One woman rides the ups and downs of IVF

One woman rides the ups and downs of IVF
'I cried for a week after I miscarried the twins'

------------------------------------------------------------

MICHELLE

My entire life I knew that I wanted children. I come from a large family and everyone has kids. The women in my family are so fertile that my mother used to tell me to double up on birth control. I married in my late twenties and because my husband is older, we decided to have kids right away.

After trying for about nine or ten months, we went to the doctor. My husband has three adult children from a previous marriage, but they tested him anyway. He was fine. Most of my tests also were fine, so my doctor did exploratory surgery to see if he could find anything wrong. And he did. Both my ovaries were full of cysts. He removed the cysts and then gave me Clomid to help me ovulate. I still didn't get pregnant, and I kept failing the postcoital test: The morning after intercourse my husband's sperm would not be moving inside me. For some reason his sperm could not survive in my body.

Climbing the high-tech treatment ladder

My doctor recommended we try intrauterine insemination, a procedure in which my husband's sperm would be inserted past my cervix and directly into my uterus. I was so pleased. Finally, after a year and a half of tests, surgery, and drugs we were actually going to try to get me pregnant. Time had started to drag and I was very aware that you only have about 12 tries per year. The idea of going through life without ever having children was painful and frightening.

But the intrauterine insemination didn't work, and I was heartbroken. My husband couldn't understand my grief completely because he has children already. And in all the time I've spent dealing with this, never has any doctor or nurse seemed to take notice of my extreme grief and need to talk to someone. I was and still am, for the most part, all alone with my feelings.


Going to the next level — IVF

The next step was in vitro fertilization (IVF). I didn't think our insurance policy would cover it because it wasn't mentioned in the book. But luckily I asked, and I found out that they would pay. Still, the doctor made us take out a loan for a deposit in case the insurance money didn't come through.

When the time came for the first round, I was very excited and hopeful. My husband faithfully gave me hormone shots every day to help me produce eggs, and I went in for numerous ultrasounds. On the first try, they got seven embryos. They implanted three, but I did not become pregnant. I was crushed but knew that I had more embryos and looked forward to trying again. A few months later they implanted four embryos and to my extreme joy I became pregnant. I had never been so happy in my entire life! I called everyone I could think of and told them the news. Then two weeks later I had an ultrasound and found that I was carrying twins. I again called everyone and told them the good news — I even got a picture of the ultrasound.


Why isn't anything working?

The next day I miscarried the twins. I was completely and totally devastated. I think I cried for a full week, only stopping to sleep when I was too tired to cry anymore. There didn't seem to be anyone I could talk to who wouldn't say 'Well, maybe you should accept the fact that you are not going to have kids' or 'Just relax and it will happen.' I didn't need to hear that, and I was very angry with God and the rest of the world.

Through the first three years of infertility treatments all I ever hoped for was to get pregnant. I never really thought that I might miscarry. This was the hardest thing to accept.


An unexpected child arrives

Two months after I lost the twins, a friend of mine asked me if I wanted to take care of her six-year-old nephew, whose mom was in prison. I said yes without thinking. Jeff moved into our home eight months ago, and he has made my life richer and happier, and has helped me overcome the grief I experienced when I miscarried.

Having a child to care for is wonderful, but I still want a baby of my own. I prayed that it would happen the next time we tried IVF, but had little faith that it would. About four months ago, I tried IVF again and we were able to get ten embryos. Again they implanted three. I was much more cautious this time. The day I found out that I was pregnant I also found out that I was miscarrying. I handled the second miscarriage much more calmly and I am now trying another round of IVF with the leftover embryos. I'm not sure how many more times I can cope with the roller coaster ride my heart goes on with all this.
------------------------------------------------------------

Michelle is now 31 and lives in Wisconsin where she works as an accountant. Her husband, Ken, 51, is the general manager of a factory. They love having Jeff in their home.

Could I have a fertility problem?
If you're under 35 and have been trying to get pregnant for less than a year (or fewer than six months if you're over 35), you have no reason to be concerned yet. To make sure you're doing all you can to enhance your chances of getting pregnant, see our articles on the importance of timing intercourse, detecting ovulation, and tracking your basal body temperature and cervical mucus.
If you're under 35 and have had frequent unprotected sex for more than a year (or at least six months if you're over 35) without conceiving, there's a good chance you or your partner may have a condition that's interfering with your chances of conceiving — but only a doctor can diagnose a fertility problem for sure. Researchers estimate that as many as one in ten couples has trouble getting pregnant. If you're one of them, that doesn't mean you'll never have children. Many struggling couples (some estimate 50 percent) go on to have children, but they often need extra time or medical intervention to get pregnant. Read on to learn more about conditions that can lead to impaired fertility.



