What You Wish You Knew Before Starting Your Fertility Journey
A few weeks ago I put out a call to social media and asked all of you to share your stories with me. What do you wish you’d known before starting your fertility journey? I got back lots of responses, so thank you.
I’m doing this show in part because it’s also what I want you to know before going down the path of starting a family.
Thank you to everyone that’s helped contribute to this show, and for sharing what you’ve learned so that everyone on a fertility journey can benefit.
Here’s what you shared with me:
Many people wish they knew if their fallopian tubes were open before they spent precious time trying to conceive.
They would have liked if someone had told them that being diagnosed with chlamydia, endometriosis or undergoing surgery for a ruptured appendix could have compromised their tubes. If the tubes are blocked you can’t get pregnant naturally.
If one is open and one is blocked it doesn’t mean that you have a chance to get pregnant every other month either. The side you ovulate on is as consistent as heads or tails with a flip of a coin. You could ovulate on the right side every month for 6 months before you ovulate on the left. Imagine finding this out years after starting fertility treatments only to learn later that you wasted so much time doing treatment when there was no chance it would work. Quite the buzzkill. This is what we want to avoid.
Many patients wish that someone had done a pelvic ultrasound before trying to conceive.
Especially patients who have painful periods. Imagine being told every time you talk to someone about your pain that it’s normal and you should just deal with it to find out years later after trying to conceive that it was endometriosis the whole time. Endometriosis can often be detected (not always) by a simple ultrasound.
We spend so much time in doctor’s offices getting annual pelvic exams, but this isn’t enough to detect a growth in the uterus. A pelvic ultrasound can be used to diagnose a polyp or fibroid. Unless a doctor has a camera on the end of their finger there is no way they can see a polyp or fibroid without this ultrasound. If you have either of these inside the cavity of your uterus, getting pregnant will be difficult. For this reason, I urge you to ask for a pelvic ultrasound before you try to conceive or start fertility treatment. I don’t want you to be like one patient who shared…
I wish I knew I had a fibroid before I spent a year taking medication that would have never worked. A simple pelvic ultrasound would have diagnosed it.
Sperm health is just as important as egg health.
Many of you shared stories with me about how you wished you knew the quality of your partner’s sperm before doing treatments like IUI and IVF.
Several of you wrote to tell me you would have liked to have a semen analysis checked. That it was not standard in your pre-conception testing.
I had someone tell me they wished they had known about their husband’s condition called congenital absence of the vas deferens (CAVD). After 6 months of trying she asked her OBGYN for some tests and the doctor told her to keep trying for 6 more months. In reality, her husband’s condition meant he had no sperm.
I feel frustrated just thinking about this. Getting a semen analysis done is so easy. Fertility issues aren’t anyone’s fault. 1/3 are sperm-related, 1/3 are due to female factors, and 1/3 are a combination of the two.
Please don’t start fertility treatment before checking on sperm health. A semen analysis is a really simple test. During this test, you will be able to learn about the sperm count, motility and shape. This won’t come as a surprise to you, but every healthy pregnancy needs a healthy sperm cell too.
Hormone issues are so easy to screen for, yet many times they are overlooked and not part of pre-conception testing.
I have had many of you send me messages about how you wished you had done an egg whisperer fertility awareness panel. This would have given you information about your egg health well before any type of treatment. Thyroid disorders can also get in the way of ovulating regularly and conceiving easily.
A simple test could have told you that you are running out of eggs or have other hormone problems that are easy to treat.
“Get your (fertility) levels checked”
It’s something you often hear me say on my show. So be sure to do so before you start trying to conceive, especially if it’s taking time to get pregnant or you are starting fertility treatment.
Knowing Your Genetic Profile Can Be Empowering
I had a couple share that they wish they knew about carrier screening before having a baby with cystic fibrosis. That breaks my heart, as I want to make sure that people know that there are tests out there that they can do pre-pregnancy.
Most people are familiar with testing available through 23andme, EverlyWell, and other genealogy testing companies. However, not many people know that the American College of OB-GYN also recommends DNA testing before conceiving.
A carrier screen is a simple blood or saliva test that can be done before or during pregnancy. Right now these tests look at 300 genes for recessive diseases and if you and your partner are both carriers it could mean that your baby has a 25% chance of inheriting the disease. Information from these tests gives you powerful knowledge so you can decide if you want to do a procedure called IVF with PGT-M (previously known as PGD) to screen embryos for a disease.
So now you know why I always say, “Get your TUSHY checked!” If you do this then you’ll have less regret. You’ll be able to say — I knew all of this information from the beginning of my fertility journey and made decisions according to what I knew at the time. You won’t say “I wish I knew.”
If you’ve had your TUSHY checked and people are still using terms like “unexplained infertility” there’s a good chance there is still a reason or they didn’t do a thorough TUSHY check. I had a patient come and see me with that diagnosis. When she told me she was forty-one, I knew her infertility wasn’t unexplained, it was due to age.
Our age is our greatest predictor of pregnancy outcomes. My hope is that you keep asking questions about your fertility. If you talk with your doctor and you don’t think you’re getting the answers you need, then please find a doctor that you think will help.
You can do a complete TUSHY check during one menstrual cycle. Here’s how it would go:
1. Go to the lab on cycle day #3 for your hormone levels including your preconception panel.
2. Schedule a pelvic ultrasound and antral follicle count early in the cycle and get the kit for your carrier screen from your doctor at this visit.
