Welcome Your fertility treatment journey begins here Fertility treatment can be complicated Managing expectations, keeping track of medications and appointments, remembering all the information your physician shares with you it would be a lot to handle even if it weren t so emotional a process. These worksheets are designed to help. With a guide to treatment options, basic information about genetics, and useful tips about what kinds of questions to ask, consider this packet a passport for your reproductive journey. It also includes prompts that will encourage you to reflect on the emotional aspects of what you re experiencing, so you ll be as prepared as you can be for whatever your journey has in store. What s included Fertility treatment basics 2 A quick guide to the different treatment options your physician may discuss with you Genetics 101 4 What you should know about how your genetics may be impacting your reproductive health Appointment journal 5 Prompts for helping you keep track of what you learn, what to ask, and what you need to do next
Fertility treatment basics Treatment options TIMED INTERCOURSE For heterosexual couples, timed intercourse involves predicting ovulation using relatively low tech methods like tracking your cycle, checking your cervical mucus, or testing your levels of LH (luteinizing hormone) and then having sex at home once ovulation has occurred. Progesterone supplements may also be used to help prepare your uterus for the implantation of a fertilized egg. OVULATION INDUCTION (OI) If you ovulate unpredictably or not at all, your physician may prescribe medications designed to boost levels of certain hormones in your bloodstream. These hormones stimulate your ovaries to produce an egg, after which additional medications are used to encourage the release of that egg into your fallopian tubes. You ll then be instructed to have sex with your partner at home. INTRAUTERINE INSEMINATION (IUI) Intrauterine insemination is the practice of placing a concentrated sperm sample directly into your uterus by way of a catheter that passes through your cervix. It s quick, requires no anesthetic, and is typically performed alongside ovulation induction in order to ensure proper timing. IN-VITRO FERTILIZATION (IVF) In-vitro literally translates to within the glass, and describes the process of joining eggs and sperm in a laboratory setting to create embryos. An embryologist then tracks their development, and healthy embryos are transferred to the uterus. Eggs and sperm can come from you and your partner or from donors. They can be transferred into your uterus or to a gestational carrier. Though treatments vary, the basic steps are as follows: 1. Ovary stimulation: You ll be given medication that stimulates the ovaries to produce eggs. You can expect to visit your treatment center several times during this phase for drug injections and monitoring. 2. Retrieval: Once your ovaries have produced mature follicles (eggs ready for fertilization), a physician will use ultrasound imaging to guide a needle and catheter directly into the ovaries through the vaginal wall. The needle will then gently pull the eggs from the ovaries. Anesthesia will used to make you as comfortable as possible during the retrieval, and you can expect to resume your normal activities within a day or so. At about the same time, your physician will collect a sperm sample from your male partner, a sperm bank, or a donor. 3. Fertilization: An embryologist will prepare the eggs and sperm, and then put them together in one of two ways. If the sperm are healthy and active enough, they will be placed in a petri dish with the eggs so that they can find their way on their own. If there aren t enough sperm, or if there are problems with the motility (ability to move) or morphology (shape) of the sperm, an embryologist will inject sperm directly into the eggs in a process called intracytoplasmic sperm injection (ICSI). 4. Development: Once the eggs are successfully fertilized, an embryologist will monitor them to ensure proper development. 5. Embryo transfer: Guided by ultrasound, your physician will use a catheter to introduce the developing embryo(s) into your uterus, through the cervix. The procedure is quick and requires no anesthesia. The number of embryos transferred will depend on your specific treatment plan (see next page). Progesterone supplements will be used to help prepare your uterus for implantation. 6. Pregnancy testing: A couple weeks after transfer, you will take a pregnancy test. 2
Transfer options SINGLE EMBRYO TRANSFER (SET) This is when a single embryo is transferred into the uterus during an IVF cycle. DOUBLE EMBRYO TRANSFER (DET) This is when two embryos are transferred into the uterus during an IVF cycle. The increase in success rates associated with DET is small, but measurable. The increase in the rate of multiple births, on the other hand, is big. Because multiple pregnancies come with an increased risk of complication, the use of DET has fallen significantly since the early days of IVF. You should expect to discuss your options for how many embryos to transfer with your physician. FROZEN EMBRYO TRANSFER (FET) Your physician may retrieve and fertilize more eggs than can be used in a single IVF cycle. The viable embryos that are not transferred are frozen in case they are needed for future use. When a frozen embryo is thawed and transferred, it is called a frozen embryo transfer. This might be done once you ve already had a child and are returning to grow your family, or after an unsuccessful IVF cycle. Genetic tests & screenings THE FERTILOME GENETIC TEST Your physician may recommend the Fertilome genetic test, which examines your DNA for markers associated with an increased risk for developing certain reproductive conditions. When combined with your clinical metrics and family history, Fertilome results may help you and your doctor make important decisions about when to begin treatment, how to proceed after a failed