What factors are linked to fertility problems?
If any of the following conditions or activities applies to you or your partner, tell your doctor. Waiting a full six months or a year to try to conceive naturally may be a waste of your time.
For women:

A history of:


• Endometriosis

• Uterine fibroids

• Pelvic inflammatory disease

• Blocked Fallopian tubes from an infection or previous surgery

• Sexually transmitted disease such as chlamydia or gonorrhea

• Painful or irregular periods

• Excessive facial and body hair

• Pelvic or abdominal surgery

• DES exposure in utero (a drug given to pregnant women between 1941 to 1971 to prevent miscarriages)

• Chronic illness such as diabetes, cancer, or thyroid disease

Or if you currently:

• Smoke

• Are more than 25 percent under- or overweight

For men:

A history of:

• Infection with the mumps virus after puberty

• Chronic illness such as diabetes, cancer, or thyroid disease

• Undescended testicles

• Testicular tumors, cysts or cancer, varicoceles

Or if you currently:

• Take medications such as some steroids or antihypertensives

• Smoke tobacco or marijuana

• Use a hot tub or sauna regularly

• Go on frequent long-distance bike rides

Learn more about what causes fertility problems, in men and women.

What should I do if I suspect a problem?
Talk to your primary care doctor or gynecologist. You should feel free to bring up any concerns or fears no matter how long you've been trying to get pregnant. Your doctor should be able to answer your questions or, if necessary, refer you to a fertility specialist for a complete workup. If you'd like to find a specialist on your own, see our fertility resources article for links to organizations with referral services.

If I've had a miscarriage does that affect my fertility?

Expert: The BabyCenter Editorial Team [See Biography]

Question: If I've had a miscarriage (or more than one), does that affect my fertility?
The BabyCenter Editors: No, having a miscarriage or even two does not make you less fertile. But having several miscarriages in a row may be a clue that you have an existing condition that is affecting your fertility, such as a genetic or uterine abnormality, fibroids, or, less commonly, an infection or immune condition. Some studies suggest that testing be done after three or more miscarriages, although nowadays it is often done after just one or two, especially if they occurred when the woman was more than two months along in her pregnancy.

If you've already had a miscarriage, you do have a slightly higher risk of having another one in the future. While many doctors believe that testing and treatment of recurrent miscarriages is not necessary until after a third pregnancy loss, this depends on your age and what your chances are for getting pregnant again. So if you already know you have a condition that's linked to infertility, even one miscarriage is cause for concern and testing.

Even though the cause of recurrent miscarriages can be identified in only 50 percent of cases, it's still worth getting tested because the solution can be as simple as low doses of aspirin or progesterone.

Can having too much sex affect our chances of conception?

Expert: The BabyCenter Editorial Team [See Biography]

Question: Can having too much sex affect our chances of getting pregnant?
The BabyCenter Editors: No. While many couples believe they have to save the man's ejaculate until the exact moment of ovulation, that's not true. It is a myth to think you should have less sex in order to conceive. All the evidence shows that the more you have sex, the better your chances of getting pregnant. In fact, having sex often ensures that the sperm in a man's ejaculate is as healthy as it can be. Storing it up can decrease its motility, so don't be tempted to put off intercourse until you ovulate, and don't abstain for more than seven days in a row. While it's true that the density of sperm in each ejaculate diminishes with frequent orgasms, all that really matters is that there is some sperm in the woman's Fallopian tubes during the time of ovulation.

This is not to say that you should have or need to have sex every day when attempting pregnancy. Every second day during the middle of the cycle is ordinarily enough.

The importance of timing intercourse
Approved by the BabyCenter Medical Advisory Board

--------------------------------------------------------------------------------
What's below:
• When is the best time to have intercourse if we're trying to conceive?

• How do I know when I'm ovulating?

• If my periods are irregular, will it be harder for me to get pregnant?

• Can't we just try and see what happens?

• See also | Other Sources
--------------------------------------------------------------------------------


When is the best time to have intercourse if we're trying to conceive?
Timing is everything. Sperm can live for two to three days, but the egg is around for only 12 to 24 hours. To increase the likelihood of conception, schedule intercourse for one to two days before ovulation. That way, there's more likely to be a healthy supply of sperm waiting in the Fallopian tube when an egg is released.
Of course, exactly when a woman ovulates isn't altogether clear. It all depends on the length of your menstrual cycle. A woman typically ovulates 14 days before her next period — not mid-cycle as is commonly held. If you have a 28-day cycle, which is the average, then you would ovulate halfway through your cycle. But if you have a 35-day cycle, you would ovulate around day 21 not day 17.

To determine the time when you're most likely to be fertile, try our ovulation calculator.



How do I know when I'm ovulating?
Some women are very aware of when they ovulate. Other women don't notice any changes at all. If you're thinking about getting pregnant, try to track your cycle for a couple of months. Some subtle signs of ovulation include:
• Breast tenderness

• Slight feelings of discomfort in your middle abdomen

• Increased ******l discharge that takes on a wetter, egg white-type quality

• A slight increase in basal body temperature, or BBT (which you can detect only by taking your temperature each morning before you get out of bed), two days after you ovulate. You can get a good sense of your cycle if you chart your BBT for a few months.

(For more information, see our articles on detecting ovulation and basal body temperature and cervical mucus. The book Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control and Pregnancy Achievement, by Toni Weschler, can also teach you to read your body's signals.)

If you still have trouble pinpointing the exact date of ovulation, you might consider trying an ovulation predictor test.

