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Author name: Risa Kerslake, RN

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Fertility Treatment

Dealing With IVF Injections When You’re Scared of Needles

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Anyone who has previously gone through in vitro fertilization (IVF) knows that if you once had a fear of needles, you won't anymore. Because the truth is, when it comes to infertility treatments, we often don’t have any other choice. Since I’ve done plenty of shots over the years, I’m here to tell you that yes, you can do it, and yes, you will also survive them. Dare I even say they become no big deal after a while? Get Educated Before any of the actual shot giving can occur, your clinic will need to know you are OK with giving them, and if not, who will be administering them. This usually happens at a nurse consult appointment, typically following a consultation with your doctor when IVF is given the go-ahead. You or you and your partner will meet with the nurse to go over your medications, and you’ll get a crash course in injections. Get Organized After you’ve received the IVF medications and supplies from the pharmacy, you’ll administer them according to your doctor’s orders. Most women have to do several shots a day, at specific times, and it’s necessary to keep a calendar of it all. Most clinics provide a calendar in their information paperwork, but if it doesn't work for you or you prefer digital, make your own. Related: The Complete IVF Process Explained 16 Tips to Prepare for IVF What Research Says About Stress as a Cause of Infertility Books About Infertility What to Expect When You're Injecting Here is what you can expect when dealing with IVF injections, the different places you may be giving them, as well as tips for—you know—actually going through with it. Types of Injections With fertility medications, there are typically two different types of injections that are required: Subcutaneous Injections (SC) Subcutaneous injections go right under the skin before you reach the muscle. Usually, the best injection site for these is right in your abdomen or “love handles.” Other places can be the fatty part on the back of your arm or your thigh, but depending on the type of medication, these places could be more painful. The syringes are small because the maximum dose of a medication is only one milliliter. These needles are tiny, and you may not even feel them go in. They have a gauge of 19-27 (the smaller the number, the smaller the needle's width). When you’re going to inject yourself with an SC shot, it can help to pinch up the skin if there isn’t a lot of fat in the area or inject it at a 45-degree angle. Likewise, if there is plenty of padding, you can spread your skin with your fingers or inject it at a 90-degree angle. The most common medications you would give this route are the stimulation medications to grow your follicles and your hCG trigger shot right before your egg retrieval. This might include : Menopur Lupron Gonal-F Follistim Bravelle Intramuscular Injections (IM) Intramuscular injections are just as they sound: they are the injections that go right into your muscle, and understandably, these are bigger in all aspects. Most of the time, intramuscular injections go into a muscle called the dorsogluteal, and it’s located almost on your buttocks. By dividing the buttock into four quadrants, this area is located in the upper-outer quadrant. Another place you could inject is the area on your thigh, but since the dorsogluteal area has more fat, it’s the best site for lessening the pain. These syringes usually are for two to three milliliters of medication, and the most common IM medication is progesterone. I hate to say it, but these needles are one to two inches in length and a lot wider than the subcutaneous ones with gauges of 26-30. Tips on Giving Yourself IVF Injections If you’ve made it this far, I have good news. There are things you can do to make the experience of injecting yourself easier. And yes, it is fair to expect some discomfort. You can expect to have some pain and bruising at the injection site. Considering the number of shots you will likely be required to give, the odds are that you aren’t going to execute the perfect shot every time. And depending on what the medication is (the blood thinner Lovenox, for example, can cause some wicked bruising), you could have different degrees of pain and bruising. One of the stimulants, Menopur, also burns upon injection. Read: What You Need To Know About Ovarian Hyperstimulation Syndrome (OHSS) Ice and heat With subcutaneous injections, it’s beneficial to ice the area before injecting so you can numb it, and it won’t hurt as much going in. The same is true for IM injections, but sometimes it’s actually better to use heat for ten minutes before and after the medication. This is especially true for progesterone because of the thick oil you have to inject. The heat helps to spread out the oil because it can “clump” and cause painful knots. Pressure and Massage With some blood-thinning medications, you don’t want to put pressure on the site after or massage, but this can be OK for other medications. Your pharmacy instructions will state when to use pressure or not. With IM injections like progesterone, pressure and massage will be your friend. As discussed above, it helps to prevent painful lumps from forming under your skin. Massage is great to help dissipate the medicine and be sure to hold pressure over the site when you pull out the needle and find blood. Getting Over the Mental Roadblock Make sure to relax. Easier said than done—right? But really, this is important. Practice some deep breaths and make sure the muscle you are going to inject is loose. Don’t tense your fingers. Pretend you’re braver than you feel. Remember the reason why you are doing this. Count to three and shoot. Much of this process is a mind game and a lesson in overcoming. Count to three and

