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Caitlin Whyte: Jumping into the world of fertility treatment can be a lot, a lot of time, a lot of money, and a lot of learning new words and acronyms. We here at All Things Fertility are breaking down the top 10 questions asked by fertility newbies. If you miss the first five, you can find that podcast in our feed. But here is the rest of that list. Dr. Schulte, so you know we're working through the timeline here. I know I want a baby, now I know I need infertility specialists care. What should I look for in a fertility center in general?

Dr. Schulte: What patients should look for in a fertility center is first and foremost, they need to be comfortable with who they're seeking care from. So having a physician who listens, understands concerns, and that you have a good rapport with, I think is the biggest part of going through this fertility journey. From a sub-specialist standpoint, your fertility specialist should be fellowship trained in reproductive endocrinology and infertility. So what that means is that they completed medical school and then they completed OB GYN residency, and then they completed a three year sub-specialty fellowship in reproductive endocrinology and infertility, which focuses on assisted reproductive technology and all reproductive endocrinology in general. So they are, you know, well-versed and trained to actually help you with this process. And then I think it's really a feel, you need to get a feel for the actual center that you're going to be going to because you're going to be spending a lot of time there.

So meeting with the physician, meeting with the nurse, having points of contact and feeling comfortable where you're getting your care is huge. So I think that, you know, taking the time to choose wisely is really important when you are seeking that initial step because you need to be confident in the people who are taking care of you. So that's from their background, their training and how they make you feel. And then know who you're going to be seeing when you're coming into the center, and who's going to be making your decisions behind the scenes for your IVF cycle or your IUI treatment. The other point to think about is that you want a center that gives individualized care and what that means is they truly look at you and what you are going through and your reason for seeking care for fertility treatments, and take all of that into account and develop a personalized individualized plan in order to best help. So I think that is a huge component so that it doesn't, you're not just feeling like you have a protocol placed on you, as does everybody who walks through the door, that they actually are tailoring treatment to you and your medical history.

Dr. Dayal: I mean, I think if a practice, and I was going to say, just to answer the next question, you know, when is it time to transfer to another center? I mean if there's a practice that is making repeated errors over and over and over again, and they're not making any, taking any steps to make things better or make or make it easier for that individual, that could be a reason to change clinics. Because a lot of mistakes unfortunately, are not, they're not done maliciously and they're not done for any bad reason. But it just makes you wonder if they're on top of their game. It's tricky because it's true. I mean, not every practice is going to be perfect and you know, there are going to be things that might be inadvertently overlooked and there might be things that occur that with without control from anyone. And yet, you know, everybody has, you know, the, the patients or the couple’s best intentions at heart. And it's just to remember that everybody is striving for the same goal. We all want that patient or a couple to have a pregnancy and have a family.

Dr. Schulte: Time to transfer care when you're not being listened to and you feel like you're not being heard, right. And you're not being respected, you're no longer feeling comfortable. Yeah.

Host: Now a little trivia question, I guess Dr. Schulte, what is ovulation induction?

Dr. Schulte: Ovulation induction is used in patients who are anovulatory or not releasing an egg from their ovary. And there are certain medications that we can use to initiate this process. So those medications, some of them are oral, so Clomid or Letrozole. And they essentially just help your ovary develop a dominant follicle in order to release an egg to get pregnant. And then otherwise we can use injectable medications called gonadotropins. So these are shots and those are a little stronger and they will recruit multiple follicles in order to get pregnant.

Host: Rounding out our top 10 here, you know, we're going to get back into some general definitions and acronyms. All right, so Dr. Dayal, what is IUI and IVF?