If my periods are irregular, will it be harder for me to get pregnant?
The more irregular your period is, the more difficult it is to predict ovulation. You can figure out the days you're most likely to be fertile by tracking when you ovulate each month. Say your cycle is 28 days one month, 21 days the next month, and 32 days the following month. Keep a record of your menstrual cycles for several months. Then subtract 17 from your shortest cycle and 11 from your longest cycle. The days in between the two are the ones you're most likely to be fertile.

Can't we just try and see what happens?

Of course, you don't have to plot basal body temperature or keep complicated logs if you don't want to. You don't even need to have an orgasm to get pregnant. Try having sex at least twice a week and the law of averages will most likely prevail.

Eat More, Exercise Less
According to Time, women who are having difficulty conceiving may just need to revise their exercise routine and eat a little more. Energy stores sometimes become too low with dieting and too much exercise which causes a drop in the amount of leptin, a hormone. This in turn may cause a drop in the reproductive hormones. So, if you're not conceiving as quickly as you'd like, try slowing down and eating more.

How long it takes to get pregnant
Approved by the BabyCenter Medical Advisory Board

--------------------------------------------------------------------------------
It's difficult to say exactly how long it will take any one individual or couple to get pregnant. Factors such as your age, general and reproductive health, and when you have intercourse all impact your chances of conceiving a child. (Take our quiz to find out just how much you know about timing.)
However, these general statistics may give you an idea of how long it will take. Normally fertile couples have a 25 percent chance of getting pregnant each cycle, and a cumulative pregnancy rate of 75 to 85 percent over the course of one year. Still, some healthy couples can take even longer to get pregnant.

To get a more detailed look at pregnancy rates based on your age, see our chart.

And you can try to increase your likelihood of getting pregnant sooner by learning to pinpoint exactly when you ovulate, and by familiarizing yourself with the cyclic hormonal and physical changes that take place in your body each month

Want to Have a Baby? Get Happy!
Infertility and depression can go hand in hand, but new research says getting through one could help take care of the other. A new study, presented to the American Society of Reproductive Medicine, found that 60 percent of depressed women with fertility problems had babies after taking a stress management course. By comparison, Reuters wire services reports, researchers from the Mind/Body Center for Women's Health at the Beth Israel Deaconess Medical Center in Boston found that only 24 percent of those who weren't depressed and took the course had successful pregnancies. The message? If you're down in the dumps and trying to conceive, talk to a mental health professional--you'll feel better and up the chances of having a

Pinpointing a fertility problem
Approved by the BabyCenter Medical Advisory Board

--------------------------------------------------------------------------------
What's below:
• We've made an appointment with a fertility specialist. What happens next?

• What tests will we be taking?

• What are our chances of pinpointing the problem?

• See also | Other Sources
--------------------------------------------------------------------------------


We've made an appointment with a fertility specialist. What happens next?
You, your partner, and your doctor are now a team, working together to unlock the clues to your fertility problems. The male and female reproductive systems are extremely complex, and today's fertility specialists are high-tech super sleuths trained to uncover and, with luck, repair any glitches in this amazing machinery.
Since fertility problems are a shared concern, you and your partner should go to the first appointment together. Bring copies of your health records to your visit and have copies sent to your doctor ahead of time to avoid the hassle and expense of duplicating medical tests. Expect to be asked about your sexual history, when you first menstruated, whether you've ever had any sexually transmitted diseases, miscarriages, or abortions, how often you make love, whether you use lubricants, and more. Not much about your private life will be private anymore, so you'll want to feel comfortable with your doctor.



What tests will we be taking?
After looking over your medical history, your doctor will want to do a complete workup on you and your partner. This initial assessment will probably include most or all of the tests described below. Bear in mind that you may need to rearrange your schedules to make time for some of these procedures.
For women:

Blood tests: You'll have several blood tests so your doctor can check your hormone production, including your levels of thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, prolactin, and sometimes androgen and progesterone.

Clomiphene challenge test: This test may give your doctor more information about your ovarian function than some of the other hormone tests. You'll have a blood test on the third day of your cycle to check your follicle stimulating hormone (FSH) level. Then, you'll begin taking a five-day cycle of Clomiphene, a fertility drug, on the fifth day of your cycle. Afterward, your doctor will measure your FSH level on the tenth day of your cycle. The results will give him some insight into how well therapy may work for you, and how aggressive it should be.

Charting basal body temperature (BBT): Your doctor may ask you to track your basal body temperature so you can tell whether you're ovulating. You'll take your temperature every morning upon waking for at least a month and record it on a BBT chart. When your body releases progesterone following ovulation your temperature rises slightly. (You can also use over-the-counter ovulation predictor kits for this purpose. The kits detect the telltale surge of luteinizing hormone (LH) in your urine just before you ovulate. Click here to buy a kit from our Store.)

Endometrial biopsy: Your doctor may perform this quick in-office procedure to assess the quality of your uterine lining and also determine whether you're ovulating. It has to be done at a certain point in your cycle, can be uncomfortable, and sometimes needs to be repeated.

Hysterosalpingogram (HSG): This X-ray procedure will allow your doctor to see whether your Fallopian tubes are open. It also helps determine whether the contour and inside of your uterus is normal or you have polyps, fibroids, scar tissue, or other uterine abnormalities that could affect your fertility. Your doctor will inject a dye through your cervix and into your uterus and Fallopian tubes and trace its movement by X-ray.

