By Monika Friedman, Fertility Coach and 4X IVF Warrior.
Fertility Coach, Monika Friedman
The moment my mental switch flipped to “I want to get pregnant,” the ticking of my biological clock was so loud I could hear it.
At first, you don’t suspect that you or your partner may have a fertility issue, because this kind of stuff happens to others, but not you, right?
Knowing what I know now after a half a decade of trying to conceive, I wish someone had given me this checklist I’m about to share with you much earlier in the journey.
Instead of waiting for years while trying to conceive naturally, and certainly at the very latest after miscarrying, I wish I was more proactive in the beginning.
I believe that being educated about fertility is empowering and helps with decision-making, even if such decisions are made by elimination. If a fertility test comes back negative, you have more data points and can move forward — and potentially save yourself a lot of time and unnecessary treatments so that you can get closer to getting pregnant with the help that is right for you.
Being educated about fertility is empowering and can help you make decisions on your fertility journey.
Ask the questions that are right for you!
Okay, so here are the top 10 things to check off your fertility to-do list — and they all involve speaking to your fertility doctor (so it’s even more important to listen to your gut when you first meet with them).
Alright, you are doing this! You have an appointment in the calendar for your first visit at the fertility clinic. Well done, I bet getting to this point wasn’t easy... This first visit is usually a get-to-know meeting with lots of forms to fill out and medical questions to answer. Don’t let this first visit just be run by the clinic, this is also YOUR time to ask questions and collect as many data points as possible to see if the clinic is a good fit for you.
The first appointment at a fertility clinic is the time to get your questions answered and get to know your doctor.
1. What types of treatments do you offer?
Most clinics offer standard treatments from ovulation induction, IVF, ICSI, IUI to egg donation. Not all clinics do PGS (genetic embryo testing), natural killer cells testing and treatment, or other specialty (and more expensive) treatments. Ask them what their latest addition to their services is — this might give you a clue of how advanced the clinic is, depending if that is important to you or not.
2. What are my chances to get pregnant?
Every clinic has their success rates advertised somewhere, some more aggressively than others. Remember, you are NOT a statistic. Ask the doctor what your personal success rate might look like and what it depends on. Treat this percentage with a lot of caution. Don't panic, it is just a number. And don't read too much into it and get your hopes up because, again, it is just a number. Every round of IVF is said to have a 5-50% chance of getting you pregnant. That is a wide interval with lots of room for disappointment, unfortunately. Just remember, strong women like you beat the odds all the time.
3. What are the costs and the additional/hidden costs?
The obvious costs are the costs for the specific treatment. But additional costs for medication, regular hormone blood tests, additional scans can easily double that bill and are not included. Ask the doctor or nurses for the maximum costs you could expect going through this…then you won't be as shocked every time you are being asked to pay for something. The financial toll of infertility can be soul-crushing, but it doesn't have to be if you manage your expectations from the beginning and are prepared for what is to come.
Ask your fertility clinic for accurate contact information so you know where to go with questions about medications, timing, or symptoms during your cycle.
4. Who do I contact for everyday questions?
The bigger the clinic, the more likely you will be in touch with the nurses and not the doctor. Get their email addresses, phone numbers, after-hours emergency numbers (if your clinic offers this, not all do) so that you know who to contact with medication, timing, and symptom questions throughout your cycle. Believe me, those unexpected questions will pop up on a Sunday morning and you'll be happy there is someone you can call or email.
5. Which additional tests are necessary right now?
Usually your clinic will want to do all baseline hormone tests (TSH, Vitamin D, progesterone on day 21, sperm analysis) themselves, but if you do have lab results from previous clinics, definitely bring them along as you could save yourself some money.
Some fertility tests are standard, while others become relevant only after you’ve had failed treatment cycles or miscarriages. To counter that, it is definitely worth discussing the following 5 fertility tests with your fertility doctor sooner rather than later:
Anti-Mullerian hormone blood levels reflect the size of the remaining egg supply - or "ovarian reserve". A low AMH, often in conjunction with age or genetic disposition, can indicate fewer remaining follicles. A high AMH over 4ng/ml can be a sign of polycystic ovary syndrome. Anything between 1 ng/ml and 3 ng/ml is considered ‘normal’.
The thyroid-stimulating hormone shows if you have an overactive or underactive thyroid, which can have a significant impact on your menstrual cycle and, as a result, on your ovulation, fertilization, and implantation.
Natural killer cells, which protect your uterus from infections and cancer. If there is higher than normal activity, these cells can prevent implantation and lead to recurring miscarriages.
Sounds like an abbreviation for a curse word but stands for methylene-tetrahydrofolate reductase and is the ability to convert food into folate in the body. Women with a positive MTHFR gene mutation may have an increased risk of inability to conceive, miscarriages, and pre-eclampsia (high blood pressure during pregnancy). Always make sure your prenatal vitamin includes methyl folate.
10. DNA fragmentation
Going beyond a conventional semen analysis of motility and concentration, this test looks at sperm at the molecular level. Higher fragmentation levels lead to higher male sub-fertility, miscarriage, and lower chances of conceiving naturally or with IVF.
Conclusion: Regardless of whether you just started or already have been trying for a while, these 10 things should be considered sooner rather than later as you embark on the next part of your fertility journey. Knowing that you are with the right clinic and having done the right tests for you will give you so much peace of mind along this journey.
I am a Fertility Coach helping professional women like you increase your chances to get pregnant with less anxiety and more joy along the way. My Full-Circle MethodTM is a holistic blend of solution-oriented coaching, powerful mind-body-connection techniques and a practical step-by-step guide addressing mindset, lifestyle and tactics along your fertility journey.
I’m a 4 time IVF warrior, a yoga teacher and a working mom with an MBA and 15 years of corporate experience under my belt. My own challenging journey to motherhood has made me passionate about helping you with yours.
I’m German native, but a global citizen at heart. I’ve lived and worked all over the world (Germany, US, Dominican Republic, Switzerland, Singapore, UK), and now reside in the beautiful Rocky Mountains with my husband, daughter and red Labrador Retriever.
Also, I love re-watching Friends and can never say no to chocolate. Have I mentioned chocolate?