Conception FAQ

Medication Guide

Here is a list of commonly prescribed medications related to infertility.  It is not broken down between IUI or IVF, but you can look up medications you may be discussing with your RE.

Click here to see medication guide.

Vitamin B6 for Luteal Phase Defect

 

Vitamin B6 to Combat Luteal Phase Defect (LPD)

by Brigitte (MikeandBrigitte)
 
A "short luteal phase" or a "luteal phase defect" (LPD) is when the interval from the time you ovulate until you have your period is too short.  A fertilized egg needs a certain amount of time to implant in the uterine lining.  If you menstruate in less than 10 days after ovulation, the pregnancy will not be able to implant firmly and you will get your period even though you may in fact have conceived.  I always thought it was suspicious that we had not been using contraceptives for the almost 10 years we had been married and had never gotten pregnant.  Once we decided to start actively TTC (temping and charting), I was nervous because of our "track record".  I began to notice that while our timing was great, I was not getting the sought after BFP.  I started to analyze my chart and found that my luteal phase on average was 8 days (if the interval between the day of ovulation and the first day of your period is less than 12 days, you may have LPD).  I also had a few symptoms of PCOS (fibrocystic breasts, cystic acne, etc.) but have never been diagnosed.

Once I concluded that I had LPD, I called my gynecologist office to voice my concerns.  I was told that it generally takes about a year to conceive and that I needed to wait it out before they were willing to do anything for me (although they did offer to let me come in and get a blood test).  If I had been trying for over a year at that point (even though we were not using protection for almost ten), a reproductive endocrinologist would have supplemented my progesterone level. However, because we had actually been "aggressively" TTC for a shorter amount of time, I decided to look into alternatives to help myself.  That was when I found documentation to support the supplementation of vitamin B6 to lengthen LPD.

My prenatal vitamin had 5 measly mg of B6 (which is 250% of the daily value).  However, the dosage typically needed to correct LPD is between 50 mg and 300 mg daily.  I started out with an additional 50 for an entire cycle.  If your luteal phase does not change, or does not change enough, increase another 50 for each additional cycle until correction is seen.

The first time I took B6 I only took 50 mg daily and the cycle corrected instantly.  I ovulated on day 17 and got a positive pregnancy test on day 31.  I never did go back for the blood test, but it is still on my list of to do's.  I was also taking a prenatal, selenium and additional folic acid.  The only new things that cycle were the B6 and selenium (and I had DH taking the selenium as well).
 

***Pharmacy Coupon for Fertility Meds!***

Schrafts Pharmacy - A Walgreens Specialty Pharmacy - has a special for patients who are paying out of pocket for their fertility medications!

If your order totals $500 or more, you will get a $100 coupon that you can use right away!

This is only for the month of May.  Check it out.  Schrafts generally has great prices on fertility meds, and of course they include all syringes and free overnight shipping!

Click here to go to the Schrafts/Walgreens Pharmacy page.  Call  800-876-4545 for more information on the coupon in May!

To find info on cost comparisons by pharmacy - please click here!

Review: Red Bush Tea

Review of Red Bush Tea

by Katy (Katykin)

 

For anyone trying to cut out caffeine while pregnant, lactating or trying to conceive, red bush tea (also known as rooibos, red tea, African tea) from South Africa is an excellent alternative. It can be drunk with or without milk and sugar, and tastes similar to normal black tea. I’ve actually grown to prefer the taste.  It is good hot or iced!

Red bush tea is naturally caffeine free (unlike green tea), is low in tannins and full of antioxidants, vitamin C and minerals making it an ideal, safe drink for pregnancy, breastfeeding and pre-conception.

 

Women in Africa have been drinking this tea during pregnancy and breastfeeding for generations. In the UK red bush tea is becoming more widely available in supermarkets, health food stores and online.  Click here to see examples available from ConceptionFAQ.com! 

Why go caffeine free? It is recommended that caffeine intake is reduced or eliminated during pregnancy to reduce the risk of miscarriage. It is also thought that too much caffeine during pregnancy can lead to a reduced birth weight. During IVF many clinics suggest that caffeine intake is reduced to increase chances of success.

 

Tannins in tea may reduce the absorption of iron and calcium which is vital during early pregnancy, so the low tannin content of red bush makes it a perfect choice for mothers to be.

 

It is also said that red bush tea helps with nervous tension, insomnia, allergies and digestive problems.