cycle, or whether to consider egg or embryo freezing. PREIMPLANTATION GENETIC SCREENING (PGS) PGS is when an embryologist tests a developing embryo for chromosomal abnormalities that may cause developmental disability or difficulty maintaining pregnancy. PREIMPLANTATION GENETIC DIAGNOSIS (PGD) Depending on your family history and known genetic risk factors for disease or chromosomal abnormality, your physician may recommend testing your developing embryos to determine whether indications of a genetic disorder exist. Donors & carriers DONOR SPERM If you re a single woman, in a lesbian couple, or if your male partner s sperm can t be used for fertilization, donor sperm will be used. Your physician will be able to recommend a certified sperm bank in your area, or you may consider receiving a sperm donation from someone you know. DONOR EGG If you are diagnosed with a fertility condition that prevents you from using your own eggs for IVF, a donor s eggs may be used. Depending on your diagnosis, donor eggs can dramatically increase the chances of conception. GESTATIONAL CARRIER A gestational carrier is a woman who carries a pregnancy to term if you are unable to do so. Eggs and sperm are collected and fertilized just as they would be in a standard IVF cycle, but instead of being transferred to you, they are transferred to the gestational carrier. Gestational carriers can also carry pregnancies achieved through donor eggs and/or donor sperm. 3
Genetics 101 Your genetic signature is unique Understanding your genetic signature may help you and your physician build a family-building plan that is customized to your biology. Variants in your genes may put you at increased risk for developing certain reproductive health conditions that could impact your fertility. The Fertilome genetic test checks your DNA for these variants, and when combined with your clinical metrics and family history, Fertilome results may help you and your doctor make important decisions about when to begin treatment, how to proceed after a failed cycle, or whether to consider egg or embryo freezing. But what are genes? And how do genetic variants impact your body? Read on to learn the basics. If you decide to take the Fertilome genetic test, counselors will be on hand to answer any questions you might have. GENE Genes, which are made up of DNA, are the body s instruction manual. Genes tell the cells of your body how to grow and function. Normally, you have two copies of each gene, one each from your biological father and mother. CHROMOSOME Genes are organized into chromosomes. Normally, each person has 46 chromosomes 23 from each of your biological parents. DEOXYRIBONUCLEIC ACID (DNA) DNA is the alphabet that makes up genes. There are four letters in the alphabet: A, T, G, and C, which stand for Adenine, Thymine, Guanine, and Cytosine the four nucleotides (molecules) that are combined in different ways to create genes and chromosomes. Your specific collection of As, Ts, Gs, and Cs comprise your genetic signature, or genome. VARIANT A genetic variant is a difference between your DNA and the expected DNA in the typical human genome. If most people have a G in a specific location of their genome, and you have a C, you have a genetic variant. Many variants have little or no effect on your biology, but some can stop a gene from functioning, which in turn causes the cells of your body to work differently than they would without the variant. GENOTYPE Normally, individuals have two copies of the gene one each from their biological father and mother. The genotype describes whether a genetic variant is inherited from the father, the mother, or both. 4
Appointment journal #1 Date: Purpose of visit: Who did I speak with? Doctor: Nurse: Other: What did I learn? What tests were ordered? What are the next steps? What appointments do I need to make? What medications do I need to buy? What terms do I need to look up? Do I understand all the options being offered to me? What websites, books, or other resources can I use to better understand my options? Am I ready to move forward with the next steps? Besides my physician, who can I discuss this with? What would make me feel more confident about what I choose to do next? Additional notes 5
Appointment journal #2 Date: Purpose of visit: Who did I speak with? Doctor: Nurse: Other: What did I learn? What tests were ordered? What are the next steps? What appointments do I need to make? What medications do I need to buy? What terms do I need to look up? Do I understand all the options being offered to me? What websites, books, or other resources can I use to better understand my options? Am I ready to move forward with the next steps? Besides my physician, who can I discuss this with? What would make me feel more confident about what I choose to do next? Additional notes 6
Appointment journal #3 Date: Purpose of visit: Who did I speak with? Doctor: Nurse: Other: What did I learn? What tests were ordered? What are the next steps? What appointments do I need to make? What medications do I need to buy? What terms do I need to look up? Do I understand all the options being offered to me? What websites, books, or other resources can I use to better understand my options? Am I ready to move forward with the next steps? Besides my physician, who can I discuss this with? What would make me feel more confident about what I choose to do next? Additional notes 7
Appointment journal #4 Date: Purpose of visit: Who did I speak with? Doctor: Nurse: Other: What did I learn? What tests were ordered? What are the next steps? What appointments do I need to make? What medications do I need to buy? What terms do I need to look up? Do I understand all the options being offered to me? What websites, books, or other resources can I use to better understand my options? Am I ready to move forward with the next steps? Besides my physician, who can I discuss this with? What would make me feel more confident about what I choose to do next? Additional notes 8