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How Am I Going to Fit Fertility Treatment Into My Already Crazy Schedule?
Deborah Wachs, MD, REI, discusses the time considerations surrounding fertility treatments, including frequency and duration of appointments. She also shares why having a support system in place prior to treatments can have a significant impact on success.
Featuring:
Dr. Wachs is also a Junior Fellow of the American College of Obstetrics and Gynecology and member of the American Society of Reproductive Medicine. Dr. Wachs participated in several federally funded research studies on polycystic ovary syndrome (PCOS) and has published widely on the topic. Her other areas of special interest include diminished ovarian reserve, recurrent pregnancy loss and preimplantation genetic testing.
Deborah Wachs, MD, REI
Dr. Deborah Wachs is a board certified specialist in Reproductive Endocrinology and Infertility and Obstetrics and Gynecology. She earned her undergraduate degree from the University of Michigan and her medical degree from Georgetown University. She completed her fellowship in Reproductive Endocrinology at the University of California, San Diego.Dr. Wachs is also a Junior Fellow of the American College of Obstetrics and Gynecology and member of the American Society of Reproductive Medicine. Dr. Wachs participated in several federally funded research studies on polycystic ovary syndrome (PCOS) and has published widely on the topic. Her other areas of special interest include diminished ovarian reserve, recurrent pregnancy loss and preimplantation genetic testing.
Transcription:
Prakash Chandran (Host): If you’re struggling with infertility and need help getting pregnant, there are fertility treatments that can help increase your chances of having a baby. But how much time will it take out of your busy schedule? We’re going to talk about it today with Dr. Deborah Wachs, a Reproductive Endocrinologist at the Reproductive Science Center of the San Francisco Bay Area.
This is Fertile Edge, a podcast by the Reproductive Science Center of the San Francisco Bay Area. I’m Prakash Chandran. So, Dr. Wachs, why don’t you start by telling us the most common types of fertility treatments that there are.
Deborah Wachs, MD, REI (Guest): Two big categories of fertility treatment, the first is called IUI which stand for intrauterine insemination and the second is IVF which stands for in vitro fertilization. And when we talk with patients, usually we are guiding them to either IUI cycles or IVF cycles.
Host: Okay so let’s talk about the time required in each of these treatments and when a patient might start getting the process started.
Dr. Wachs: Okay so, at the first visit, when we see a patient, we take a detailed history, we find out how long they’ve been trying to get pregnant, what testing they’ve done, and have they done any treatment before. Sometimes patients come to us and they’ve already been doing insemination procedures. Sometimes they’ve even done IVF procedures. But if we meet a patient and she’s never done any fertility treatment, then we are going to use all the information that we learn about her ovaries and her ovulation and her fallopian tubes and help determine what is the best next step.
With an insemination procedure, we are essentially assuming that the sperm and the egg will meet in a fallopian tube and woman will be able to get pregnant on her own. We’re just helping the egg a little and helping the sperm a little. With IVF, we are actually collecting the eggs and working with them outside of her body to help sperm and eggs come together and then putting an embryo back inside the uterus. So, the treatments are very different. Success rates are very different, and indications are different in terms of when would a patient use IUI versus when would she be a great candidate for IVF.
Host: And I imagine the time requirements are also quite different. Like for insemination, I’m imagining that it’s a much shorter time period than IVF. Is that correct?
Dr. Wachs: You’re exactly right. So, an insemination cycle which is generally about 28 to 30 days; could very easily be an ultrasound appointment in the mid cycle time period when a woman should be ovulating and then an appointment one to two days later for the insemination. If she’s using donor sperm, it’s thawing sperm on the day of that insemination and if she’s got a male partner; it is a sperm collection from her partner that day. And then approximately a two hour sperm prep. Then two weeks later, it’s a pregnancy test. So, the time commitment and the number of appointments is pretty low.
Host: Yeah, it seems really just like a couple days in total. But for IVF, for example, how frequent are the appointments and what is the flexibility in scheduling?
Dr. Wachs: So, with IVF, we are doing a lot more. We’re actually taking over a woman’s cycle and we’re helping a large group of eggs grow, rather than just doing an ultrasound to make sure we have the timing correct for her ovulation the way we are in an insemination cycle. So, with IVF, we generally tell our patients to anticipate four to five ultrasounds in about a ten day period. That ten day period is the timeframe when she’s taking shots each day to help the eggs grow and the ultrasounds that we do over the course of those days help us to measure the follicles and we do a blood test that measures the estrogen level as it’s rising and those two factors, the ultrasounds and the blood tests let us know when those eggs should be mature and when we are ready to schedule the egg retrieval procedure.