 

A word of warning, make sure that you do not drink red bush tea which has been blended with any other herbs such as rosemary, as these may not be suitable for pregnancy.

 

 

http://www.rooibosltd.co.za/lifestyle/mothers.html

Progesterone in Oil Injection Tips!

PIO Tips!

by Jess (Flying Monkeys)

My introduction to progesterone in oil (PIO) shots was during my first IVF cycle in 2005. I wasn't sure about my husband giving me the shots since he almost passed out when our vet described the surgery he had done to place pins in our dog's leg. The last thing I wanted was to have him pass out and get stuck trying to reach the needle to pull it out, flailing around like a wounded whale, what a sight. I eventually handed over the duty. These are tips that worked for me, they may not work for everyone and some things that didn’t work for me may work for others.

*Ambesol does not numb the injection site. Even after it dries, it stings.
*If you divide your butt/hip into quadrants, the upper and outer most quadrant is the most comfortable and desirable spot. I tried my thigh and thought I was never going to get the cramp out. I suppose you could have your spouse give them in your arm.
*It’s easier to have your spouse do them for you. They drew wonderful circles that we continued to retrace so he couldn’t miss ‘the spot’.
*Slow is not the way to go. Use fast darting motions. I had my husband practice on an orange or an apple to get the darting motion down and more comfortable for him. This tip came from a friend who is a nurse anesthetist. The difference between the previous cycle and the cycle he gave us this tip was enormous. My ass thanks him.
*Warm it up. The oil is pretty viscous so I would fill my syringe, recap it and while my cheek was numbing (explained next) I would stick it in my armpit, if you have breasts that will work too. I have tinies, not cleavage to hold it. Be careful not to depress the plunger. It made the PIO go in more smoothly.
*Ice it. I would take a gallon Ziplock bag, fill it about 1/3 with water and lay it flat in the freezer to freeze. About 20 minutes before the shot I would wrap it in a thin dish towel and stick it in my sweats against the side I was getting that night’s injections. (I’m sure I could have left that part out but you never know.) After the shot I’d put it back in the freezer for the next one.
*Make sure he squeezes up some skin where he’s shooting. The pressure helps needle insertion and discomfort.
*Rubbing the site or a heating pad after the injection helps. After the injection I would firmly rub the area or place some heat on it to help the oil disperse.
*Get up and walk around, you want to keep the blood flowing, that will help you not develop lumps and sore spots, and help distribute the medicine.

The warming and icing helped me survive PIO shots through 17 weeks of my pregnancy (don’t worry, that is not the norm for the duration of shots) and 4 of the 7 cycles it took to get me there. Good luck!

Review: Natural Factors Whey Protein

Natural Factors 100% Whey Protein Mix

by Krystal (Kndkane)

I had been TTC since Jan 2007. I moved to medical assistance in Sept 2008. After four unsuccessful rounds of Clomid (three with IUI) we decided to move to Gonal-F with back to back IUIs in February 2009. Because I was paying for everything out of pocket (and possibly moving to IVF if this didn’t work) I wanted to do everything I could to get the most “bang for my buck”.

I did some research and found an “IVF To Do” list on Fertility Friend. One of the recommended items was to drink protein shakes to help boost ovary quality. Joy recommended a whey protein shake made by Natural Factors. She said she had tried the strawberry flavor and it tasted like strawberry Quik…I was sold! So, I ran out to Central Market and found it in chocolate and vanilla {no strawberry }. The chocolate is so YUMMY, though! The Central Market employee that helped me find it said it was by far her favorite brand.

I had one shake a day and followed the recipe suggested by another wise Fertility Friend member:
In a blender, blend one scoop of the protein powder, one banana, one cup of milk and lots of ice.
Super easy and delicious!

(Comment from Joy - CONGRATULATIONS ON YOUR BFP!!)

Be sure to see the other posts about protein!

Review: Preseed

Preseed

by Vanessa (Incognito Mosquito!)

After taking clomid, I noticed a decrease in my cervical fluid, and since I am skeeved by the thought of putting a raw egg in my neither regions, I decided to try Preseed. I asked my DR, and he (of course) said, he'd prefer I use nothing, but he didn't see the harm if it was absolutely necessary. Being as that I was dry enough that I was scared the friction might start a fire, I decided it was worth the cost.

