Your Fertility Questions, Answered
By Arielle Spiegel, Founder, CoFertility
When you’re trying to get pregnant, your whole life can feel consumed by questions. Even if you have access to amazing care, doctors you love, and super-supportive friends and family (#blessed), you inevitably always. have. questions. And oftentimes, the answers to these questions only bring up more questions.
I’ve been there. In fact, I’m still there. As someone who’s been trying to conceive for two-and-a-half years, I know that these questions can feel super overwhelming...and they might not be things you want to ask your doctor, your friends, or even your spouse.
That’s why I created CoFertility—a site that aims to address every fertility question out there.
We recently joined forces with The Fertility Tribe, one of our favorite fertility community resources out there, to make sure we’re answering your questions. We asked you to tell us any fertility questions on your mind, and you definitely delivered. Let’s dive in, shall we?
What’s the deal with acupuncture and IVF?
I know the thought of even more needles during an IVF process might send you running for the hills. In fact, I actually burst out in tears at my first acupuncture appointment before my practitioner even touched me, just because I was so nervous (true story—blame it on the hormones).
But once I began acupuncture treatment, I realized how silly that reaction was. The needles barely prick, and it’s actually the one moment in my crazy life when I feel totally zen and chilled out. Now, I don’t go a week without it. And many fertility specialists are recognizing acupuncture’s benefits. Here’s why:
● A 2002 Fertility and Sterility study indicated that regular acupuncture treatment can regulate patients’ endocrine systems (where sex, mood and sleep hormones are manufactured).
● Another Fertility and Sterility study published by the American Society for Reproductive Medicine following 160 women through their IVF transfers (half receiving acupuncture before and after the transfer) showed that 42.5% of those receiving acupuncture got pregnant vs. only 26.3% of those who didn’t.
● It’s been shown to support a healthy lining pre-transfer.
So yeah, if you’re having trouble getting pregnant, acupuncture may be worth trying. But keep in mind, there are some things acupuncture won’t do: it won’t fix structural issues, like septums, fallopian tube blockages, and other infertility causes that might require surgical intervention.
What happens if I thaw frozen embryos for PGS?
In short, it depends. While it’s definitely possible to thaw embryos, biopsy (for pre-implantation genetic screening—or PGS), and re-freeze, there are, unfortunately, always potential embryo survival implications whenever you thaw. Just something to keep in mind as you manage your own expectations.
If you’re thinking about thawing your embryos to conduct PGS testing, Dr. Jaime Knopman, reproductive endocrinologist at CCRM NY, advises you to consider how many embryos you have and what’s potentially at stake. “I always say you have to be careful. Conducting PGS testing on previously frozen embryos isn’t necessarily too hard on the embryo, but you don’t want to do it multiple times and on embryos of poor quality”
It also matters what type of embryos you’re thawing. A 2011 study published in the Journal of Human Reproductive Sciences, for instance, states that thaw survival rate improves when the embryo has reached blastocyst stage (versus, say, a day-3 embryo or zygote). And, according to Dr. Knopman, the same goes for the actual process of PGS: the more advanced the embryo is, the fewer risks you’ll encounter—biopsying a couple of cells of a day-5 embryo gives more to work with than one cell of a day-3 embryo—and the more accurate the results may be.
Different doctors have different philosophies on PGS testing, which may or may not depend on the quality of their lab and the doctor’s confidence in their ability to successfully carry out the testing. But there are a few reasons Dr. Knopman cites that PGS can be super beneficial:
● It can increase pregnancy rate: While an embryo might look awesome to an embryologist, morphology might not tell the whole story. According to Dr. Knopman, doing PGS may help you avoid moving forward with a transfer that might not yield you anything—especially in women between the ages of 38-41.
● It can reduce the risk of miscarriage: If you do get pregnant, you’re less likely to miscarry with a PGS tested embryo. If you’re a numbers gal, consider this: a Fertility and Sterility review indicated a decrease in miscarriage rates from 28% in the natural conception group to 9% in the group using a PGS embryo.