So, the appointments are very, very important to getting the timing correct for an IVF cycle and that’s why they are more frequent. There is some flexibility with when to schedule them in terms of hours. We do our best to work with our patients. In the Bay area we have a large, large subset of patients who work. Many of our patients have jobs with little flexibility in terms of time off. They sometimes have travel involved or our patients may manage a big team which prevents them from being able to come and go throughout the day.
We start very early in the morning. We try to start our ultrasound and blood draw appointments as early as 7 o’clock in the morning. That way many patients can be done at our office and still make it to work on time. But there are certain appointments that may have to fall during the work hours. We try to give as much notice as possible. And there is some flexibility but once you are in the middle of an IVF cycle; there are certain days where we absolutely will need you to come in.
Host: Yeah, it does sound like once you start the process, you kind of need like the around ten days of time where you are able to come in and like you said, while there’s some flexibility in how early they can come in, sometimes it may require a woman take a day or two off work to make sure that they are hitting those appointments because they are so important. Is that correct?
Dr. Wachs: Yes, we generally can map out a cycle for a woman, give her a sample calendar so she can see when is that time period where she should plan to be more available. We ask our patients don’t plan an IVF cycle when you have a huge project at work, or you are giving a huge presentation because you know that’s going add to the stress of what is already a stressful time period. Because the treatment is allowing you to be living your normal life; most patients don’t actually have to take time off from work except for two days. The day of the egg retrieval procedure. We will ask a patient not to work. And the day that we do an embryo transfer is the second day that we will ask a patient not to work. But otherwise, throughout the whole treatment, most of our patients continue to live their regular lives.
Host: Yeah and you mentioned about how a woman might feel with all the different stress levels that they’re experiencing and not to potentially schedule something during a big project, but a lot of women may not necessarily have a choice in that. So, they may be thinking that I’ll just be able to get this done while I’m getting the treatment. Talk a little bit about how a woman might expect to feel while undergoing treatment and will they feel like themselves? Will they feel like they need potentially more support from their partner? Talk a little bit about that.
Dr. Wachs: So, the – for IVF in particular, patients will generally fell like themselves, but they will feel bloated. We know that when we help a group of eggs grow because it’s more than one egg ovulating, which is what a woman is used to, she will feel bloated. But patients always ask are they going to be an emotional wreck, are they going to not be able to concentrate? And most patients at the end of their cycle really do say they felt completely normal throughout. So, I would say for IVF, I tell patients plan that you will be able to do your normal daily activities but from a physical standpoint; you will have a little bit more discomfort around that midcycle timing as the eggs are close to being ready. But you make a great point, talking about the support part of it, because that’s huge and that’s sometime unexpected for patients. They are focusing on having to use needles and have these appointments and take these medications, but they are not always anticipating what are they going to need from both their partner, their friends and even at work.
I’ve been surprised at the number of patient who felt like they couldn’t talk about it at work because they didn’t want to divulge that they were having trouble getting pregnant or they certainly didn’t want to talk about doing treatment that was going to lead to a pregnancy because they weren’t sure how their employer was going to react. But I’ve been really amazed at the number of patients who said once they did talk to people at work; they were surprised at how many people were in similar situations either needed to do fertility treatments themselves or had been in friendships where they’d supported someone going through it.
So, if find, for a lot of patients, it ends up being really beneficial to seek support from the people around you and quite often, it’s the people at work who you are spending a big, big percentage of your time with. But also seeking support from your partner and or your friends during this time can also make a big difference. Because it’s a lot to hold in and it’s a lot to carry yourself.
Host: Yeah, certainly. I think that’s really good advice to seek support of those around you because you might be surprised of how many people might be going through the exact same thing. And just in wrapping up here, I’m curious, what do you wish that more women knew before they came to you to seek fertility treatment? We’ve talked about a lot of things today, but I’m sure you see common patterns over time, maybe different types of emotional states. So, maybe talk a little bit about yeah just something that you wish more women knew before they came to see you.
Dr. Wachs: I’m so glad you asked that because this is a great chance for me to be able to say it. So, I think that nowadays, with people in general being far more open about what they are going through, whether it’s on social media or just talking about it openly and with Google and patients looking things up on the internet. I think that patients often psyche themselves out before they even walk in the door. They hear one bad story from a friend, or they look one thing up on the internet that sets them off and they either won’t come in or they come in with sort of a preconceived idea of what it is we’re going to say to them or what it is we’re going to tell them they need to do.