Fertility Treatment

16 Tips to Prepare for IVF

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After going through three rounds of in vitro fertilization (IVF), the entire process has become second nature to me. But with that first one—I remember those overwhelming feelings of inadequacy and confusion like it was yesterday. Along the way, I've collected all the tips, tricks and ways I organized myself throughout my cycles to share with you. Here are 16 ways you can help to prepare yourself for your own IVF cycle. 1. Get Your Finances In Order In preparation for the enormous price tag of IVF, try and pay down that credit card debt as much as you can before you start. Put together a budget and stick to it. If you can, put away as much money as you can afford into savings. A baby is the goal, but coming from someone who spent all of their money trying to conceive one, it’s no fun to be a new parent and broke. 2. Think About How You'll Save For Your Cycle While you are getting your finances in order, think about how you will pay for your cycle. Does your insurance cover anything fertility-related? Will you take out a medical loan or a second mortgage? Does your 401K or equivalent have an option to borrow against? Do you need to start saving or hold a fundraiser? Perhaps you have a rich relative? IVF is expensive and the financial side needs to be addressed long before you actually transfer. (And just kidding about the rich relative part. But if this is you, consider yourself lucky!) 3. Do Your Research This likely isn't a new tip, so why include it? Because everyone who has gone through IVF will tell you the same thing: You have to be your own advocate. Getting informed is your first step to being able to properly advocate for yourself. Research different clinics and figure out how the payment process works and what the success rates are for each clinic. Start to become more knowledgeable about the range of fertility procedures. Read: 12 Things I Wish I Had Known As An Infertility Newbie 4. Make a List of Questions To Ask Your Doctor at Your Consultation It’s overwhelming meeting your doctor for the first time when you decide to pursue IVF. Write down your questions a few days before your appointment, and make sure to bring a pen and actually write down your doctor’s answers, because your IVF consultation will probably be an overload of information. 5. Practice Your Injection Technique I’m a nurse who’s given plenty of injections. However, giving them to myself was quite a different matter. Ask your clinic nurse to help teach you, and if giving them to yourself is not your thing, get your partner or support person on board, or find someone who has experience. Read: Dealing With IVF Injections When You Are Afraid of Needles 6. Ask Your Questions Your doctor and the clinic nurses are there for you. That’s what you’re paying them for. Don’t ever feel like you’re an inconvenience, or have a stupid question. Many clinics have someone available on call for after-hours as well. 7. Find Others Who Are Doing IVF at The Same Time as You Having a “cycle buddy,” someone who is going through IVF at the same time as you, can be a life-saver. You'll have someone to lean on who is going through the same thing to bounce ideas off of or share injections tips and tricks with. Some of my closest friends came about because we were going through IVF simultaneously. 8. Keep a List of Relaxation Techniques It’s always good to have this handy list to pull out when things are getting overwhelming. Having some ideas as to what helps keep you calm so you can avoid doing things like stress eat or some other unhealthy habit you may use to cope. Think about what will be effective for you. 9. Create a Calendar of Your Shots and Appointment Schedules This one is so important. Most clinics have a booklet they give you with a calendar you can use to write in medication times and appointments. The injections can be given multiple times a day at different doses, and this is the best way to stay on top of things and avoid missed doses. With IVF, timing is important. Create your own schedule if you don’t receive a template, or if another method works better for you. 10. Decide If You Will Test Early—or Not Some people start using home pregnancy tests right away and some refrain from any testing until they hear the results of their blood tests. Both are perfectly fine, but if you’re a person like me who gets a little obsessive over that pink line and drives themselves crazy, you may need to be mindful of early testing. Thinking about how you might feel in advance might help a bit with those two-week wait nerves. Read: 10 Ways To Survive the Two Week Wait After Infertility Treatment 11. Decide Who You Are Going to Tell Your best people are those who will be there to uplift and encourage you. Decide in advance with your partner who you will tell about your cycle and those who aren’t supportive don’t need to know. This time is about you and it’s important to surround yourself with the positive influences in your life. Read: Why It's OK To Be Selfish While Experiencing Infertility 12. Nurture Your Relationship If you’re partnered, take some time now before the flurry of doctor’s appointments takes over. Get out on dates, keep in touch with each other on how you’re feeling, and find new ways to reconnect. You will need your partner when going through your cycle. Read: What Men Should Know About Emotions and Infertility 13. Don't Plan on Starting Intense New Exercise Routines It's not time to start marathon training or take on a crazy new routine. Walking is a great exercise for when you’re going through IVF. It's likely that

