For me, fertility treatment (which I really want to rebrand as "fertility care" because the word treatment makes me cringe) often feels like this specific Eight of Swords from the Tarot del Fuego. This feeling of being blindfolded (aka never knowing what's going on), while being poked and probed continuously.. There is also this sense of giving away my power and putting all my trust in someone else's authority. The strength needed isn't so much of brutal force, but rather a quiet resilience that would keep me afloat.
If you are curious about fertility treatment, here is a short description of what happened during my very first month. Please note: We are a heterosexual couple and this is written from my perspective only. I used to have on average a 35-day cycle, which you will see reflected in the scheduling. Every clinic has its own terminology and policies.
Typically doctors will refer patients to a fertility clinic when they have been Trying To Conceive (TTC, yes that’s a real acronym) for at least six months naturally, without success. That’s really an average. Some doctors may wait up to a year, others will take less time. As for moi, I began consulting with a nurse for general bloodwork (to make sure everything was good) and after five months of that I went ahead with the referral.
So what happens after a referral is submitted? I waited about two weeks to receive the initial phone call. The new patient advisor asked some preliminary questions and emailed me a few evaluation forms and documents to peruse. Shortly after, a first consultation with the fertility doctor was scheduled. This was an opportunity to “phone meet” the doctor and ask questions about health concerns and procedures. Then, on Day 1 of the next cycle (that’s the first day of bleeding) after this meet-and-greet, I called the clinic to schedule a Day 3 appointment for myself and my partner. This cycle is the investigative cycle, where we are screened for various medical conditions.
The tests for me included blood screening (about 5-6 vials), urine test, and pelvic ultrasound. This last one requires you to drink 1L of water an hour before and to hold your bladder until the transabdominal exam is over. (Pro tip: If your appointment is very early in the morning, just hold your morning pee.) It is then followed by the transvaginal ultrasound, equally pleasant. When they did the bloodwork, they also included the Anti-Mullerian Hormone (AMH) test. For my partner, it was blood screening and urine testing, in addition to semen analysis. And that was it for him, lucky guy. The rest was on me.
A week after that, once bleeding has stopped around Day 10, a follow-up appointment for bloodwork (1 vial) and transvaginal ultrasound (empty bladder) was scheduled. This really is the winning combo: bloodwork + ultrasound. This is what to expect at every appointment for the rest of the cycle. Day 10 was also the time for a sonohysterogram and a long overdue pap smear. The purpose of this appointment of bloodwork + ultrasound was to look at follicle development.
Around Day 12, bloodwork + ultrasound was again scheduled in order to predict ovulation. This is when the clinic gave us green light for intercourse. The nurse recommended every other day, but our doctor wanted us to try every.single.day. Long gone are the sexy days, let me tell you. But fear not, for here comes another appointment for bloodwork + ultrasound! This took place around Day 15 to confirm the release of the egg. More timed intercourse, please.
After all of this we got a little break. A two-week break in fact. The infamous two-week wait, which I’ve seen abbreviated as 2WW. The first time I read that very quickly, my brain thought it was WW2. And maybe it was like that internally, a war waging between Team Hope and Team Anxiety. Once the wait was over, a blood test was scheduled to confirm pregnancy. It was Day 31 for that first cycle. The result was negative. At that point, a review was scheduled with the doctor. I always received the results of my tests on the same day, but here is when the doctor summarized all the results again and made recommendations.
For me, since it was a case of unexplained infertility (aka they couldn’t find anything as per the diagnostic tests, which excludes looking at the egg under microscope), the recommendation was medication, or medication with IUI. They only briefly mentioned IVF but didn’t think it was necessary, at least for now. For other health situations, it may be possible that IVF is recommended right away. For my second cycle, I chose to continue with only monitoring and went through the entire process again (as above, without the diagnostic tests).
The continuous monitoring can quickly become overwhelming and isolating. Eventually I met with a therapist, which somewhat helped. It also takes a lot of time and energy and, depending where you are, you might also pay for many of those appointments. In Canada, all the tests of the investigative cycle are covered except for the AMH and the semen analysis (we have work insurance). My clinic sometimes also charges a consulting fee, depending on the type of cycle they are monitoring.
🌔 ♈
Featured deck: Tarot del Fuego (Ricardo Cavolo)