The Mommyish Definitive Guide To Infertility: Hysterosalpingograms and Fertility Medications

medicationsYou’ve been trying to get pregnant for a while now, with no success. You’ve met with your OB, or maybe even an a reproductive endocrinologist(RE). You and your partner have been poked and prodded like pin cushions, just to find out that you have infertility issues.Your doctor thinks medication is a good first step. After shedding some tears and taking some time to come to terms with your diagnosis, you still want to try and get pregnant. Here’s a guide to what may happen next.

Do I need any more tests before starting medication?

Just the facts:

If the test results indicate that the fertility trouble may stem from you and not your partner, your doctor may want to perform a hysterosalpingogram (HSG). An HSG is a procedure where the doctor will insert a thin tube into your uterus through your vagina. Then the doctor will flush dye through the tube to create contrast so that the structure of the uterus and Fallopian tubes are more visible. X-rays will be taken during the procedure for further study. You may have some spotting or leakage from the dye following the procedure. The procedure itself may feel like period cramps, and your doctor may prescribe Tylenol for you to take prior to the procedure.

The real deal:

Big shout out to awesome Mommyish commentator Abby for jogging my memory about the horror that is the HSG. I had wanted to write about intrauterine insemination (IUI) this week, but you can’t do a series on infertility justice without talking about the HSG ordeal. My mind had blocked out the entire incident, just like birth amnesia, which makes sense because I don’t think it’s too far off to say that the HSG feels much like a bad contraction. Look on the bright side- at least you’ll get a preview of what labor feels like. I was utterly unprepared for the HSG. My doctor prescribed some antibiotics for before and after, because there is a slight risk of infection since they are going deep into your uterus. I also took the Tylenol that was prescribed. Because the nurse told me I could drive myself, that the procedure only took five minutes and felt like period cramps, I stupidly went to the appointment alone.

I am no wimp when it comes to pain. I’ve danced on a sprained ankle, broke my own nose and handled third degree burns, so please don’t think I’m exaggerating when I say the HSG SUCKS. It is quick, so there’s that, but you know those really bad cramps where you can feel the tissue pulling off the walls of your uterus and you break out in sweats because the cramps are so strong? That’s what it felt like to me, only drawn out for five minutes with very few breaks between cramps. Yes, you can endure it and yes, the end game is worth it, but please be smarter than I was and bring someone with you to hold your hand. Make them drive and have them treat you to a yummy snack of your choice afterwards. And bring comfy pants. No one wants to put on anything tight or with a zipper after going through that. When my HSG was over I shakily got into may car, called my husband and sobbed. He left work immediately to come home, where he plied me with ice cream and heating pads. It was nice, but I still would have rather he’d been there to help me through the procedure.

How do fertility medications work?

Just the facts:

Two of the most common fertility medications prescribed are Clomid and Femara. Both medications work by stimulating the ovaries in hopes of helping them to ovulate. These medications are taken orally. Your doctor will give you strict dosing instructions, along with a list of possible side effects.

The real deal:

Please note that I am by no means a doctor. The most advanced medical training I have is my infant/child CPR certification. Therefore, please consult your doctor before taking these or any other medications. While I did not take either of these medications myself, there are numerous online forums discussing side effects of fertility medications. The most common complaints are hot flashes, headaches and feeling emotional.

A word on your dosing instructions. While it is important to try and maintain the schedule set forth by your doctor, try not to be irrational about it. When I was preparing for my IVF I was out to dinner one night and realized I had forgotten to take a pill an hour after it was scheduled. I had a Mariah Carey sized meltdown in the car. I was completely convinced that I had ruined my chances of the procedure working and had just thrown several thousand dollars out the window. In the end, I took the pill and everything worked out. Yes, your medication schedule is important, but life happens. If you forget to take a dose and are concerned, don’t hesitate to contact your doctor.

Will I have twins?

Just the facts:

According to WedMD, for women who get pregnant after taking Clomid, out of 100 pregnancies, about seven to ten of the pregnancies will be multiples, usually twins. Twin rates for pregnancies with Femara are lower, around three out of 100 pregnancies.

The real deal:

Of the people I know who have twins (5 people) two of them took fertility medications, two naturally conceived their twins and the fifth used IVF. I don’t think that five is a particularly statistically relevant number, but make of it what you will. My advice to you, if the thought of having twins scares you (and it shouldn’t because having twins is awesome) you may want to talk to your doctor and discuss your treatment plan.

What if the oral medication doesn’t work?

Just the facts:

Your doctor will monitor your ovulation and may try medications for several cycles before discussing a new treatment if the oral medications didn’t work. Common next steps are injection medications or intrauterine insemination (IUI), possibly in conjunction with medication.

The real deal:

If you are taking fertility medications, I wish upon you all the pregnancies your heart desires in a quick and healthy fashion. Trying to reduce stress while on the medications will help you feel better overall, so make it a point to take care of yourself. If the medications don’t seem to be working and your doctor wants to explore more invasive techniques, do you best to remember that you still have options and there are many ways to make a family.

Coming next week: Intrauterine Insemination and Injectable Medications, As Explained By Your Best Friend



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