Coping with Infertility

7 Things To Stop Doing to Yourself If You’re Living With Infertility

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As much as you try to prevent it, infertility can grow to be all-consuming. It’s easy to develop habits in order to get through the experience (otherwise known as survival mode). But when you’re trying to get pregnant, these habits may not be healthy and are certainly not going to help you in the long run. Here are 7 things you should stop doing while experiencing infertility, simply because you deserve better. 1. Thinking It's Your Fault It’s easy to go back and think of all the things we shouldn’t have done: waited too long to have kids, drank out of too many plastic bottles, consumed too much alcohol or too many carbs. Stop thinking that there is something you could have done to prevent this because it ’s going to drive you crazy. It also won't help. At all. The truth is, there isn't anything that most of us could have done to prevent it. You can do everything by the book and still end up in the same situation. 2. Sitting Back And Waiting Life is happening now. You don't need to wait until you get pregnant to actually live your life. Don't be afraid to define what a full life looks like to you right now and to prioritize what needs to be done to get you there. It might not be easy, but those family traditions can start now. You don't need to put the rest of your life on hold while trying to get pregnant. 3. Defining Your Life by Negative Pregnancy Tests I’m a failure. It’s never going to happen. How often do we think these thoughts each month while staring down at that single pink line? When we’re experiencing infertility, it’s easy to break our life down into monthly cycles. Your negative pregnancy tests don’t mean that you yourself have failed. 4. Letting Infertility Define Your Worth as a Woman In our society, we tend to conflate womanhood and motherhood. We’ve seen the memes floating around social media that you don’t know true love until you become a mother. Whether you become a mother to a child or not, you still matter as a person, as a woman, as a wife or sister or daughter. Having a baby doesn’t change that. 5. Comparing Yourself to Others Someone you know did seven IVF cycles before they finally got pregnant. A close friend did intrauterine insemination (IUI) three different times and she has three children. It’s so hard not to compare and either be jealous of someone else’s luck or terrified the same reality that hit someone will happen to you. Your story is your own. Not anyone else’s. 6. Using "What Ifs" What if we did one more round of IUI before trying IVF? What if we waited too long and missed our chance at a baby? It’s never-ending. When you go through infertility treatments you will always wonder if you’re doing the right thing. You will always wonder if one more of the same treatment will be the one that works. You’re never going to feel 100% about a treatment decision because there will always be some sort of doubt. The best-case scenario (besides the obvious) is to come out of infertility knowing you did all you could, financially, emotionally, physically, and mentally. And that looks different to everyone. 7. Thinking You Can do it Alone Women are strong, we are determined, and we are notorious for taking it all on. But trying to navigate infertility alone is likely to end up with nothing but intense isolation—maybe even shame and embarrassment. Finding a fertility support group online or in person, or connecting in real life with someone you know who is also struggling can make all the difference. Find someone to commiserate with, to bounce ideas or questions off of, or to share your highs and lows. It's probably realistic to assume that you'll find yourself doing one or all of these things at one point or another, and that's OK. Having an awareness of what isn't helping your experience can be beneficial too. It's might not be easy, but this mindset can help you persist and perhaps even come out the other end stronger.

