaneously showing whether there is a blockage.  In my case, I was able to watch the die as it spread.

Although your doctor will probably tell you that you “might” feel a “slight discomfort” during this procedure, the HSG experience is different for every woman.  I have a few friends who said it didn’t really bother them and one friend who said she came up off the table.  I guess I was somewhere in the middle of the road on that one.  It was somewhat painful for me, most likely because my tubes were blocked and that is said to add to the discomfort of the procedure.  I had actually taken a prescription strength Tylenol before my first HSG.  After having surgery to unblock one tube and remove the other, I had pain medication left over that they let me take before my second HSG.  There was one girl in my fertility support group that was terrified of the HSG and was actually prescribed one valium by her doctor before the procedure.

The HSG is a very important tool to help determine what your next course of action is in the fertility process.  If the HSG shows no abnormalities or blockages, then they can rule that out as a possible cause of your fertility problems.  If they do discover blockages in one or both of your tubes, then they will discuss your alternatives.  Basically you have two choices: either have surgery and attempt to unblock the tubes which will increase your probability of pregnancy or keep your tubes as is, which will obviously decrease the probability of pregnancy.  It is a personal decision and one that you need to discuss before proceeding.

There are some complications associated with having a blocked tube.  First of all, a blocked fallopian tube increases your risk of having an ectopic pregnancy.  Second of all, it is not recommended that you do an IUI or IVF procedure with a blocked tube as they can decrease your chances of success and can actually work against the procedure.  For instance, in an IUI, if your tube is blocked, then even if sperm is injected directly into the uterus, the chances that sperm and egg will meet are very slim since their means to meet is still blocked.  If you do an IVF procedure with a blocked tube, then the blocked tube can actually cause fluid to back up into the uterus, hindering implantation of an embryo.

If you do choose to have a procedure to unblock your tubes, your doctor should schedule an HSG after you have heeled from the surgery.  They need to make sure that everything looks good and clear after the surgery.  Again, this second HSG will help determine your next step in the fertility process.

There are two things that I learned from my HSG that I wanted to pass on to you.  First of all, do not go by yourself.  I went by myself–not that my husband wouldn’t have gone– I just insisted in going by myself because I thought it was going to be ok.  When it wasn’t ok, I wished he had been there.  Secondly, definitely take whatever pain medication your doctor offers before the procedure.  If you are one of the lucky ones that feels no pain or discomfort during the procedure, then great for you.  If not, then you will be better prepared for the discomfort.

All in all, the Hysterosalpingogram is a relatively easy procedure that gives you results while you are there.  For me, it was one of the most important tests done during our fertility journey as it gave us instant results and instant answers as to what was going on to prevent us from getting pregnant.  Although, slightly invasive, it is over quickly and you can to take the information you receive and move forward on your journey.

When you are sitting in the Fertility Clinic waiting to see the Doctor, they might have a book of photographs for you view.  These are of families and babies that have been born thanks to the assistance of the clinic.  And when I say babies, I mean babies:  Twins, Triplets, and possibly higher multiples.  I think that this made my husband sweat a little bit, especially as our journey led us closer and closer to Intrauterine Insemination and then on to a successful IVF procedure.  You know that it is a possibility any time you consider In Vitro Fertilization or any other type of Fertility Treatment, yet it really is something you need to discuss before starting the procedure.

Most clinics will put in a certain amount embryos based on your age, embryo quality and the amount of eggs that fertilize.  For instance, as a general rule, they will put in two embryos if you are under 35 years old and three if you are over 35 years old.  If your embryo quality is not great, they might put in three embryos even if you are under 35 years of age.

Embryo quality is based on a number of factors, specifically at what rate the cells are splitting and what the embryo looks like as it grows.  Many clinics grade them as A, B, C, etc. and will not put in embryos that are less than a C as they have a very low chance of taking.  However, the clinic might give you an option of putting in poorer quality embryos, especially if you don’t have any embryos that are above a D grade.  In the end, the choice is up to you, but most clinics will give you their personal recommendation based on past success experience.  If you don’t have any embryos graded A or B, they might put in up to four embryos.

The amount of eggs you have that fertilize and that are a good quality also influences the amount of embryos that they place in you during In Vitro fertilization.  If you have only four good, quality embryos, there is no point in freezing just one as they might or might not make it when they are thawed.  At that point, you will have to decide how many embryos you want to use.

Keep in mind; this is all a general rule.  Some clinics put in four, five, six and even seven embryos no matter what.  This puts a greater risk for the mother and for the babies, as the higher the multiples the higher risk the pregnancy is.  It is a personal choice and you really have to weigh the pros and cons and decide what is best for your family.