Laparoscopy: This outpatient surgery performed under general anesthesia will provide your doctor with a view of your pelvic organs so she can check for signs of scarring or endometriosis.

Pelvic ultrasound: Your doctor will use this painless procedure to determine whether your follicles are growing in order to anticipate ovulation, and also to identify any problems in your pelvis and ovaries such as ovarian cysts or fibroids.

Post-coital test: Your doctor will use this procedure to evaluate the interaction between your cervical mucus and your partner's sperm. You'll be asked to have intercourse on a certain day of your menstrual cycle. Then, within 24 hours, your doctor will collect a sample of your mucus for testing. He'll look at the quality of the cervical mucus, and at how vigorously the sperm are moving. The movement of the sperm may indicate that antibodies in your mucus are impeding the sperm's progress.

Hysteroscopy: During this procedure, your doctor will place a tiny scope (a thin tube with a camera at the end) through your cervix and into your uterus to see whether you have fibroids, polyps, or other abnormalities in your uterine cavity that could impair your fertility. The procedure doesn't allow your doctor to evaluate your Fallopian tubes, but it does provide him with a clear picture of your uterus — and sometimes the opportunity to correct the problem at the time of the procedure.

For men:

Semen analysis: You'll be asked to provide a semen sample, usually by *********ing and ejaculating into a specimen jar. Your doctor will examine your sperm under a microscope for count, shape, appearance, and movement.

Post-coital test: Your doctor will use this procedure to evaluate the interaction between your sperm and your partner's cervical mucus. You'll be asked to have intercourse on a certain day of her menstrual cycle. Then, within 24 hours, your doctor will collect a sample of her mucus for testing. He'll look at the quality of the cervical mucus, and at how vigorously the sperm are moving. The movement of the sperm may indicate that antibodies in the mucus are impeding your sperm's progress.

What are our chances of pinpointing the problem?
In many cases, more than one factor causes fertility problems, and some causes are harder to detect than others, so a clear diagnosis isn't always possible. (See our articles on the most common causes of fertility problems in men and women.) In 10 to 15 percent of cases, testing reveals no abnormalities at all; doctors characterize those patients as having 'unexplained' fertility problems.

Fortunately, even unexplained problems can be treated.

What's below:
• Is fertility treatment really the emotional roller coaster we keep hearing about?

• Why do women seem to suffer so much more than their male partners?

• Our love life seems so mechanical now. Does this happen to other couples?

• People keep asking us when we're going to start our family. What can we say without being rude?

• We're fighting about money because the treatments are so expensive. What can we do?

• We've been seeing a fertility specialist for more than two years. How do you know when to stop?

• See also | Other Sources
--------------------------------------------------------------------------------


Is fertility treatment really the emotional roller coaster we keep hearing about?
For most people, it is. While undergoing fertility treatment many couples tend to live in month-to-month cycles of hope and disappointment that revolve around ovulation calendars and menstruation. As they navigate a tight schedule of tests and treatments, they place their lives on hold — postponing vacations, putting off education, and short-circuiting their careers. Others find that the sorrow, anger, and frustration that can come with prolonged fertility problems invade every area of life, eroding self-confidence and straining friendships.
Realize and accept that you and your partner will have some ups, and, most likely, a great many downs as you deal with your fertility problem. Examine your commitment to becoming parents and consider joining a support group if you decide to go ahead with treatment. Connect with others in your same situation on one of our Fertility Problems bulletin boards.

And, see our top ten coping strategies to help you get through this time.



Why do women seem to suffer so much more than their male partners?
Most women are raised to think that they'll become mothers some day. From the first baby doll to the last baby shower, girls and women are surrounded by images and expectations from parents, peers, religion, advertising, and media. For some women, motherhood is a large part of their image of themselves as female; for others, it's their highest ambition. Even women who don't necessarily want to become mothers are aware of social expectations to do so. The pressures to marry and raise a family can be enormous — to the extent that women who are unable to do those things can feel as though something must be deeply wrong with them or deeply lacking in their lives.
Men are not pressured in the same way to become fathers. And most men are brought up to repress their feelings, or at least keep them to themselves. They may be feeling similar frustration and disappointment as they and their partner go through yet another treatment and yet another month without a pregnancy. But many see their role as being strong for their partner. Or they may be so used to holding in their feelings that they don't know what they feel, or that they can ask for help. If the fertility problem is clearly his, such as poor sperm quality, then a man's image of himself can start to suffer.

Studies show that, as a group, women with fertility problems are as anxious and depressed as women with cancer, heart disease, or HIV. One reason for this may be the physical demands of fertility treatments — blood tests, pills, daily hormone injections, ultrasounds, egg retrievals, and surgery can all be a source of stress and emotional upheaval in women. Also, society often fails to recognize the grief caused by fertility problems, so people denied parenthood tend to hide their sorrow, which only increases their feelings of shame and isolation.

Learn how to avoid the most common pitfalls for couples facing fertility problems. And, see a list of resources that can help you and your partner cope.

