Challenges of Fertility and how to overcome to achieve parenthood-Part 3

Thanks to everyone for their kind words of encouragement. If my words are able to help anyone in any way I am grateful for the opportunity.

In the previous article I covered the first step in fertility treatment - Clomid with natural conception efforts. If this does not work, additional factors will have to be considered.

If natural conception is not working the doctors increasingly prefer IUI ( intra uterine insemination ) This may overcome some structural issues, certain male factor issues, etc. However care has to be taken to prepare the sample and not all clinics are good at this. Also, the timing of the IUI is very important. Since one cannot predict exactly when ovulation will occur, most doctors suggest doing two IUIs on consecutive days. So if you took your Ovidrel trigger shot on Sunday night, first IUI is done monday morning and second IUI is done Tuesday morning. Some doctors even advise the couple to try naturally Monday night too.

Points to note -

Before you start IUI, your clinic will probably need a semen assay. This would include statistics of count, normal forms, morphology, etc. You can also ask to see a sample under the microscope. It can be an experience to remember - as you see the life forms swimming, you will feel a lot of hope.

If results seem abnormal it's best to approach a urologist who will treat male factors. One common problem is varicocele - easily corrected with a minor procedure. Other simple lifestyle changes involve change of clothing, avoid high temperature baths and avoid sitting on hot car seats. ( Personal note - After a hot day, DH would start the car, run the A/c for a full 5 minutes before he would drive. He also took tribulus terrestris, a popular supplement that boosts testosterone and may help sperm production.)

Note - We never had a male factor problem. We were just being proactive. But the important thing is that making changes like we did might help people with some male factor issue and bring it to an acceptable level. Another important point - it does not matter if one of you has great statistics or even if both of you have great stats - both of you have to be good and on top of that things have to click. That is what is so frustrating to couples who are TTC for a long time. Everything seems OK but still the required result is elusive. Patience and perseverance are the only solution.

Though Clomid is the first line of treatments, it comes with it's own share of disadvantages. The first and most important one is thinning of the endometrial lining. Other side effects include hot flashes, mood swings which need to be dealt with. However a thin endometrial lining causes issues with implantation, and if the lining does not measure atleast 8 mm prior to the day of IUI, the chances are dim for that cycle.

Docs will increase Clomid to a max dose of 250mg. If that's not working, one may have to move to Femara ( Letrozole) Many RE's in the US have stopped prescribing Femara because of studies related to embryo defects. While this is very small chance, Femara remains popular with Indian doctors as it is cheap and orally administered.

If you have tried several rounds of Clomid with your doctor, with no success, now is the time to think whether you are in the right hands. Ask yourself the following questions -

1. Does your clinic have good equipment? Can you see follicles on the Ultrasound machine? Does your doctor explain to you what is going on and answer your questions ?

2. Does the doctor prescribe Ovidrel or another triggering medicine ? Does your clinic do the multiple IUIs? Is the clinic available to do IUIs no matter if is Saturday or Sunday ?

3. After each unsuccessful attempt, does the doctor consult with you and explain what his/her future course of action is ?

If you don't feel your clinic meets your expectations, you should promptly look for some other place that is well known and treats you well. Costs will be comparable especially in India where everything comes out of your pocket.

In the next part we'll look at injectibles and other advanced strategies.