It is recommended that you take all of this into consideration and discuss it with your spouse before beginning any procedure.  It is a highly emotionally charged time and the more you discuss up front, the more answers you will have as you are faced with various questions.  Everyone’s In Vitro Fertilization procedure is different and, if you have to do more than one round, chances are each round that you do will be different, so the more you discuss ahead of time, the less pressure you will feel when the time comes to make these decisions.

I was unaware of the term “Antiphospholipid” until a very good friend of mine suffered three heart wrenching miscarriages and was finally diagnosed Antiphospholipid Antibody Syndrome (APS).  She and I had started a fertility support group for women about the time she received this diagnosis, which gave everyone in the group a chance to learn along with her.

Her antiphospholipid levels were elevated which showed that she was at an increased risk for blood clots.  What essentially was happening to her was that, because of the increased levels, her body was treating the baby as a blood clot and was causing her to miscarriage.  The doctors used the term “spontaneous abortion” which just added to the heart break as it somehow alluded to the fact that she caused the baby to die even though we know it is a medical term.

Unfortuneately with no known history of APS, a doctor will not even test the antiphospholipid levels until a woman experiences at least three miscarriages.  In the medical world, testing antiphospholipid levels is still somewhat controversial.  Some in the medical field feel that there is no association between antiphospholipid levels and pregnancy loss.  However, 2 out of 20 women in my support group were diagnosed with APS after multiple miscarriages and after taking heparin throughout their pregnancy they both had beautiful, healthy boys.  In fact my friend just did the heparin treatment during a subsequent pregnancy and now has two healthy boys.  So, it is hard for me to believe that there is no association between those levels and pregnancy.

If you are someone who is experience reoccurring miscarriages, I must first tell you how deeply sorry I am that you are experiencing this pain.  I also want you to know that you are not alone, although you may feel so at this time.  There are other women who know exactly what you are feeling, who know about your pain. Your fertility clinic might be able to put you in contact with someone else who is going through this now.  Hopefully there is a fertility support group in your area.  If not, you can find support at an online forum for women or couples experiencing fertility issues.

You need to know that not all doctors will test your antiphospholipid levels even after multiple miscarriages unless you ask.  The second girl in our group began to ask her doctor about testing after her second miscarriage.  He did not feel that he needed to test until after her fourth miscarriage and it wasn’t until then that she was finally given a reason behind the miscarriages.  If she had not advocated for the testing and pushed her doctor, she wouldn’t have her son today.

You can find more information about antiphospholipid levels at various sites online.  Be aware that, as I said before, some sites will say there is no connection between those levels and pregnancy.  Although it is important for you to learn all you need to know about antiphospholipids to make an informed decision about testing, it is important to realize that the testing is a simple blood test that might give you the answers and help that you need.  I know three beautiful boys and two happy moms that can attest to this.  They continue to educate other women about the subject through our support group and I feel certain that it will help other women in the future, hopefully beginning with you.

When you are sitting in the Fertility Clinic waiting to see the Doctor, they might have a book of photographs for you view.  These are of families and babies that have been born thanks to the assistance of the clinic.  And when I say babies, I mean babies:  Twins, Triplets, and possibly higher multiples.  I think that this made my husband sweat a little bit, especially as our journey led us closer and closer to Intrauterine Insemination and then on to a successful IVF procedure.  You know that it is a possibility any time you consider In Vitro Fertilization or any other type of Fertility Treatment, yet it really is something you need to discuss before starting the procedure.

Most clinics will put in a certain amount embryos based on your age, embryo quality and the amount of eggs that fertilize.  For instance, as a general rule, they will put in two embryos if you are under 35 years old and three if you are over 35 years old.  If your embryo quality is not great, they might put in three embryos even if you are under 35 years of age.

Embryo quality is based on a number of factors, specifically at what rate the cells are splitting and what the embryo looks like as it grows.  Many clinics grade them as A, B, C, etc. and will not put in embryos that are less than a C as they have a very low chance of taking.  However, the clinic might give you an option of putting in poorer quality embryos, especially if you don’t have any embryos that are above a D grade.  In the end, the choice is up to you, but most clinics will give you their personal recommendation based on past success experience.  If you don’t have any embryos graded A or B, they might put in up to four embryos.

The amount of eggs you have that fertilize and that are a good quality also influences the amount of embryos that they place in you during In Vitro fertilization.  If you have only four good, quality embryos, there is no point in freezing just one as they might or might not make it when they are thawed.  At that point, you will have to decide how many embryos you want to use.