Our love life seems so mechanical now. Does this happen to other couples?
Yes. Many couples say that once they start worrying about having a baby, sex becomes more of a chore than a pleasure. Most fertility treatments require you to make love at very specific times — hardly an ideal way to set the mood for romance or enjoy sexual spontaneity.

If you find your sex life deteriorating and yourselves unable to remember the meaning of romance, take a break from your treatment regimen for a month or two and try to revive the love and fun that brought you together in the first place.

Keep in mind that your fertility problem is temporary — sooner or later, it will be resolved, and once it is, you'll want to continue a healthy, fulfilling sexual relationship with your partner. For now, if difficulties persist, consider couple's therapy; seek a counselor who has experience with fertility issues. Ask RESOLVE for a referral or check out the InterNational Council on Infertility Information's list of therapists.

People keep asking us when we're going to start our family. What can we say without being rude?
Parents Talk


Have an opinion about this? Add your comments to the bottom of this page.



They may seem uncaring or thoughtless, but friends and family mean well when they ask about your plans for parenthood. They may not know you're having fertility problems or, if they do, want to know how things are going. Nevertheless, having to entertain such questions can be painful for you, particularly at get-togethers and during the holidays when family — and children — are focal points. You might respond simply, 'We're working on it,' or 'You'll be the first to know when we have good news.'

However, if you're comfortable talking about your fertility problems and think you have a sympathetic listener, by all means be open about it. Talking about what you're going through can be a huge relief, experts say.

If certain gatherings or celebrations are too painful for you — all your siblings had babies in the last two years, say, or you keep getting invited to baby showers — give yourself permission to avoid them or at least to have a good cry afterward. Protect yourself and your sense of well-being as you undergo treatment.

We're fighting about money because the treatments are so expensive. What can we do?
Even in the best of times, financial concerns exert enormous pressure on relationships. Factor in a couple's intense, frustrated desire to have a child plus the high cost of fertility treatments, and the conflict over money can escalate to an unbearable level.

Force yourself to face facts about finances, hard as that may be. Only about one-quarter of U.S. employer health plans cover fertility treatments, and even if you have adequate coverage, your finances will likely suffer for a time. With in vitro fertilization (IVF) averaging $10,000 to $17,000 a cycle, it's no wonder couples feel anxious about money, especially since women often need to go through multiple cycles before becoming pregnant.

To head off arguments about money, sit down together and develop a financial plan. Start with your insurance: Find out exactly what it does and doesn't cover. If it covers some or all of your treatments, decide whether you or your partner will monitor the paperwork and negotiate with the insurance company. Then look at all your assets and determine how much you can spend and on which treatments. Ask yourselves:

• Are we willing to deplete our savings to become pregnant?

• Are the odds of an IVF pregnancy too slim to risk our savings?

• Are we comfortable borrowing money? Will we be able to repay the debt once we have a child?

• Will we have enough money left to pursue adoption if the fertility treatments fail?

Allowing yourself to be carried away by the desire to have a child is easy to do, but finances require rational thinking. Set a ceiling on what you can spend.

We've been seeing a fertility specialist for more than two years. How do you know when to stop?
Letting go of a dream is difficult, and the array of medical technologies available today leads many couples to keep trying month after month, year after year. But about a third of couples treated for fertility problems won't bring a baby to term and often they must make peace with that before they can move on with their lives. Just as one partner was probably more eager to pursue treatment in the first place, one may be ready to accept a life without children or pursue adoption sooner than the other. These are highly individual decisions, and the timing differs for everyone.

The bottom line? Learn to listen to each other, and communicate clearly with your partner and your doctor. You'll know when the time is right for you and your partner to accept the situation and stop treatment.

Fertility Problems
Therapists' top ten tips for coping with fertility problems
Approved by the BabyCenter Medical Advisory Board

--------------------------------------------------------------------------------
The pressure to raise a family can be enormous, and the thought of not being able to can make many people feel something is wrong with them. We talked to respected psychologists who work with couples with fertility problems to find out which coping strategies really work.
Recognize that a fertility problem is a crisis. A fertility problem may be one of the most difficult things you'll ever face. Acknowledging this is a key to coping, says Kate Marosek, who's counseled couples with fertility problems in the Washington, D.C., area for more than ten years. 'It's normal to feel a monumental sense of loss, to feel stressed, sad, or overwhelmed. Don't chastise yourself for feeling these ways.' Facing and accepting your emotions can help you move beyond them.

Don't blame yourself. Resist the temptation to blame yourself or to listen to the little voice in your head that may be saying, 'I shouldn't have waited; I'm being punished for having that abortion; I should have lost more weight or taken better care of my health; I shouldn't have assumed that I could have children when I wanted,' or whatever.

People can get caught in negative-thinking patterns that only make things worse, says Yakov M. Epstein, a psychologist at Rutgers University and co-author of Getting Pregnant When You Thought You Couldn't: 'Instead of berating yourself, look forward to how you and your partner are going to manage the situation.' When you start feeling like you 'should have' or 'could have,' remind yourself that your fertility problem is not your fault. Even if you could have made different decisions in the past, they're behind you. Concentrate on your future.