Coping with Infertility

Why It’s OK To Be Selfish While Experiencing Infertility

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I hung up the phone, feeling like a terrible friend. It was May of 2013 and I was days away from my egg retrieval for an in vitro fertilization (IVF) cycle. I was bloated and uncomfortable from my enlarged ovaries and was feeling pretty overwhelmed with the constant doctor appointments to monitor my follicles. I had canceled, yet again, on a friend that I had dinner plans with. The truth was that I just wanted to lay on the couch and watch a movie. I struggled with my feelings during that IVF cycle, just as I had for the last four years. I had so much going on that at the end of the day I didn’t feel like socializing. Plus, my husband and I had just taken out a $50,000 loan to pay for our treatments. Spending money on meals out with friends brought on a ton of guilt. I spent the first few years of my infertility journey feeling selfish. I felt bad for feeling so selfish. It took me a long time to understand that the word “selfish” gets a bad rap. Being selfish is typically considered to be a negative trait. It is defined as concerning yourself with your own interest, regardless of others. From my view, if ever there were a good time to focus on your own interests, experiencing infertility might be just the occasion. Infertility and infertility treatments might be the hardest experience that some people will go through. It genuinely makes sense to take the time you need to focus on building your family during this time. If you’re feeling guilty about prioritizing your needs during your infertility journey, I’m here to tell you it’s OK and this is why: 1. Because You Are Already Extra Busy With Treatments From the many doctor visits to injection schedules, you are booked a lot of the time. You might have to say no to outings with friends because you have appointments. You might have to say no to dinners out because you have an early ultrasound the next day. If you already have too much going on, ease the guilt by giving yourself permission to realize just how time-consuming fertility treatments can be. 2. Because Your Financial Priorities May Have Changed Remember that $50,000 loan I mentioned? This made our financial priorities different from those of many of our friends. You also might need to prioritize your financial obligations differently than those around you. It can be hard —but very necessary—to turn down pricy activities. Suggesting low-cost or free activities is a good workaround so that not every outing involves spending money. 3. Because Relationships With Partners Need Extra TLC Infertility can push people to the edges in a relationship. With everything else that you have going on physically, mentally, and emotionally, you may want to use any spare time that you have to focus on your relationship with your partner. It’s important to know that the friends and family who care about you will understand when you need to prioritize your downtime. They may not understand infertility, but they likely get that you know what’s best for you. 4. Because Infertility Treatments Won’t Last Forever Going through cycles are intense, but they will come to an end— either with a pregnancy or not. There is also a final treatment cycle or some sort of decision that brings about resolution. This experience won’t last forever. If you think in the short term, it just might be easier to focus on what is truly important to you for a while. 5. Because Making People Understand Infertility Is Exhausting It can be hard for someone who hasn’t undergone fertility treatments to understand just how taxing they can be. It can also be exhausting trying to explain to other people just how taxing treatments can be. And sometimes you just aren’t going to make people understand. Don’t feel like you need to spend time with people who don’t support you in the ways you need. Crazy emotions are already part of the process so why add additional layers if you don’t need to. 6. Because Self-Care Isn’t Actually Bullshit This whole idea of “being selfish” during infertility is really just practicing good self-care. There is something to say about focusing on your own health and well-being during treatments. If it makes your life easier or more enjoyable, go ahead and miss outings with friends or say no to extra obligations during your treatments. Even if that means taking more naps and attending yoga rather than a party, give yourself permission to only say yes to the things that will make you happy. 7. Because It’s Your Priority There is a good chance that you are heavily invested in your journey and the outcome. This alone is reason enough. Prioritizing yourself during infertility isn’t actually being selfish. It might feel that way, but there are many good reasons why it makes sense. Also, this isn’t about shutting down and shutting out the good people in your life. You don’t need to seclude yourself away in order to have a successful treatment cycle, but do give yourself permission to decide what you can and can’t handle at this point in time. While I did cancel plans with friends, I made sure to see them when I was having good days and I certainly reached out to them when I was struggling. The important thing is to take care of yourself and decide when is the best time is to focus on just you— guilt free.