3. Schedule your HSG (test done to check if your tubes are open) around cycle day #8
4. Have the semen analysis done either 4 days before ovulation or 4 days after ovulation (this way you can keep trying around your ovulation window).
I know this seems like a lot of work, and it is. However, it is empowering to know your fertility indicators so that you can have the family of your dreams with the clearest strategy outlined from the get-go.
If you follow this schedule, you will have all the information by the end of the cycle you will be ready to make a plan moving forward that suits you and your needs. I call this your “personalized fertility care plan.” I give this to each of my patients. No two plans are alike. No two fertility patients are alike.
What else are people wishing they knew before their fertility journey?
I wish I had tested my hormones and done a consult with you before I tried home inseminations.
In this instance, a woman was doing home inseminations with sperm from a sperm bank without really knowing much about her cycles. Sperm is really expensive. Getting a diagnosis before treatment (with the TUSHY method), while it may seem daunting, is $2,000 or less. Spending that money up-front on testing may have saved her a lot of anguish and money on failed attempts at conceiving.
What a waste of money when I didn’t even know how my own ovulation works.
That’s really important. Not everyone ovulates on day 14. Using an ovulation predictor kit to pinpoint ovulation is helpful. And the Proov Test is an easy and affordable way to understand your ovulation as well. You can also go to a fertility doctor like me and we can confirm you are ovulating by ultrasound and with blood work.
I wish I had done everything you and the acupuncturist suggested from day one with exercise, nutrition, and stress to get my body in top form.
That is so important, but I don’t want patients to delay getting pregnant because they are not at their ideal body size. Remember, fertility isn’t skin deep. You may be in shape, but that isn’t a sign of your egg health.
I think one thing that I wished I would have known before starting my fertility journey was what to do with my remaining embryos and my feelings about them. I sometimes struggle knowing that there are two male embryos left and I’m sad for them.
I know that they’re there for me if we decide to have more children, but that’s not in our plan right now. I know there’s embryo adoption, but that’s not something we want. And then there’s destroying the embryos. My husband and I aren’t very religious. He grew up Christian and I was raised in a Buddhist household.
Neither of us wants to destroy the embryos, but we are also not sure we want more children. Before I started IVF, I should have thought about how I would feel if I were to have unused embryos.
This is a really important thing for us to learn from. Often when I ask patients about how many children they want the answer is, “we would be grateful for one at this point!”.
It’s very difficult to think about the possibility of extra embryos when you are doing everything you can to just get one that’s healthy.
This is where it’s important to have a supportive network. I call it your fertility team. Consider seeing a fertility therapist. You and your partner can sit down and discuss what you want to do with unused embryos. What if you end up splitting up? How would you handle it? Maybe even consider discussing your wishes with a family attorney. When talking through these issues before IVF, you may decide to do something differently. Egg freezing is an option where you only fertilize the number of eggs you think you may need. Realize that egg freezing may not be as good as using fresh eggs, especially if sperm quality is poor or the egg quality is low. As you’re looking through consent forms really consider them as legal documents. Think about these things up front and get advice from psych and legal professionals if needed.
I wish I knew that we had fertility issues from the beginning of the journey.
I hear this so much. I started a website www.eggwhisperer.com so I could teach about fertility through egg freezing parties and offer women an easy and affordable way to get their fertility levels checked. It doesn’t matter how long you’ve tried. I want everyone that’s 25 or older to understanding their egg health. It’s so much harder to get pregnant over the age of 37.
Remember, your fertility isn’t like the last celebrity you read about in her 40s that got pregnant.
I wish the doctors listened more because they always said that we are young…just wait.
In my humble opinion, a young person should get help if they want help — and quickly. I want to check fertility indicators early and often for anyone that wants a family.
I wish I had known how hard the 2-week wait would be and better prepare for it.
In my office, we check 8 days post Embryo transfer. There are a lot of tips and tricks that you can do along the way. Fill your days with activities and do things that are fun and fill your day with joy. Use that time to distract yourself.
Every cycle will have a certain number of eggs meant for us. I work with my patients to have a positive and realistic outlook for how many healthy embryos we may get. Often with patients over 40 I’m honest in saying that it may take several cycles to get even one healthy embryo.
I wish I had known how painful the shots were.
The shots really are a pain in the a**. Sometimes patients place their shot too low. One thing you can do is warm the syringe in a heating pad or under your leg. There are hand massagers that can massage the area too after the injection. I’m happy to talk with my patients about the best tips and tricks to make this part of the process less painful, but at the end of the day, it is a shot so prepare yourself for that!
I wish I knew that miracles can happen. I have so many specific things to list here, but I don’t have time right now because I have two kids!
I thought this quote was a very special way to end this article. What a sweet sentiment!
Don’t forget to get your TUSHY checked! The 5 simple tests you can do to get your fertility diagnosis so you can avoid doing treatments blindly.
As a reminder:
“T” in TUSHY stands for tubes (the fallopian tubes)
“U” in TUSHY stands for an ultrasound of uterus.
“S” in TUSHY stands for semen analysis.
“H” in TUSHY stands for hormone testing.
“Y” in TUSHY stands for your genetic profile.
As always please reach out if you have any questions or topic suggestions for future shows.
Send me a note: email@example.com
You can also catch more of me and topics like this through the Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!