Work as a team with your partner. You and your partner should help each other through this time (and definitely not blame each other for your difficulty getting pregnant). This doesn't mean you need to feel the same thing at the same time — that's one of the most common pitfalls for couples facing fertility problems. It does mean paying attention to what your partner's going through. 'If you're taking care of each other emotionally, you can unite to fight the problem,' says Marosek.

Work together to find practical ways to share the burden, too. If you're undergoing treatment, he can take care of the insurance papers. Or if he needs injected therapy, you can administer the shots.

Educate yourself about fertility problems. Read as much as you can about fertility problems, and ask your doctor and other couples in your same situation questions. This is especially important when you're dealing with a fertility problem because the technologies behind the treatments are complicated and change quickly. 'You've got to understand what's happening medically,' says Epstein, 'or you won't be able to make informed choices.'

See our resource guide for a list of books, Web sites, and organizations that can help, or learn the basics by starting at the beginning of our Fertility Problems area.

Set limits on how long you're willing to try. Some couples decide from the get-go that they won't go to extreme measures to have a baby. Others spend years and thousands of dollars trying out all their treatment options. No one can tell you when to stop trying to conceive — that's a decision you need to make with your partner and doctor — but you'll feel more in control of your life if you start thinking in advance about how far you're willing to go to get pregnant.

Start by discussing your medical odds of getting pregnant, which treatments you're not willing to try, and your end goal. (For more help making this decision, see Making the decision to end fertility treatment)

Decide how much you're willing to pay. With in vitro fertilization (IVF) averaging $10,000 to $17,000 a cycle, it's no wonder couples feel anxious about money, especially since women often need to go through multiple cycles before becoming pregnant. To cope with the anxiety caused by the high costs of treatment, sit down and develop a financial plan. Start with your insurance: Find out exactly what it does and doesn't cover. If it covers some or all of your treatments, decide whether you or your partner will monitor the paperwork and negotiate with the insurance company. Then look at all your assets and determine how much you can spend and on which treatments. 'You should always have a plan B,' says Alice Domar, a Harvard University Medical School psychologist who specializes in helping couples with fertility problems. 'Because nothing, especially with fertility treatments, is certain.'

Get support from professionals or others with fertility problems. Society often fails to recognize the grief caused by fertility problems, so those denied parenthood tend to hide their sorrow, which only increases their feelings of shame and isolation. 'Finding other people who are going through the same thing can help you see that fertility problems are widespread and your disappointment is understandable,' says Linda Klempner, a clinical psychologist and mental health consultant at the Diamond Institute for Infertility and Menopause in Millburn, New Jersey. Connect with others who can relate on one of our Fertility Problems bulletin boards.

If you'd like to talk to a therapist, look for one who understands fertility problems. 'Fertility problems are very complex, and if a therapist does not understand the medical issues he or she won't be able to help,' says Epstein. Ask RESOLVE for a referral or check out the InterNational Council on Infertility Information's list of therapists.

Just say no to baby-focused activities. If certain gatherings or celebrations are too painful for you — all your siblings had babies in the last two years, say, or you keep getting invited to baby showers — give yourself permission to avoid them or at least to have a good cry afterward. To avoid hurt feelings, send a gift, but send children's books to save yourself a troubling trip to the toy store or baby boutique.

Balance optimism and realism. 'You need to be optimistic to go through a procedure,' says Epstein, 'but if you're too hopeful, if your hope is unrealistic, you'll be setting yourself up for a huge fall.' By keeping up to date on the technology and your diagnosis, you can get a good handle on what chance of success you have with each treatment.

The array of medical technologies available today leads many couples to keep trying month after month, year after year. But about a third of couples treated for fertility problems won't go on to have a biological child, and often they must make peace with that before they can move on with their lives. Staying realistic can help you make smart choices as you work your way through the emotional minefield of treatment.

Take care of yourself by pursuing other interests. Being treated for a fertility problem can feel like a full- or at least part-time job, so it's important to keep up with some of the activities or hobbies that bring you pleasure. 'It won't be easy,' says Marosek, 'especially if you're doing something like going in for a blood test every other day, but look for ways to take care of yourself.' She recommends that people get a massage, have a manicure — anything that can give them relief from the focus on fertility treatment.

If your old activities are painful — maybe all your friends are parents now — look for new diversions. If hiking is your thing, do that. Or take a class — painting, dance, or something else that's always tempted you. And remember, laughter is one of the best healers. See a funny movie, head out to a comedy club, and re-read your favorite funny novel.

You may think you know how to make a baby. But do you really understand all the intricate details? Sure, you've got the basics covered — man meets woman, they both get naked and have sex, and nine months later out pops Junior — but there's a lot more to it than that (not to mention a host of modern variations on that theme). For instance, do you know exactly where sperm and eggs come from, or how these two microscopic miracle-makers ever find each other and combine to create a new life? Or that you have only about a 25 percent chance of getting pregnant during each cycle, even if you time it just right? We'll spare you that awkward talk you probably got from your parents or middle school health teacher and instead give you just the facts — that is, the fascinating biological facts about getting pregnant.



