RESOLVE January 7,2016
What to Expect ?
By Lynn M. Collins
Infertility has its own vernacular, or terminology, and I will help you understand some of the “infertility lingo”.
Some fertility programs are located in a large hospital setting and some in a more intimate clinic setting. The staff can consist of four to five Reproductive Endocrinologists (RE), Urologists, Nurses, Embryologists and professional counselors. Larger programs could have a larger staff. The clinic will have a laboratory, which may be called an Andrology Lab (Andrology is the study of the male reproductive organs). The lab consists of three to five medical technologists, depending upon the size of the clinic and whether or not it specializes in Andrology. The Andrology lab performs the blood tests and measures hormones; performs semen analysis and sperm washing for Intrauterine Insemination (IUI), and may possibly have a sperm bank. The clinic may have an In-Vitro Fertilization (IVF) lab or be affiliated with a hospital that has the lab. An IVF lab consists of many embryologists, which perform the intricate testing that goes along with IVF.
The Pivotal Role of Your Nurse
Depending on the program, a nurse is assigned to one or two specialists. The RE works together with you as a couple, and will order blood work and other diagnostic tests. But when it comes to physical exams the RE examines only the female partner. If the male has an abnormal semen analysis or any conditions that relate to the male reproductive system, he’ll be sent to an Urologist for an examination. The nurse that is assigned to a couple in a fertility program remains involved with the patients at every step, building communication and trusting relationships with the patients. Sandy Vance, nurse manager at Women’s Health Center has said, “Infertility has been compared to a terminal illness and when a woman has tried everything and cannot get pregnant, she begins to experience grief, shock, denial, isolation, depression and guilt. We work to get the woman to a place where she can understand what her status is.” (This is perhaps the only field in which nurses work more with the patients than the physicians.) Once you have the first consult with the specialist, the nurse then becomes the person with whom you will communicate the most on a monthly, weekly or even daily basis. Your nurse will give you a packet containing information on testing. It may also contain orders for your testing, instructions on giving injections, operational hours of the center, and who to call in an emergency. Please read this information and keep it in a safe spot at home. These nurses are on their phones most of the day, answering questions, encouraging, or giving instructions to their patients. One of the hardest calls they make to a patient is that her pregnancy test came out negative and it doesn’t get any easier. The best call is the one that delivers the news to the patient that her pregnancy is positive. Nurses are so excited and make that call first. In either case, as one of our nurses at our Women’s Health Center, Paula Ayers, has said, “The most gratifying compliment I can receive is when a woman does not achieve success in conceiving, despite all of our efforts, and she thanks us for the respect and supportive approach to her care.” One patient, who went through the program at the age of 40 and was diagnosed with old eggs, was able to get pregnant after her first IVF cycle. She said, “It may sound easy but until you are the one going through it you can’t appreciate the kindness of the nurses. Even on my lowest day, thinking this wasn’t going to happen, Sandy found something positive we could hold on to.” As you can see, nurses in a fertility program grow very attached to their patients and work very hard, with great compassion, to help patients navigate the ongoing ups-and-downs of an infertility program. I posed this question on Facebook to some fertility nurses: In a perfect world, what would make your day-today job easier when it comes to caring for your patients? Sandy Vance responded: “We all like it when patients ask questions, because it shows that they really want to understand their treatment. But it would be helpful if they would read all of the materials we send home with them. They really are helpful in explaining the process.”
How the Process Begins
The first phase will start you with one of the following Assisted Reproductive Technologies (ART) procedures and may progress to others depending on your success. These procedures include and not limited IUI and IVF. Beyond that, IVF can break down to include other techniques, such as, for example Intracytoplasmic Sperm Injection (ICSI). Below are a few brief descriptions of both IUI and IVF.
The IUI procedure is a simple procedure that takes little time and involves minimum discomfort. At the time of ovulation the sperm is collected and processed. The sperm is then placed in a catheter and is placed in the female’s uterus. It is very important that this procedure, also known as artificial insemination, occurs with ovulation. Using the over-the-counter ovulation kits can easily monitor the time of ovulation. The hormone Luteinizing Hormone (LH) is measured, noting when it spikes. This indicates ovulation has occurred and the female is at her most fertile time. The IUIs are performed seven days a week and take only about one hour. The males collect the specimens in the morning and drop it off at the lab. (Some centers prefer the males to collect the specimen at the center.) The lab performs a sperm wash to the specimen, wherein the non-motile sperm is separated from the motile sperm and other debris from the semen. The female partner returns to the center around 11:30 a.m. to 12:00 noon for IUI procedure. The washed specimen is placed in a catheter and is inserted through the cervix into the uterus where the specimen is released. The procedure is very similar to getting a pap smear. The patient relaxes in the exam room for about 10 to 15 minutes after the procedure and then she can resume her daily routine. The nurse instructs her to notify the nurse in two weeks if she has not gotten her menstrual cycle. At that time her blood will be drawn for a pregnancy test.
IVF is more involved than an IUI. An IUI is less invasive and the cost is much less. This procedure differs from an IUI because the eggs are removed from the female’s body. The female will take the gonadotropins follicle-stimulating hormone injections that will stimulate the ovaries to produce as many eggs as possible. The eggs will be removed surgically, which is called the retrieval, and then placed in a petri dish where your partner’s sperm will be washed and placed with your eggs. The dish is incubated and evaluated a few days later to see how many eggs fertilized. The female returns for an embryo transfer, which is where a certain number of embryos will be placed back or transferred into the uterus. The embryos will be placed in a catheter like the sperm for the IUI and placed in the uterus. You’ll return to the center in approximately 14 days after the procedure for a pregnancy blood test. The success rate for IVF is higher than IUI. Which procedure you start with depends on the results of your initial testing (for both of you), insurance coverage, and how aggressive you want to be, depending upon your success, or lack of success at other clinics. This will all be discussed with your medical team.
Lynn M. Collins is the author of Sperm Tales: An Informative Guide Through the Challenges of Infertility. Lynn draws on her experience as a laboratory supervisor for a leading national sperm bank and manager for a multi-million dollar infertility laboratory. In Sperm Tales, she offers compassion, humor, and clear step-by-step information about the numerous challenges–medical and otherwise–that attend the process of infertility treatment