Originally, the company only offered single use tubes... these should be labeled MULTI-USE. If you choose to use the entire tube, which is the suggested amount, you might want to have sex with a safety net. It will be similar to a slip-n-slide for your husband. Yes, it makes for a night of entertainment, but it's a bit of a problem, if you actually plan to get the job done. Use just enough to moisten for your comfort, otherwise you are just wasting the extra. With the single use tubes, I just kept the opened tube in a zip lock bag for cleanliness. It really does make a huge difference when you need moisture, but don't want to deal with the only other safe alternative of a real egg white.

Good news is this: They now offer a multi-use tube with a screw on cap. It is still a bit on the pricey side, but it lasts for a very long time and will make all the difference in the world when you are on day 1 million of TTC.

Boosting Your Fertility with Reflexology

DIY Reflexology

by Carole at michokobeautybio.canalblog.com

In this post you will learn how to stimulate with reflexology the zones associated with fertility.

Before we start I'd like to remind you of a few category of people who are strongly advised not to use reflexology (and a decent reflexologist should always ask you these questions):

- are you pregnant , especially in the 1st trimester or with a risk pregnancy?

- do you suffer from thrombosis or other serious venous problems?

- precautions should be used with babies, kids, older patients and people with disease like Aids or cancer or diabetes

Having said this, I don't think you should fall into any of these categories so let's start and enjoy our reflexology session!

The reflex points which I am going to show you will work on the following systems which are all relevant to fertility:

-  the hormonal system, with the reflex point of the pituitary gland and the thyroid

- the pelvis area, to help with blood circulation

- and finally the ovaries, uterus and Fallopian tube areas

Unlike other reflexology points, these points are quite easily found, you can do it yourself or have a friend or partner do it to you, which would be more relaxing. Of course, a full reflexology session would not concentrate only on these points and would enable you to relax as well (and we know we do get stressed TTCing....)

But as I cannot describe a full session online, I will only concentrate here on the areas for fertility.

To start with your feet must be clean and dry (no oil or cream), and your hands nails must be filed short unless you want it to be more a torture than a pleasurable experience!! 

Sit in a comfortable position if doing a self reflexology session, or lie down if you have it done to you.

All the reflexology moves are made with the thumb or index fingers.

We'll always start our session with the left foot and do all the points before moving on to the right foot.

I apologize as my reflexology charts are in French, but I have highlighted all the areas in red on them and also gave you the translation, so there should not be a problem for you.

1) Start with the pituitary zone (marked hypophyse on the chart): first press on the point situated in the middle of the big toe, then follow the red arrow by massaging following a clockwise motion from the center to the side,  eventually covering an 180° area. Finish by relaxing the area by massaging it with your thumbs.

2) Continue by massaging all around the big toe, which is the thyroid area (marked thyroide on the chart); to massage you must use your thumb and make what can be described as a "caterpillar move", by flexing your thumb. Then you go down along the para thyroid area, which goes from the space between the big toe and 2nd toe to the internal side of the foot. Do it several times then relax it by massaging it with your palms.

3) Then massage the pelvis area situated on the lowest part of the foot, underneath the line marked "sciatique" on the chart. It is easier here to massage it in diagonal then change the diagonal way.

4) Find the ovary area, situated on the internal side of the foot; to find it, trace an imaginary line going from the top of your ankle bone to the angle of your heel, the ovary point is right in the middle of this line. Massage by applying pressure for a few seconds then releasing, and continue like this for a few minutes. This area is generally quite tender... Then relax it by massaging it with your palm. Next massage the zone marked "sciatique" on the chart, along the Achilles tendon, going up. This area is also quite useful if you suffer from painful periods or constipation.

5) Now do the same thing on the external side of the foot, where the uterus point is located . Relax the zone like previously.

6) To finish, place one index finger on the uterus point and the other on the ovary point, then move slowly by using the caterpillar move until the meet on the top of the ankle; do it several times then relax by gently rotating your ankle.

Now, repeat the same moves on your right foot!

Voilà! so did you find this difficult?

Notes:

- the  stimulation can be tender or slightly painful, this is generally the sign there is an imbalance in the area; the painful sensation should diminish over the sessions.

- to stimulate male fertility the points are exactly the same: the uterus point becomes the prostate point , and the ovary point becomes the testicles area; the Fallopian tubes are the canals in which sperm travels. So you have all the information to treat your man too!

- beside trying to conceive, this reflexology moves are also very useful to regulate the cycles, help with painful periods etc...

