Decoding the ABCs of Fertility

It’s hard enough to try having a child, let alone now needing to learn a new language. Let’s save you some heartache and decode fertility lingo. Let’s share a story about Jane, so we can put the terms into context.

NOTE: The story is meant to be general and illustrative. Protocols and exact timing varies clinic to clinic and patient to patient.


Jane is 32 years old and has been trying to conceive (TTC) for over a year. She started with tracking her cervical fluid and BBT (basal body temperature). She then graduated to fertilty tracking apps.


Nothing worked.


Jane books an appointment with her OB/GYN given her concern over how long she has TTC. With her age and length of time TTC, she technically has infertility (IF).The doctor runs bloodwork (b/w) on cycle day 3 (CD3) and tests for FSH (follicle stimulating hormone), LH (luteinizing hormone), E2 (estradiol), AMH(anti-mullerian hormone), and Prolactin (Prl) and ultrasound to check AFC (antral follicular count).


Jane monitors her cycle further using an OPK (Ovulation Predictor Kit), and around CD21, which is during her Luteal Phase(LP), her P4 or Prog (Progesterone) is tested to ensure she ovulates. If her levels are high, it indicates she has ovulated.


Based on Jane’s results, specifically the DOR and AFC, it seems she has diminished ovarian reserve (DOR) and her OB/GYN recommends she see a fertility specialist, known as a REI (Reproductive Endocrinologist). The REI asks several questions of Jane’s and her partner’s medical history (HX) and repeats the b/w, adding a few more tests, which include:


  • Thyroid panel: TSH (Thyroid Stimulating Hormone), TRH (Thyroid Releasing Hormone), and T4 (Thyroxine)

  • HSG (Hysterosalpingogram)

  • SA (semen analysis) on her partner

All tests come back normal, except, again, for AMH and AFC, which validates DOR. Jane’s health insurance mandates 3 IUIs (Intra-uterine Insemination) before it would cover IVF (in-vitro fertilization).


She starts with the mandated 3 IUIs. Beta (pregnancy test) after beta — Negative. Negative. Negative.


It’s time for the first IVF. Luckily, Jane and her doctor already had a treatment (Tx) plan and ordered her prescriptions (Rx). They included things like:

  • Lupron

  • Gonal-f or Follistim

  • hCG (Human chorionic gonadotropin) or Ovidrel

  • Doxycycline

  • Progesterone in Oil (PIO)

Jane visits her clinic for CD3 bloodwork and sonohysterogram (sono, SHG, SonoHSG). At 2 PM, the nurse calls her with her protocol. Jane was ready to go that night and comes in for “blood and ultrasound” every few days or every other day, where her protocol was adjusted as needed.


Now it is time for egg retrieval (ER). Jane did great — 20 eggs. To optimize her chances, Jane and her partner opted for ICSI (Intra-cytoplamic Sperm Injection) and PGT-A (preimplantation genetic testing for aneuploidies) testing, formerly known as PGS (preimplantation genetic screening).


Two days later, they get the call. 15 eggs fertilized. Five days after ER, they get the good news that 10 embryos made it to blastocyst (embryo that has grown to 5 days post insemination) and 5 came back normal via PGT-A testing.


Jane goes into the clinic for ET (embryo transfer) and freezes the remaining for a future FET (frozen embryo transfer).


Now is the hardest part — the 2 week wait (2ww). Every time Jane’s body feels “different,” she Googles “signs of early pregnancy.” She reads every article hoping to find an answer, but logically, she knows she must wait for the Beta. Nonetheless, she purchases a home pregnancy test (HPT).


Negative.


And her Beta confirms this.


After a few months of mental recovery, Jane and her partner decide to do an FET with her remaining embryos.


Sadly, Jane miscarries (MC) at 7 weeks.


They decide they have enough desire and energy left, they want to give it one more try.

Once again, anxious, she purchases a HPT.


BFP (Big Fat Positive)!!!!!!!!


Could it be?


The next day, she visits her local lab for the Beta. The doctor calls — yes, she is pregnant! She is reminded, however, that the Beta needs to be repeated to ensure her numbers are doubling.


Nine months later, Jane delivers a healthy baby girl.


If you are looking for a comprehensive list of acronyms, click here for a list from Resolve.




Originally published on Medium.

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Our content is for informational purposes only — it's not a substitute for medical advice, diagnosis, or treatment.

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