And sometimes, if they’ve been trying to get pregnant for a very long time; they are almost afraid to come in because they feel like once they come in, if we don’t have great news for them, that’s the end of the road. And so, I wish patients came in either a little bit earlier before they have worked themselves into a tizzy or just with an open mind to know that sometimes all we’re going to say is let do some testing and if your testing looks fine; you may be a great candidate for getting pregnant on your own or getting pregnant with some of our easier treatments. And even if we are saying to you, we think you’re going to need to do IVF; for most patients, doing IVF is a very, very successful treatment. So, it doesn’t have to be seen as a failure that a woman is being recommended towards an IVF cycle but rather as a very successful way that she will finally be able to achieve a pregnancy.
Host: All right Dr. Wachs, well I know that people listening will appreciate that clarity and those supportive words. That’s Dr. Deborah Wachs, a Reproductive Endocrinologist at the Reproductive Science Center of the San Francisco Bay Area. Thanks for checking out this episode of Fertile Edge. And for more information please visit www.rscbayarea.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.
Prakash Chandran (Host): If you’re struggling with infertility and need help getting pregnant, there are fertility treatments that can help increase your chances of having a baby. But how much time will it take out of your busy schedule? We’re going to talk about it today with Dr. Deborah Wachs, a Reproductive Endocrinologist at the Reproductive Science Center of the San Francisco Bay Area.
This is Fertile Edge, a podcast by the Reproductive Science Center of the San Francisco Bay Area. I’m Prakash Chandran. So, Dr. Wachs, why don’t you start by telling us the most common types of fertility treatments that there are.
Deborah Wachs, MD, REI (Guest): Two big categories of fertility treatment, the first is called IUI which stand for intrauterine insemination and the second is IVF which stands for in vitro fertilization. And when we talk with patients, usually we are guiding them to either IUI cycles or IVF cycles.
Host: Okay so let’s talk about the time required in each of these treatments and when a patient might start getting the process started.
Dr. Wachs: Okay so, at the first visit, when we see a patient, we take a detailed history, we find out how long they’ve been trying to get pregnant, what testing they’ve done, and have they done any treatment before. Sometimes patients come to us and they’ve already been doing insemination procedures. Sometimes they’ve even done IVF procedures. But if we meet a patient and she’s never done any fertility treatment, then we are going to use all the information that we learn about her ovaries and her ovulation and her fallopian tubes and help determine what is the best next step.
With an insemination procedure, we are essentially assuming that the sperm and the egg will meet in a fallopian tube and woman will be able to get pregnant on her own. We’re just helping the egg a little and helping the sperm a little. With IVF, we are actually collecting the eggs and working with them outside of her body to help sperm and eggs come together and then putting an embryo back inside the uterus. So, the treatments are very different. Success rates are very different, and indications are different in terms of when would a patient use IUI versus when would she be a great candidate for IVF.
Host: And I imagine the time requirements are also quite different. Like for insemination, I’m imagining that it’s a much shorter time period than IVF. Is that correct?
Dr. Wachs: You’re exactly right. So, an insemination cycle which is generally about 28 to 30 days; could very easily be an ultrasound appointment in the mid cycle time period when a woman should be ovulating and then an appointment one to two days later for the insemination. If she’s using donor sperm, it’s thawing sperm on the day of that insemination and if she’s got a male partner; it is a sperm collection from her partner that day. And then approximately a two hour sperm prep. Then two weeks later, it’s a pregnancy test. So, the time commitment and the number of appointments is pretty low.
Host: Yeah, it seems really just like a couple days in total. But for IVF, for example, how frequent are the appointments and what is the flexibility in scheduling?
Dr. Wachs: So, with IVF, we are doing a lot more. We’re actually taking over a woman’s cycle and we’re helping a large group of eggs grow, rather than just doing an ultrasound to make sure we have the timing correct for her ovulation the way we are in an insemination cycle. So, with IVF, we generally tell our patients to anticipate four to five ultrasounds in about a ten day period. That ten day period is the timeframe when she’s taking shots each day to help the eggs grow and the ultrasounds that we do over the course of those days help us to measure the follicles and we do a blood test that measures the estrogen level as it’s rising and those two factors, the ultrasounds and the blood tests let us know when those eggs should be mature and when we are ready to schedule the egg retrieval procedure.
So, the appointments are very, very important to getting the timing correct for an IVF cycle and that’s why they are more frequent. There is some flexibility with when to schedule them in terms of hours. We do our best to work with our patients. In the Bay area we have a large, large subset of patients who work. Many of our patients have jobs with little flexibility in terms of time off. They sometimes have travel involved or our patients may manage a big team which prevents them from being able to come and go throughout the day.
We start very early in the morning. We try to start our ultrasound and blood draw appointments as early as 7 o’clock in the morning. That way many patients can be done at our office and still make it to work on time. But there are certain appointments that may have to fall during the work hours. We try to give as much notice as possible. And there is some flexibility but once you are in the middle of an IVF cycle; there are certain days where we absolutely will need you to come in.