Inside the woman's body: How an egg is hatched
For women the possibility of pregnancy begins in the ovaries, those two kiwi-shaped balls attached to either side of your uterus (see illustration above). The ovaries are like your permanent egg cartons, and they come fully stocked. Every infant girl is born with more than 500,000 eggs (more than a lifetime's supply) in her ovaries. You will never produce any more eggs; in fact, many of them begin dying off almost immediately. But don't worry, you have plenty left for your reproductive years. Altogether you'll probably release about 400 eggs, beginning with your first period and ending when menopause arrives, usually between ages 45 and 55.
Sometime during the middle of your menstrual cycle (most likely between the 12th and 16th days), an egg reaches maturity in one of the two ovaries, which releases it into the abdomen, where it's quickly ****ed up by the tulip-shaped opening of the nearest Fallopian tube; these are two 4-inch canals leading from the ovaries to the uterus. This release, known as ovulation, starts the conception clock ticking. The average egg lives only 24 hours, so it has to be fertilized soon if a baby is to be conceived. If your egg meets up with a healthy sperm on its way to the uterus, the two can join and begin the process of creating a new life. If not, it ends its journey at the uterus, where it disintegrates and is expelled a couple of weeks later during your period.



Inside the man's body: The making of baby fertilizer
While women are busy maturing a single egg at the leisurely pace of about one a month, men are almost constantly at work producing millions of microscopic sperm, whose sole purpose in life is to swim for their lives and penetrate an egg. While women come complete with all the eggs they'll ever need, men aren't born with ready-made sperm. They have to make them on a regular basis — from start to finish it takes about 64 to 72 days to create a new sperm cell. Since the average sperm live only a few weeks in a man's body and around 200 to 350 million are set free with each ejaculation, this fertilization factory is rocking 24 / 7.
Sperm production starts in the testicles, the two glands housed in the scrotal sac beneath the penis (see illustration above). The testicles hang outside the body because they're quite sensitive to temperature. To produce healthy sperm they have to stay at a balmy 94 degrees Fahrenheit — about four degrees cooler than normal body temperature. Once the sperm is created, it's stored in a portion of the testicle known as the epididymis until it's scooped up and mixed with semen just prior to ejaculation.

Despite the millions of sperm that are produced and released in each ejaculate, only one can fertilize an egg (this is the case even for twins). The gender of the resulting embryo depends on which type of sperm burrows into the egg first — sperm with a Y chromosome will make a boy baby, and sperm with an X chromosome will make a girl. Plenty of myths about how to conceive a boy or girl have been circulating for centuries, and some are backed by a bit of scientific evidence, but on the whole, a child's sex is determined randomly.

What happens while you're busy having sex
The big moment has arrived and you're actually having sex — woohoo! In addition to all the fun, your bodies are building up tension that you hope will end in orgasm, that wonderful, pleasurable release that also has an important biological function (isn't nature great?). In men, orgasm propels sperm-rich semen into the ****** and up against the cervix at roughly 10 miles per hour. This process, known as ejaculation, gives sperm a head start on their way to the egg. A woman's climax also aids conception. Some research shows that the wavelike contractions associated with the female O help pull the sperm farther into the cervix. So what's the take-home — or take-to-bed — message? Let go and have as much fun as you can. It can only help your chances of getting pregnant.

Many couples wonder if a particular sexual position is best for baby-making. No one knows for sure, but some experts believe the missionary position (man on top) or the rear-entry position (man behind woman, both facing the same direction) are best because they allow for deep penetration. But do whatever you like. The most important thing about sex is that you're both having a good time and you're doing it frequently enough that live sperm are in the woman's reproductive tract during ovulation. That means you should aim to make love at least every other day during the middle of your cycle.

During the afterglow, sperm fight to the finish
Parents Talk


Have an opinion about this? Add your comments to the bottom of this page.



If conception is going to happen, it will be in the first few hours after sex. At this point you can't do much except cross your fingers and hope, though some experts say the woman should stay on her back (with a pillow under her butt) for at least 20 or 30 minutes so gravity can help the sperm get to the waiting egg.

While you and your partner are enjoying a relaxing post-romp cuddle, a great deal of activity is taking place inside your body. Those millions of sperm have begun their quest to find your egg, and an easy journey it's not. The first obstacle is the acid level in your ******, which can be deadly to sperm. Then there's your cervical mucus, which can seem like an impenetrable net except on the one or two days when you're most fertile and it miraculously loosens up so a few of the strongest swimmers can get through. But that's not all; the sperm that survive still have a long road ahead. In all they need to travel about seven inches from the cervix through the uterus to the Fallopian tubes. When you consider that they travel at a rate of roughly an inch every 15 minutes, that's quite a trip. The fastest swimmers may find the egg in as little as 45 minutes, while the slowest can take up to 12 hours. If they don't find an egg in the Fallopian tubes at the time of intercourse, the sperm can wait there in a resting stage for up to 72 hours.

The attrition rate for sperm is so high that only a few dozen ever make it to the egg. The rest get trapped, lost — perhaps heading up the wrong Fallopian tube — or die along the way. For the lucky few who get near the egg, the race isn't over. They have to work frantically to penetrate the egg's outer shell and get inside before the others. When the hardiest of the bunch makes it through, the egg changes instantaneously so that no other sperm can get in. It's like a protective shield that clamps down over the egg at the exact moment that first sperm is safely inside.