If you can find a reflexologist in your area, I recommend you go as it will be much more pleasurable than doing it yourself, and he or she will have a more holistic view of your personal situation.

IVF Protocol for Poor Responders

"Stop Lupron Protocol"

This is an excerpt from an article in the online Oxford Medical Journals I read recently.  This is only a portion - there is more good information about poor response and ICSI, poor response and the likelyhood of ovarian failure, etc.
A rational approach to the management of low responders in in-vitro fertilization: Opinion

We prospectively evaluated the `stop-Lupron' protocol (Faber et al., 1998) at our Center (Karande et al., 1997b) Improved pregnancy rate in poor responder patients with cessation of GnRHa down-regulation prior to stimulation with high dosages of gonadotrophins. The study population included 82 consecutive low responders who underwent IVF–embryo transfer between January 1996 and October 1996. Low responders were defined as patients with either a history of a cancelled cycle or low response with standard protocol [peak oestradiol <500 pg/ml (1835.5 pmol/l), or <= 4 mature oocytes retrieved (n = 56)]. However, we also included patients with suspected abnormal ovarian reserve because we prospectively anticipated a low response in such patients. These included patients with an elevated day 3 FSH [>7 but <12 mIU/ml (7 pmol/l), n = 33] and/or elevated day 3 oestradiol concentration [>75 pg/ml (275.3 pmol/l), n = 8] in a non-treatment cycle (Smotrich et al., 1995) and patients' age >= 40 years (n = 24). Some patients had more than one abnormality. Patients with a day 3 FSH >12 mIU/ml [equivalent to a concentration of 25 mIU/ml using the Leeco assay (Scott et al., 1991)] were excluded from the study as, historically, we have not had a single live-birth in this group of patients. Twenty-six cycles (31.6%) were cancelled due to poor ovarian response. Fifty-one low responders reached retrieval and 48 had an embryo transfer. None of the patients had a premature LH surge. Based on a presumed low oocyte quality we were liberal with the number of embryos transferred in the low responder group (4.1 ± 2) and none therefore had any excess embryos for cryopreservation. The clinical pregnancy rate per started cycle was 19.5% (16/82) and per retrieval 31.4% (16/51). Surprisingly, we had a very high incidence of multiple pregnancies (43.8%). Of the 16 pregnancies, seven were singleton, five were twin, two were triplet, and there were two quadruplet pregnancies. This is in contrast to a similar group of patients, which were stimulated with a `flare' protocol where we had a dismal success rate (Karande et al., 1997a). Increasing the number of embryos transferred in low responder patients, therefore, does not seem to be a good strategy. We are currently investigating the role of blastocyst transfer in low responder patients (Gardner et al., 1998).

The mechanism by which the `stop-Lupron' protocol apparently improves ovarian responsiveness is unknown. It is possible that Lupron has a direct inhibitory effect on the ovaries and that, by reducing the dose or stopping it altogether, it removes this suppression and increases ovarian response (Parinaud et al., 1992; Kowalik et al., 1998). The mechanism of continued suppression (despite 11.1 ± 1.5 days of stimulation) of premature LH surges under this protocol is presently also still unknown and needs to be further investigated. Continuous suppression of LH after stopping leuprolide acetate has been reported (Sungurtekin and Jansen, 1995): a brief, 5 day course of GnRHa appeared to suppress endogenous GnRH activity for at least 1 week afterwards. In 19 patients, after stopping leuprolide acetate, LH was often undetectable within 48 h and remained so for at least 7 days.

What is Down Regulation?

Down Reg for IVF

Down regulation aka 'down regging' 'DR' or 'd/r' or "suppression", a LHRH Analogue drug is started on day 21 (CD21) of the menstrual cycle and continued for anything between 1-8 weeks. Down regulation is often used in conjunction with bcp. The drug is available either in a nasal spray or injection and has to be administered by the patient daily. The nasal spray is taken 3 times a day and the injection once into subcutaneous tissue, for example the upper thigh or tummy.

The drug will shut down the ovaries (although not prevent menstruation) so that no eggs can mature or be released - perfect for the IVF consultant to plan a treatment where eggs are harvested and collected all within a certain time frame.

Menstruation will occur at the usual time (approximately 7-9 days later) and the womb lining will shed. The woman can now start the next stage of IVF which involves stimulating the ovaries to produce numerous follicles and (hopefully) several eggs to be collected.