● It can explain previously “unexplained” infertility: Sometimes, PGS can solve the conundrum of why you aren’t getting pregnant. It’s possible that you and your partner have been creating abnormal embryos, and PGS can clarify that.
Some good news to think about: according to the Ethics Committee of the American Society of Reproductive Medicine, current research does not indicate any risks of birth defects associated with biopsied normal embryos vs. embryos that haven’t undergone PGS. In other words, conducting PGS on an embryo shouldn’t contribute to any additional risks beyond the existing risks of IVF.
What are my chances of success with IUI?
I wasn’t surprised to see this question. Success rate transparency is actually one area I see huge opportunity for fertility clinics to improve within.
Given that the CDC doesn’t track clinic IUI success rates because they don’t involve the manipulation of eggs, it’s up to you to ask your doctor to supply individual data on how their IUI rates match up with the delivery of babies. If you’re considering IVF, however, you can view your clinic’s most up-to-date success rate data, if they reported it, here.
Officially, the American Pregnancy Association estimates IUI has an average success rate of 20%. But this doesn’t account for fertility diagnosis, age, and other factors. So when you chat with your doctor, in addition to asking for official clinic stats, be sure to get his or her take on your individual outlook, and keep in mind that (unfortunately) age can strongly affect the outcome of an IUI cycle.
How can I cope with secondary infertility?
Secondary infertility is the real deal. In other words, it’s HARD. You’re basically taking the challenges of infertility and throwing some survivor’s guilt in there, plus the fact that you’re already juggling your other responsibilities for your existing child. Add in lots of unwanted judgment from outsiders, and you’ve painted the picture of secondary infertility. Yeah, not fun.
Causes for secondary infertility are pretty similar to those for primary infertility. But unlike primary infertility, these factors are often amplified by the inevitable increase in age of the parents-to-be. It’s also possible that new complications have developed in your system that are preventing you from easily conceiving a second child.
Bottom line: if you’re trying for another baby and it’s taking longer than you expected, chat with your OB/GYN or an RE. As a refresher, according to Dr. Jane Frederick, reproductive endocrinologist at HRC Fertility in Orange County, California, the amount of time you should try conceiving on your own varies with age. To her, this means:
● If you’re under 35: try for a year before seeking treatment (to me, anyone with this kind of patience is a saint, but I’m just the messenger here!)
● If you’re between the ages of 35-40: try for six months before seeing an RE.
● If you’re over 40: consider going straight to a specialist in the interest of time.
What should I expect in my first fertility consultation?
Once you get to the point where you’re ready to chat with a fertility expert, you’ll want to know the right questions to ask. Some important ones, right off the bat:
● Do you have an age requirement for your patients?
● Do you have an embryologist on staff, or are the lab portions of IVF done by an independent lab?
● Do you have an in-house egg donor team or would I have to find an agency?
● Do you work with gestational carrier surrogates, should I need one?
● Will I work with just one doctor or a team of doctors...or mostly with a nurse?
● What’s the patient support like at your practice? Do you offer advocacy services to help with billing and finances?
Obviously, most of these questions are situational and may be specific to your treatment needs. But it’s good to get some of these answered up-front so you know which clinic is right for you. More importantly, you should think about what you want out of a clinic. Do you expect to see the same doctor every time? Do you want hand-holding or no-nonsense? What type of bedside manner are you looking for? Have a conversation with your partner (if you have one) about what you’re looking for.
At your first appointment, you will undergo a whole host of fertility tests, so brace yourself. While annoying and somewhat overwhelming, these tests will help inform you and your doctor of the most appropriate next steps, so you can work together to crack the mystery of why you’re still not pregnant and come up with a game plan.
The net net
While infertility can feel like a roller-coaster of ups and downs, the one constant is that we’ll always have more questions. No, you’re not annoying for having them. Yes, you should always be able to ask them without feeling stupid or insecure. In the meantime, we at CoFertility are always here to support your journey.