Fertility Roadmap Module 1

Fertility Roadmap

Module 1

Taking Charge of Your Fertility

It’s been 3 ,6…12 months since you began trying to conceive and each month you are greeted with 1 line on the home pregnancy test. You are not sure if it is time to go see a doctor yet or if you are just being a pessimist. It’s understandable to struggle to take a step forward into exploring if there’s an issue with your fertility. It’s OK to be concerned! And it is also OK to voice that concern!

Step 1: Are you ovulating and do you know when?

An average cycle lasts 28-30 days and one ovulates 14 days before the next period. However, many women ovulate and cycle on their own unique schedule.

In case you’re wondering: An ovulation home test monitors your hormones to detect ovulation by testing the levels of the luteinizing hormone (LH) in your urine. Basically, starting after the last day of your period every morning you will urinate on a stick (or in a cup and put the stick in) to test for the presence of LH. Some of these kits will have 2 lines to indicate ovulation others will have a smiley face. When the test detects a rise in this hormone called the LH surge, it indicates that ovulation will occur and this is your fertile window.

Keep in mind: According to most research sperm can survive in your body for up to 3 days.

Practically speaking: Once you know your pattern, it can help to have intercourse a day or two before you ovulate and then again the day of and day after you get a positive ovulation test.

If you are not ovulating consult your doctor to determine the cause and if necessary, request a referral to a Reproductive Endocrinologist and move on to step 2.

If you are ovulating before going to the Mikvah, consult with your doctor and Halakhic adviser to discuss options.

If you are ovulating regularly, use this new information to ensure that you are having intercourse during your fertile window. If after trying for a few months you are still not pregnant, move on to step 2.

Step 2: Make an appointment with your OBGYN

Discuss your concerns with your OBGYN about not yet conceiving, despite trying for multiple months. You should request a full blood workup.

OVARIAN RESERVE:
Did you know that you are born with all your eggs? Interesting fact, your egg production peaks in utero at 20-weeks gestation with approximately seven million eggs. Each month when you cycle that number diminishes. And for each woman this process varies and the quantity and quality of eggs remaining may diminish faster for some without you evening knowing. To get a better picture of your ovarian reserve your doctor will likely order a blood panel including but not limited to those listed in the Blood Work Up of hormones to test your egg quality and quantity as well as ultrasound imaging of your ovaries to determine your fertility.

Learn more about ovarian reserve testing from the American Society of Reproductive Medicine.

Step 3: Review your results with your OBGYN

Schedule a time to discuss the results with your OBGYN and create a plan to move forward. Some OBGYN’s will continue to treat fertility challenges. You may request a referral to a Reproductive Endocrinologist (RE) who is trained to specifically treat reproductive challenges.

It is now time to get ready for your first appointment with your Reproductive Endocrinologist.

Step 4: Check in with yourself

This can be stressful! Who are your supports? What are you doing to practice self care?
It is understandable to not be ready yet to address the next steps…be kind to yourself.

Respect the Emotions

The First RE Appointment

You made it to the first consult. A brave step forward!

This can be both an exciting and scary next step in taking charge of your fertility.

You are not alone on this journey! To be paired with a Yesh Tikva Trained Peer Mentor on the other end of a similar journey sign up for Fertility Friends.

Meet the infamous “Waiting Room”:

The business of the waiting room depends on the time of day of your appointment. Entering the waiting room of an RE’s office can make you feel very vulnerable and exposed. The culture of the waiting room may differ between practices but the overwhelming majority of waiting rooms are filled with people scared to make eye contact or start conversation, despite everyone being in a similar place of challenge.

*Note: Depending on your doctor’s office you can spend a significant amount of time waiting. To help pass the time consider bringing a book, crossword puzzles, doodling/coloring book, music or podcast or some other activity you enjoy.

Meet your doctor:

This will usually take place in his/her personal office rather than an exam room. During this meeting you will begin by reviewing your entire medical and fertility history.

Don’t forget to come prepared with the relevant items from your Yesh Tikva Bring Along Check List.

Meet the exam room:

Many doctors will perform a pelvic ultrasound, usually a transvaginal ultrasound, at which time you will meet the famous wand.

Did you know?

The ultrasound is used to measure your pelvic lining and look for possible abnormalities with the uterus, fallopian tubes and/or ovaries.

This will be the first of many along your journey – this may be slightly uncomfortable, consider strategies to reduce discomfort like deep breathing or asking to hold someone’s hand.

If you are not offered, know that you can request a nurse to be present in the room during each ultrasound.

Meet the phlebotomy room:

After the ultrasound, you will be asked to give blood. It will be the first of many blood draws. If you have not already done fertility blood work and genetic testing your doctor may have you and your partner have blood drawn at this appointment or shortly after.

Whether you are afraid of needles or not, numerous blood tests can be overwhelming. But it is a necessary part of the overall treatment goal: ‘growing your family’.