Now the real miracle begins. The egg will be fertilized within about 24 hours as the genetic material from the sperm combines with the genetic material in the egg to create a new cell that will rapidly start dividing. You're not actually pregnant until that bundle of new cells, known as the embryo, travels the rest of the way down the Fallopian tube and attaches itself to the wall of your uterus. (Although you can have an ectopic pregnancy if the embryo implants somewhere other than the uterus, usually in the Fallopian tube. An ectopic pregnancy is not viable, and the embryo has to be surgically removed to prevent rupture and damage to the Fallopian tube.) That final leg of the trip can take another three days or so, but it may be a few more weeks until you miss a period and suspect that you're going to have a baby.

Once you have missed your period — or noticed one of the other signs of pregnancy — you can use a home pregnancy test to find out for sure if you've got a little one on the way. If so, congratulations, and welcome to the start of another incredible journey

Pregnancy symptoms: Top ten signs you might be pregnant
Approved by the BabyCenter Medical Advisory Board

--------------------------------------------------------------------------------
What's below:
• 10. Tender, swollen breasts

• 9. Fatigue

• 8. Implantation bleeding

• 7. Nausea or vomiting

• 6. Increased sensitivity to odors

• 5. Food aversions

• 4. Frequent urination

• 3. A missed period

• 2. Your basal body temperature stays high

• 1. The proof: A positive home pregnancy test

• See also
--------------------------------------------------------------------------------
Most likely, you won't experience any pregnancy symptoms until about the time you've missed a period or a week or two later. If you're not keeping track of your menstrual cycle or if it varies widely from one month to the next, you may not be sure when to expect your period. But if you start to experience some of the symptoms below (not all women get them all) and you haven't had a period for a while, you may very well be pregnant. Take a home pregnancy test and find out for sure!

10. Tender, swollen breasts
One of the early hallmarks of pregnancy is extremely sensitive, sore breasts. As your body gears up for the months of pregnancy to come, you produce more of the hormones estrogen and progesterone, just as you do before each menstrual period. In fact, the tenderness you may be feeling now is probably an exaggerated version of how your breasts often feel just before your period. The tenderness will diminish significantly after the first trimester, once your rising hormone levels have stabilized and your body becomes accustomed to them.

9. Fatigue
Feeling tired all of a sudden? No, make that exhausted. Increased levels of the hormone progesterone and the extra effort your body requires to start making a baby can make you feel as if you've run a marathon when all you've done is put in a day at work. You should start to feel more energetic again once you hit your second trimester, although fatigue generally returns sometime around your seventh month.

8. Implantation bleeding
The fertilized egg begins to burrow into the lining of your uterus about 8 days after ovulation. As the embryo gets bigger and continues to implant itself, you might notice a slight staining of a pink or reddish brown color, at around 12 to 14 days after ovulation. Only a minority of women experience this implantation spotting. (If you have pain along with spotting or bleeding, call your practitioner immediately as this can be a sign of an ectopic pregnancy.)

7. Nausea or vomiting
Parents Talk


Have an opinion about this? Add your comments to the bottom of this page.



If you're like most women, morning sickness won't hit you until about a month after conception. (A lucky few escape it altogether.) But some women do start to feel queasy a bit earlier. And not just in the morning, either — pregnancy-related nausea and vomiting can be a problem morning, noon, or night. It tends to peak around eight to ten weeks, when your hormone levels are highest, and then will most likely taper off as you begin your second trimester.

6. Increased sensitivity to odors
It's not uncommon if you're newly pregnant to find that you're now overwhelmed by the smell of a bologna sandwich from several desks away and that certain aromas instantly trigger your gag reflex. This, too, may be a side effect of rapidly increasing estrogen in your system.

5. Food aversions
While some women insist they crave certain foods during pregnancy, food aversions are even more common. You may suddenly find certain foods you used to enjoy are now completely repulsive to you. This problem may come and go or last throughout your pregnancy.

4. Frequent urination
Shortly after you become pregnant, you may find yourself hurrying to the bathroom at an alarming rate. Why? It's most likely due to the fact that during your pregnancy the amount of blood and other fluids in your body increases and your kidneys work harder to quickly get rid of waste products. This symptom may start as early as six weeks into your first trimester and remain or even get worse throughout your pregnancy.

3. A missed period
If you're usually pretty regular and your period doesn't arrive on time, you probably took a pregnancy test long before you would have noticed any of the above symptoms. But if you're not regular or you're not keeping track of your cycle, nausea and breast tenderness and extra trips to the bathroom may give it away before you realize you didn't get your period.

2. Your basal body temperature stays high
If you've been charting your basal body temperature and you see that your temperature has stayed above the coverline for 18 days in a row, you're probably pregnant.
And finally...

1. The proof: A positive home pregnancy test
It's best to wait until at least the first day of a missed period before you take a pregnancy test. (If it's negative, try the test again in a few days.) Once you've gotten a positive result, make an appointment with your practitioner and head on over to our pregnancy area. Also, don't forget to update your profile and sign up for our 'My Baby This Week' newsletter. Congratulations!

No Alina, I am just sharing good info with yall when I see it.