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Understanding Infertility

Navigating infertility can be a challenging and emotional experience, but understanding the underlying processes and available treatments can empower you along your journey. Altru is dedicated to providing comprehensive support and education to individuals facing infertility.

The Menstrual Cycle

The menstrual cycle is a monthly process to prepare for pregnancy. It starts on the first day of bleeding and ends with the first day of bleeding in the next cycle. The “perfect” cycle is 28 days, but most women don’t have a 28-day cycle. 

What happens during your cycle? 

  • Day One: Uterine lining sheds (full flow bleeding).
  • Mid Cycle: Egg releases from the ovary to a fallopian tube (ovulation). Progesterone levels increase after ovulation. Some women have ovulation disorders.
  • Luteal Phase: Progesterone peaks. Your provider may order a progesterone lab to check if ovulation occurred.
  • End of Cycle: If pregnancy isn’t achieved, progesterone and estrogen levels decline, and the uterine lining sheds, starting the next cycle.

Infertility Workup

The following steps are essential components of an infertility workup, designed to identify potential causes and guide appropriate treatment options:

  1. Baseline Labs - Ordered before diagnostic procedures. Some labs are time-sensitive and may be ordered for a specific day
  2. Semen Analysis - Checks for abnormalities in your partner’s semen. Completed at Altru Hospital. Specific instructions will be given when ordered.
  3. Pelvic Ultrasound - Transvaginal ultrasound to check the uterus and ovaries.
  4. HSG (Hysterosalpingography) - X-ray to check if fallopian tubes are open and view the inside of the uterus. Time-sensitive, done before ovulation.
  5. Saline Sonogram (SIS/Sonohysterography) -  Ultrasound to check the endometrial cavity (inside the uterus). Structural issues like fibroids or polyps. Many tests and treatments aren’t covered by insurance. Call your insurance company to discuss coverage and options.  

Infertility Treatments 

  • Clomid (Clomiphene) - Oral Medication - Stimulates ovulation. Started on day 3, 4, or 5 of your cycle and taken for five days. Your provider will discuss risks and benefits.
  • Femara (Letrozole) - Oral Medication - Stimulates ovulation. Started on day 3, 4, or 5 of your cycle and taken for five days. Your provider will discuss risks and benefits.
  • Progesterone Lab Draw - Checks progesterone levels seven days after peak ovulation to indicate successful ovulation. Time-sensitive lab.
  • OPKs (Ovulation Predictor Kits) - Daily urine test to check peak ovulation (some providers may have you test twice daily). Helps time intercourse around peak ovulation.
  • Follicle Study (Ultrasound) - Transvaginal ultrasound to check the status of your follicles (potential eggs). Determines effectiveness of ovulationstimulating medications (if used). Ensures a safe number of follicles before further interventions (to prevent multiple pregnancies). You’ll see a health coach afterward to discuss results, plan, and ask questions.
  • Timed Intercourse - Have intercourse around your peak ovulation day. Every day or every other day, as advised by your provider. Start at least five days before you could ovulate, as sperm can live in the uterus and fallopian tubes for up to five days.
  • Trigger Shot (Ovidrel/Choriogonadotropin) - Helps trigger ovulation for women with ovulation problems. Given after a follicle study to prepare for timed intercourse or IUI. Ovulation usually happens 24-36 hours after the shot.
  • IUI (Intrauterine Insemination) - Healthy sperm is placed in the uterus near ovulation time. Can be done with or without ovulation stimulation, using partner or donor sperm.
  • Provera (Medroxyprogesterone) - Synthetic hormone to help with abnormal or missed periods. Starts a period. May be prescribed if you go 35 days or longer without a cycle and have a negative pregnancy test.
  • REI (Reproductive Endocrinology and Infertility) - Referral Some insurances require referrals to REI. Suggested if pregnancy isn’t achieved after several cycles. We can refer you to an REI clinic of your choice. Research which facility suits your needs. REI clinics offer IVF and other advanced treatments.

Helpful Tips

Follow your provider’s instructions carefully. Ask questions and feel comfortable with your plan. We’re here to help. If you reach day 35 of a cycle without a period and have a negative pregnancy test, let us know.

Interfertility Health Coaches at Altru.

Meet your Health Coaches 

Tawni and Kayla work closely with your provider to communicate and coordinate your plan for each cycle. They’ll communicate directly with you to ensure you understand your plan.