Fertility Health

12 Things I Wish I Had Known As An Infertility Newbie

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When working with people experiencing infertility, one of the ways I feel that I feel that I can be the most helpful is to try to prepare them for what’s coming. I always think back to my journey and how unprepared I was. There were a lot of what I now know to be common experiences that caught me totally off guard. In reality, there is no way to be completely in the know when it comes to infertility, but I do wish that I would have known certain things to feel like I had even a little bit more control over the process. Here are 12 things I wish I had known when I was first diagnosed with infertility. 1. You’re Going To Have Doubts. You’ve finally got to the point where your treatment plan has been set, and you have a plan of attack—except for that uneasy feeling. And this is OK. It is normal to have doubts, and it’s completely normal to question your doctor. Question everything. Will intrauterine insemination (IUI) really work? Is taking Clomid for six months worth your time? There will likely be some level of uncertainty when the plan has no guarantees, and the desired outcome is everything to you. Action your doubts. Make a list of your questions and stay in contact with your doctor. 2. There Will Be Physical Pain—Unfortunately. Let’s be honest; so many of those diagnostic tests can hurt. It’s not fun having dye injected through your fallopian tubes (hello, HSG); or undergoing an ultrasound through your vagina, and after all that, you may be subjected to giving yourself injections of medication. Focus on the end goal and chug through the pain. It can be done! 3. You May Gain Weight—And Not Because You’re Pregnant. Many fertility medications can make you bloat and gain weight. Not to mention the exercise restrictions you might have imposed by your doctor while actively in a treatment cycle like IUI and in vitro fertilization (IVF) to protect your stimulated ovaries. Plus, if you tend to be an emotional eater (like I am), the weight can pile on while you worry and obsess month after month. Take it easy on yourself, but don’t underestimate the value of gentle exercise and eating right not only for weight management but also for stress relief and overall health. 4. IVF Can Be An All-Consuming Time Commitment. For two years, I juggled my full-time job while undergoing three cycles of IVF and a frozen donor egg cycle, the latter of which involved extensive traveling. Some treatments aren’t as involved, and some, such as IVF, can easily take over your schedule with monitoring appointments, procedures, and phone calls, all likely requiring you to take time off work. Sometimes you live, work, and breathe infertility—and that’s a full-time job. I can’t stress this enough: keep a calendar. 5. You’ll Do Crazy Things Because It “Just Might Work.” I once stood on my head after sex because I read that gravity can help bring the sperm to the egg. I’ve drowned in raspberry tea and pineapple core, hoping it would help my embryos implant after IVF transfers. Some women change up their entire diet hoping that they’ll get pregnant because of a certain food they’re no longer consuming. We are willing to do just about anything, no matter how ridiculous, because someone out there claimed it worked for them. Decide what you think will be helpful, and don’t fall into the “what if” game. It’s just another way to wear yourself thin. 6. You Might Need To Be Open To Taking Breaks. It might seem easiest to plunge right into treatment after treatment so that this whole experience can be over with sooner, but taking time to regroup between cycles and letting your body and mind heal can be a huge stress reliever. Making sure to take care of yourself helps keep you in the game and helps you avoid infertility-related burnout. It is possible to dig in too deep when it comes to treatments, and rebounding might take more time than pacing yourself appropriately to start with. 7. Plan To Minimize Issues With Intimacy. Sex=fun and sex=baby, right? But when you need to be intimate on a timed schedule dictated by a medical team, most of us start finding sex to be a chore—something to check off a list and something to start even dreading depending on where you are in your infertility journey. And this isn’t just about the female partner, either. Communication is key and purposely deciding how to keep an intimate connection is a conversation worth having upfront. Try to even have non-baby-making sex every once in a while. 8. Infertility Changes What You Thought You Knew About Yourself. You’ll never be able to give yourself an injection? IVF isn’t for you? Sometimes you’ll be surprised at what you thought you’d never be able to do, but then you find yourself doing it anyway. Pursuing infertility treatments may show you just how far you’ll go to bring your child into the world. It may even bring out shocking emotions you weren’t prepared for, like anger, jealousy, or extreme sadness. Don’t think it’s possible to be jealous of a pregnant friend? Infertility might have something to say about that. You will likely be introduced to a side of you that you didn’t think was possible both in terms of your resiliency and perhaps an emotional side triggered by ongoing hurt. 9. You And Your Partner Aren’t The Only Ones Hurting. Infertility affects more than just you and your significant other. Yes, it is your journey, but there are likely other people who feel deeply entwined with your struggle and want the best for you. There are siblings you may want to make aunts and uncles, and parents who you wish could be grandparents; how strongly you can hurt on behalf of other people can be surprising. It can be hard to see other people in pain but

Fertility Treatment

What Are Your Options For Your Remaining Embryos?