Dr. Dayal: So intrauterine insemination is the most commonly used fertility treatment in the world. Basically it is based on the premise that when a couple has sex, you know, sperm is ejaculated and seminal fluid coats the cervix of the uterus, and then the sperm are supposed to travel through the cervix, through the uterus, go into the fallopian tube, find that egg and hopefully fertilize it. What IUI does is it bypasses some of that process. What we do is we either take a partner sample or even a donor sperm sample, and after preparing it, we basically take millions and millions of sperm and literally gently place the sperm into the uterus. So what we've done effectively is we have reduced sort of the filtering process of the vagina and the cervix. Most of an ejaculate during intercourse is actually lost in the vagina. Most of that sperm, you know, out of the millions and millions of sperm that are typically ejaculated, only a few million are getting in.

So what we do with IUI effectively is we can take even more sperm, super concentrate them, and then put them into the uterus and it actually decreases the distance that the sperm has to travel. In addition, by washing the sperm, those sperm actually are more like there's a higher proportion of them that are able to move forward. So again, when an ejaculation occurs, you have both dead and alive sperm being ejaculated. When you do an insemination, they're being prepped in such a way that the vast majority of them are now living and viable and they're swimming. So what we're doing is we're actually just enhancing the chance of getting pregnant by getting the sperm a little bit closer to that egg or to those eggs that are being released.

Host: And then how is that process different from IVF?

Dr. Dayal: So invitro fertilization or IVF is significantly different. Typically with an insemination, we are either having multiple eggs being produced again with, as Dr. Schulte was mentioning, with either Clomid or Letrozole or fertility injections. But with IVF, what we're trying to do is out of the total number of eggs that are available that month, we're trying to get as many as we possibly can with the limitation of safety. You know, we just want to make sure this is done safely. Perhaps a woman has 20 eggs and we're trying to get let's say 14 or 15 of them. So in order to do that, their medications that they're going to be taking is going to be vastly different. We don't want just two or three to develop, so we have to give them medications over the course of two to three weeks in order to what we call recruit a bunch of follicles or eggs to grow. If you think of a 28 day cycle, which is a sort of a typical monthly cycle, most women will ovulate on day 14.

So it takes about two weeks to ovulate or to get one mature egg. The same thing happens with IVS. It takes anywhere from 10 to 14 days to develop all of the eggs that they're going to be developing that month with these special medications. And after we follow them for those several days, what we do is we then go in for an egg retrieval. And an egg retrieval takes about 20 to 30 minutes to do. It's done with anesthesia, so a woman is completely asleep and it's all done vaginally, so there are no stitches or incisions on their stomach. And once we are able to harvest their eggs, the invitro is actually when we take the eggs and we fertilize those eggs with sperm. And the sperm that's used can either be their partner sperm or donor sperm and that magic happens in the laboratory, and after the egg and sperm come together and they form embryos, we allow them to develop over the course of five to six days. Unfortunately, again, as Dr. Schulte was mentioning, there's an attrition along the way, but as they grow to blastocyst we can actually then take a blastocyst and transfer that embryo back into a woman's uterus or womb in order for her to get pregnant.

IVF is much more successful than IUI because IVF actually allows us to physically have an embryo made. We know we're using an embryo when this woman is trying to get pregnant. With an insemination, what we don't know is we don't know when we release the sperm within the uterus, you know, are the sperm able to even get to where the eggs are? Are the sperm and eggs able to connect and form an embryo? Is that embryo developing and is that embryo even making it to the uterus? So there's a whole bunch of steps that take place with IUI or that need to take place with IUI in order to be successful. The same holds true with IVF, but it's a much more controlled environment and we're actually doing our best to make it happen. So when you have embryos to work with the other, you have no idea if an embryo is being formed.

Host: Well ladies, thank you so much for your time. I think we're going to have some great shows because I have a lot of questions about fertility and the female body. To learn more about the team at Saram St. Louis or to schedule an appointment, visit stlouisfertilitycenter.com.if you enjoyed this podcast, find more like it in our podcast library and be sure to give us a like and a follow if you do. This has been All Things Fertility. I'm your host, Caitlin Whyte and we'll catch you next time.