Associate Professor, OBGYN
Harvard Medical School
Assistant Division Director
Walter Reed Medical Center
There are many types of fertility treatment, but for the moment we’ll zero in on the most common (which we’ve summarized in the table below)& how you may want to think through schedules as your progress through treatment.
First, let’s talk about timed intercourse. In this case both partners need to adjust schedules to be together during the 4 - 6 days each month of the “fertile window.” While trying during just one day in the window helps, it’s really better to try more often than that, as you can see below.
This whole process can be helped somewhat if a woman takes drugs like Clomid or Letrozole.
Next is Intrauterine Insemination or IUI. There are a few versions of IUI, but let’s assume this one’s accompanied by oral drugs like Clomid or Letrozole.
The timing here is delicate. Don’t plan to schedule any travel or big meetings that could conflict with the appointments, trigger shot or the IUI. If you do, you could jeopardize the whole cycle.
Unlikely IVF (which we’ll cover next) the IUI is often relatively painless and most women are often able to go back to their normal activities the same day.
Lastly, as we touched upon in the last lesson, IUI works far more often if a man’s sperm is provided the day of the treatment. However, if there’s even a remote chance he won’t be around to provide a sample that day, providing sperm in advanced as a backup can also work.
Next in the treatment continuum is In Vitro Fertilization or IVF. As you can see below, IVF is more effective than other treatments but it’s also a more involved, complex and costly approach.
In the below chart we outline the 5 basic steps of IVF, which we’ll walk through one by one.
First, a woman injects herself with hormones every single night for up to two weeks.
Most mornings she’ll need to show up at her clinic for monitoring appointments. A patient can’t miss a single injection or appointment.
This is one reason travel becomes really difficult if not impossible when a patient is undergoing IVF. Even day trips present a problem should weather or other factors delay the trip home.
Here we’ll take a moment to address morning monitoring appointments. Clinics can run far behind schedule prompting you to miss meetings, calls or presentations.
You do not want to be rushed during these appointments. There is an excellent chance you’ll be seen by a new doctor and you’ll want to ensure they’re up on your case and your questions get answered.
Often, once you leave the clinic you’ll be headed to your next destination during peak commute hours. Getting an uber, out of the clinic’s parking lot or to your next stop can take an eternity.
Our advice is to keep your morning as light as possible, hard as that may be.
When the doctor thinks the size and volume of the eggs look about right, a woman will be injected with a “trigger shot.” 36 hours later she’ll have surgery to remove her eggs.
The timing here is incredibly delicate, and if things are off by even an hour or less, the cycle could be compromised. Don’t schedule anything that could conflict with the trigger shot or anything on the day of the retrieval itself.
Unfortunately, there’s almost no way to predict far in advance when either will happen, so it’s probably best to keep schedules open and to make things tentative that could get in the way.
The day of the retrieval itself can be intense and emotional; recovery times can be a day or longer and sometimes last up to a week if a woman “hyperstimulates.”
If you’re a partner or spouse, don’t plan to do anything other than be of help on the day of the retrieval.
After the egg retrieval, the clinic sets to work to fertilize the eggs and grow embryos. This process goes on for just under a week.
This is a stressful period because with each passing day, fewer embryos tend to survive and as patients we often want regular updates about how our embryos are progressing.
You might have trouble making sense of what the nurse tells you by phone (there is a lot of terminology when discussing embryos) and may want another call from your doctor to clarify.
These calls can come in the middle of meetings and it’s hard to ignore them. It can also be hard to refocus afterwards, as we try and absorb what we heard, or get a partner or friend on the phone.
If the clinic was able to develop one or more embryos there will be probably be a transfer to the patient’s (or a surrogate's) uterus. The transfer is normally painless and nothing like the retrieval.
Depending on the circumstances, the transfer can happen days after the retrieval or it can be scheduled for months down the road with more flexibility.
After the transfer comes an often agonizing stretch to see whether the transfer worked and whether there’s a positive “beta” or pregnancy test.
Most patients find that on the day of the call from the clinic, it can be incredibly hard to focus. Not much may be getting done before that call arrives, or after.
Unfortunately, more-often-than-not, an IVF cycle doesn’t work, in which case many patients try again or consider enlisting the help of an egg donor, sperm donor, or gestational carrier.
This brings us to third party reproduction, which for many patients is an essential component to building a family.
The routine of finding an egg donor, sperm donor, or gestational carrier can take months or years and can add a lot of complexity to an already busy process.
Sometimes hopeful parents need to be ready to drop everything to screen an egg donor or surrogate, wire tens of thousands of dollars or travel out of town or a big appointment.
The process of using third party reproduction can be daunting, but for a lot of patients it’s totally necessary and raises their odds of success dramatically.