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When you’re experiencing infertility, the last thing you think about is having more frozen embryos than you actually want to use. Simply having one child come from an emotional and complex in vitro fertilization (IVF) cycle is all that many people can focus on. But the reality is that many individuals or couples who undergo IVF will complete their family and still have embryos left over. What happens then? You may not know from the onset of your IVF procedure what your situation will end up being or the decisions you will be required to make, but there is some initial thought that needs to go into the process before any action takes place. This generally includes any legal contracts that need to be signed. Upfront, before fertility treatment takes place, most fertility clinics and storage sites require you to sign agreements for consent, stating exactly what you or you and your partner would want in any number of scenarios with any embryos created from IVF. These documents briefly address what you would want to be done with the embryos in the event of divorce or death—of you, your partner, or both. Until an embryo is transferred into the woman’s uterus, individuals or couples can change their minds of what they want to be done. This isn’t something most even think about, but in an unforeseen unfortunate event, this paperwork will determine the fate of your embryos. Once you know the outcome of your treatments, you’ll need to decide what to do with any remaining embryos. Fortunately, a number of options exist, including: 1. Keep Embryos in Long-Term Storage Thanks to the process of freezing, called vitrification, embryos can be rapidly frozen so they don’t accumulate any ice crystals. This leads to better success rates of embryos surviving a thaw. This option usually occurs when an individual or couple is unable to decide on any other option. It’s costly to store embryos, with the average clinic charging anywhere between $500 and $2,000 a year. Depending on the clinic, many will store embryos for up to ten years, but after that, they will often need to be transferred to a long-term storage facility off-site. This is to prevent endless and expensive storage of clients’ embryos and is definitely not the best solution for many individuals or couples. 2. Donate Embryos To Medical Research Another option for the remaining embryos is to donate them to medical research. Many times, these donated embryos are used for fertility-related research for improving IVF for other patients or training new embryologists. They could also be used for stem cell research for disease prevention or treatment. Some individuals or couples feel like they have benefited so greatly from the science of IVF that they want to give back and help with the progression of research. According to the American Society for Reproductive Medicine (ASRM) Ethics Committee, along with informed consent and confidentiality, donors should be informed of: The nature of the research The specific research project, if known The source of funding Any potential commercial value Any anticipated clinical applications 3. Disposal of Remaining Embryos This option means just that. Embryos are taken out of storage, thawed in the lab setting, and discarded respectfully as medical waste. Just as in the option of indefinite storage, this sometimes happens when individuals or couples can’t come to another decision of what to do with their embryos. 4. Compassionate Embryo Transfer Another option that some people may not be aware of is the process of a compassionate transfer of remaining embryos. A compassionate transfer is a transfer done at a point in a woman’s cycle when getting pregnant would be highly unlikely. The idea is for the embryos to die in a natural environment, rather than in a lab. It’s a decision that has people split—some may disagree due to the additional financial cost, while others choose it because they don’t want to discard their embryos. Some people aren’t comfortable donating their embryos to another family and don’t want to use them for medical research and need an option other than indefinite storage. It’s important to ask if a compassionate transfer is something your clinic would be willing to do. 5. Donate Your Embryos To Another Couple Sometimes referred to as embryo adoption (although not considered a legal adoption), donating embryos to another individual or couple in need is an option for helping others achieve pregnancy when you have completed your own family. It’s a big decision that is likely to come with complex emotions. Some struggle with the idea of embryo donation, as they feel like they are “giving away” their own children. It may not be the option for you if you feel similarly or have a difficult time letting go of control regarding what happens with your embryos. There are many times in the process of donation where you are in charge of decision making, such as your requirements on who your embryos can go to. But some aspects are out of your control, such as how that future child or children will be raised. Once you sign legal contracts relinquishing your rights, the receiving individual or couple signs their own legal contracts. Both parties then undergo physical and mental health exams, and the receiving individual or couple would then use the embryos by thawing and transferring them, just as in an IVF cycle. Considerations for Embryo Donation An embryo donation can be open or closed (just as in an adoption of a child) so you can decide if you want a relationship with the receiving individual or couple and any children they have that result from the donated embryos. There are more families waiting to receive then there are donated embryos, so there isn’t a concern about not having someone available to take your embryos. That said, it is ideal if you have more than one frozen embryo to donate. Intended recipients may prefer a group of embryos rather than a single one as it

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