Host: Yeah, it does sound like once you start the process, you kind of need like the around ten days of time where you are able to come in and like you said, while there’s some flexibility in how early they can come in, sometimes it may require a woman take a day or two off work to make sure that they are hitting those appointments because they are so important. Is that correct?
Dr. Wachs: Yes, we generally can map out a cycle for a woman, give her a sample calendar so she can see when is that time period where she should plan to be more available. We ask our patients don’t plan an IVF cycle when you have a huge project at work, or you are giving a huge presentation because you know that’s going add to the stress of what is already a stressful time period. Because the treatment is allowing you to be living your normal life; most patients don’t actually have to take time off from work except for two days. The day of the egg retrieval procedure. We will ask a patient not to work. And the day that we do an embryo transfer is the second day that we will ask a patient not to work. But otherwise, throughout the whole treatment, most of our patients continue to live their regular lives.
Host: Yeah and you mentioned about how a woman might feel with all the different stress levels that they’re experiencing and not to potentially schedule something during a big project, but a lot of women may not necessarily have a choice in that. So, they may be thinking that I’ll just be able to get this done while I’m getting the treatment. Talk a little bit about how a woman might expect to feel while undergoing treatment and will they feel like themselves? Will they feel like they need potentially more support from their partner? Talk a little bit about that.
Dr. Wachs: So, the – for IVF in particular, patients will generally fell like themselves, but they will feel bloated. We know that when we help a group of eggs grow because it’s more than one egg ovulating, which is what a woman is used to, she will feel bloated. But patients always ask are they going to be an emotional wreck, are they going to not be able to concentrate? And most patients at the end of their cycle really do say they felt completely normal throughout. So, I would say for IVF, I tell patients plan that you will be able to do your normal daily activities but from a physical standpoint; you will have a little bit more discomfort around that midcycle timing as the eggs are close to being ready. But you make a great point, talking about the support part of it, because that’s huge and that’s sometime unexpected for patients. They are focusing on having to use needles and have these appointments and take these medications, but they are not always anticipating what are they going to need from both their partner, their friends and even at work.
I’ve been surprised at the number of patient who felt like they couldn’t talk about it at work because they didn’t want to divulge that they were having trouble getting pregnant or they certainly didn’t want to talk about doing treatment that was going to lead to a pregnancy because they weren’t sure how their employer was going to react. But I’ve been really amazed at the number of patients who said once they did talk to people at work; they were surprised at how many people were in similar situations either needed to do fertility treatments themselves or had been in friendships where they’d supported someone going through it.
So, if find, for a lot of patients, it ends up being really beneficial to seek support from the people around you and quite often, it’s the people at work who you are spending a big, big percentage of your time with. But also seeking support from your partner and or your friends during this time can also make a big difference. Because it’s a lot to hold in and it’s a lot to carry yourself.
Host: Yeah, certainly. I think that’s really good advice to seek support of those around you because you might be surprised of how many people might be going through the exact same thing. And just in wrapping up here, I’m curious, what do you wish that more women knew before they came to you to seek fertility treatment? We’ve talked about a lot of things today, but I’m sure you see common patterns over time, maybe different types of emotional states. So, maybe talk a little bit about yeah just something that you wish more women knew before they came to see you.
Dr. Wachs: I’m so glad you asked that because this is a great chance for me to be able to say it. So, I think that nowadays, with people in general being far more open about what they are going through, whether it’s on social media or just talking about it openly and with Google and patients looking things up on the internet. I think that patients often psyche themselves out before they even walk in the door. They hear one bad story from a friend, or they look one thing up on the internet that sets them off and they either won’t come in or they come in with sort of a preconceived idea of what it is we’re going to say to them or what it is we’re going to tell them they need to do.
And sometimes, if they’ve been trying to get pregnant for a very long time; they are almost afraid to come in because they feel like once they come in, if we don’t have great news for them, that’s the end of the road. And so, I wish patients came in either a little bit earlier before they have worked themselves into a tizzy or just with an open mind to know that sometimes all we’re going to say is let do some testing and if your testing looks fine; you may be a great candidate for getting pregnant on your own or getting pregnant with some of our easier treatments. And even if we are saying to you, we think you’re going to need to do IVF; for most patients, doing IVF is a very, very successful treatment. So, it doesn’t have to be seen as a failure that a woman is being recommended towards an IVF cycle but rather as a very successful way that she will finally be able to achieve a pregnancy.
Host: All right Dr. Wachs, well I know that people listening will appreciate that clarity and those supportive words. That’s Dr. Deborah Wachs, a Reproductive Endocrinologist at the Reproductive Science Center of the San Francisco Bay Area. Thanks for checking out this episode of Fertile Edge. And for more information please visit www.rscbayarea.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.