Keep in mind; this is all a general rule.  Some clinics put in four, five, six and even seven embryos no matter what.  This puts a greater risk for the mother and for the babies, as the higher the multiples the higher risk the pregnancy is.  It is a personal choice and you really have to weigh the pros and cons and decide what is best for your family.

It is recommended that you take all of this into consideration and discuss it with your spouse before beginning any procedure.  It is a highly emotionally charged time and the more you discuss up front, the more answers you will have as you are faced with various questions.  Everyone’s In Vitro Fertilization procedure is different and, if you have to do more than one round, chances are each round that you do will be different, so the more you discuss ahead of time, the less pressure you will feel when the time comes to make these decisions.

Chances are, if you are about to go through Artificial Insemination (AI), you have already been through a number of tests and treatments by your doctor to prepare you for this procedure.  If you have not had any testing done by your doctor and he moved straight to AI (also known as Intrauterine Insemination or IUI), then we suggest that you read this article before proceeding.  There are a few tests that should have been done by now to ensure that this procedure could have success.

Because AI involves placing the sperm in the uterine cavity during ovulation, the sperm and egg still have to meet inside in order for conception to take place.  The first test that needs to be done is called a hysterosalpingogram, which is a procedure that shows whether or not a woman’s fallopian tubes are blocked.  If there is a blockage in the tube, then an egg can not get through and AI will not be successful.  Many times a tube can be unblocked through laparoscopic surgery.  After the surgery, if the man’s sperm is healthy and has a good count, then AI might not even have to be used in order to get pregnant.

Testing a woman’s ovulation cycle might rule out the need for Artificial Insemination.  If a woman is not having a regular cycle or is not ovulating all together, they might be able to take medicine such as clomid to regulate ovulation, possibly allowing for conception to happen without doing AI.

Another thing that needs to be done is to have the man’s sperm tested.  If a man has very low to no sperm count or extremely poor mobility and motility, then chances are very slim that AI would work.  At that point you would have to either find out if there is a way to improve the sperm quality or count or consider using a sperm donor.

Before you start an Artificial Insemination cycle, we suggest that you discuss this testing with your Doctor.  If he/she does not think it is necessary, you are encouraged to get a second opinion.  AI is an emotional and financial decision.  Before you make the final decision to do it, you need to be sure that you have the highest possibility of success and have ruled out any factors that could work against you.

Experiencing fertility problem or having troubles conceiving can be a lonely and worrisome time.  You have all sorts of questions, such as the “Why” and the “What is going on” yet you don’t have anyone to turn to.  When you have fertility questions there are various resources where you can share your questions and begin to get answers

The first, and most obvious, place is to go to a Doctor to ask questions or perhaps begin to start some testing to find answers.  We recommend that you go to a clinic or Doctor that specializes in fertility issues.  Although your OB/GYN will probably be able to answer some basic questions and might even be able to do some testing, they will more than likely have to send you to a specialist if things begin to get complicated.  It can be time and money wasted if you start one place and then have to start over again somewhere else.  You have probably already at least spent plenty of time at this point trying to get pregnant and you are ready to move forward not hurry up and wait

Another good place to find answers to your fertility questions is through online chat groups that focus on women and men who have been where you are or are currently going through the same thing.  You can compare notes on what you have tried or what the Doctor’s have tested or tried.  Thy might know of an experimental treatment or have had success with such things as acupuncture and IVF.  When you are talking to someone who knows what you are going through, you don’t feel so alone and you begin to feel empowered.  Control is something you lose when you are going through fertility treatments, so feeling even a little bit of control can help you make it through.  Plus, you can go back to your doctor armed with questions that you might not have even thought of before.

Check your area to see if there is fertility support group.  Much the same as a chat room regarding fertility, you have a safe place to get your questions answered and share the comfort of knowing that you are not the only one experiencing the feelings, worries and sadness, you are not alone.  Many times people in support groups will exchange phone numbers or meet for coffee outside of the group.  You can have a person to call whenever you need them.  If you can’t find a local support group, consider starting your own.  You can advertise through local churches, fertility clinics and the newspaper.  You would be surprised at how many people are going through the same thing.  A friends and I started a local support group by contacting fertility clinics, OB/GYNs, adoption agencies and running ads in the paper.  We have become each other’s biggest supporters to share joys and sorrows as they come.

The most important thing for you to realize when you have fertility questions is that no question is stupid question.  Your Doctor should never make you feel as though you can’t ask fifty questions every time you go see them.  This is about your body, your family, your child that you are trying to conceive.  So ask away at any of these places and be on your way to gaining the answers to the questions that are so important to you.