Say What?: Demystifying Fertility Talk
If there were any advice we could start you out with as you consider a co-collaborative fertility preservation journey it would be don’t be afraid to ask questions. There are so many terms associated with female reproductivity and wellness that are not a part of most people’s lexicons. Some of this language has a frightening and overwhelming sound to it, for real. We’re not so close to it that we can’t see that! Or hear that. As you work with our doctors and Fertility Coaches, our doors are always wide open for question and answer exchanges. But there are times, perhaps alone at night by the dim light of your computer, that you need some explanations and help sifting through the scariness of this fertility speak stat. Like, now.
The fertility bible is our FAQ, which you can always access when you need it. Most importantly, we love providing you with these somewhat simplified terminology posts and tutorials so you and your doctor can speak a similar language. Don’t worry – our doctors make sure to speak clearly and go over the fertility lexicon until you’re comfortable. But sometimes some Cliffs Notes to interpreting your doctor can make the process even more meaningful and enjoyable. Following are some of the more commonly overwhelming bits of information, we hear. We’ve tried to break this down in some bite-sized ways.
So, what is fertility exactly? Sometimes the most basic questions are the hardest to define.
Fertility is the ability to produce a child, essentially. For women, it’s producing fertile eggs. For men, fertility means having sperm that can fertilize an egg. Age, genetics, environment, lifestyle, and a variety of other things impact fertility.
What medications will I be taking during egg freezing so I can Google the hell out of them? Well, here is an overview:
- Gonal-F – Follicle Stimulating Hormone (FSH) to stimulate multiple eggs to grow
- Low dose hCG or Menopur – contains Lutenizing Hormone (LH) used in conjunction with FSH to stimulate multiple eggs to grow
- Lupron, Ganirelix, or Cetrotide – provides spontaneous ovulation before egg retrieval
- Lupron trigger or hCG (Ovidrel, Pregnyl, Novarel) – Medication given exactly 36 hours prior to egg retrieval; stimulates final maturation of eggs
What’s my Ovarian Reserve? You will definitely hear this term quite a bit.
Ovarian Reserve is a term that’s used to determine the ability of the ovary to provide egg cells capable of fertilization, resulting in a hopefully healthy and successful pregnancy.
Now, let’s bring out some big gun terminology. Here are the individual fertility tests we use to determine a woman’s Ovarian Reserve (OR):
- Day 3 Follicle Stimulating Hormone (FSH): The pituitary – a pea-sized endocrine gland situated right behind the bridge of the nose – is responsible for the production of FSH. High levels of FSH, determined through a blood test, indicate that the hypothalamus and pituitary gland are working overtime to stimulate a depleted egg supply. As a basis of comparison, a normal FSH count is well below 10. If a patient’s FSH is above 10 on day two or three of her cycle, there may be a decline in ovarian reserve. Multiple studies have shown that women with high FSH values experience lower conception rates when participating in fertility treatments such as In Vitro fertilization. Because FSH levels fluctuate month to month, additional testing might be warranted if levels are higher than expected.
- Anti-Mullerian Hormone (AMH): This blood test is considered to be the most accurate predictor of a woman’s egg supply, particularly when compared to FSH, which can fluctuate month to month. Timing-wise, the AMH test also isn’t dependent on a specific day of the menstrual cycle. Anti-müllerian, a protein hormone, is secreted from small antral follicles located in the ovaries at the start of the cycle. A higher AMH level is indicative of a larger number of antral follicles and a strong ovarian reserve, while a lower AMH may lead to the opposite conclusion, e.g. a low egg count
- Resting (Antral) Follicle Count: Conducted via a trans-vaginal ultrasound at the start of a woman’s period, this test allows doctors to count the number of resting/unstimulated ovarian follicles. Should the patient have a low number of resting follicles, fertility medication may not be as effective. Ideally, there are more than 10 follicles per ovary.
- Estrogen: There are three types of estrogen, all of which are responsible for female sexual development and function: Estrone (E1), Estradiol (E2) and Estriol (E3). Levels are measured by a blood test. Of the three, Estradiol is the most common among non-pregnant women. Estriol is usually only measured during pregnancy.
What is egg harvesting? What is egg extraction?
This is the actual process of egg retrieval. This is a very brief, minimally invasive surgical procedure. By using an ultrasound to identify your ovaries, our doctors will gently guide a needle attached to a catheter through the vaginal wall, and the viable eggs will be drawn out. After they are collected, they are then prepped for cryopreservation.
Cryostorage sounds like sci-fi. Can you walk me through it?
This is a pretty cool process where eggs can be preserved by cooling to very low temperatures (typically −80 °C using solid carbon dioxide or −196 °C using liquid nitrogen). This is what happens to your eggs after they’ve been retrieved and before you are ready to unfreeze them and attempt implantation.
What do you think? What else can we tell ya?
Your Trellis Family