What to Expect at Your First Fertility Consultation with Dr. Jacobs
Starting your fertility journey can feel scary and intimidating, yet also hopeful. Knowing what to expect can help ease anxiety and make you feel more comfortable before beginning this process.
With more than 45 years of experience, Dr. Laurence Jacobs has guided thousands of families through their fertility consultations. Here’s what to expect when you schedule yours:
First Steps:
You and your partner (if applicable) should plan to attend the first consultation together; it usually lasts about an hour.
What We’ll Review:
- Medical records and history, menstrual cycle, past surgeries or complications
- Lifestyle factors and any medical issues (for you or your partner)
After that, we’ll outline the infertility workup to determine why pregnancy isn’t happening. This includes:
- Hormone blood tests
- Diagnostic ultrasounds
- X-rays
- Semen analysis
5 Key Fertility Factors We Evaluate (you may have more than one)
1. Male Factor
- Semen analysis
- Sperm function test, including strict morphology, to identify if there is any difficulty in being able to fertilize an egg
2️. Ovarian Reserve (Egg Supply)
- On cycle days 2-4, you will come into the office so we can check your hormone levels, including AMH, which helps assess your egg supply.
- We’ll also do an antral follicle count transvaginal ultrasound to measure how many egg sacs (follicles) are present. The sonographer will count the antral follicles on both ovaries, looking for them to be 2-10 mm in diameter. The more follicles the better!
3️. Ovulation Evaluation
- Ovulation predictor kits, which look for a rise in a hormone called LH that tells us when you’re about to ovulate
- Ultrasound to check egg sac (follicle) size
- Follow-up progesterone test about a week later to confirm ovulation and assess if you have produced enough progesterone to be able to build up the lining of the uterus to get it ready for a pregnancy
4️. Uterine and Tubal Factors
- HSG, an X-ray using contrast dye, to view the uterus and fallopian tubes or a saline sonogram to check for fibroids, adhesions or polyps
- We also flush the fallopian tubes (part of the HSG) to make sure the fluid goes through the tubes so we know if the tubes look healthy and are functioning properly.
5. Pelvic Factors
- Check for adhesions from endometriosis, pelvic inflammatory disease or past surgeries
- Assessment for fibroids that could impact fertility
Next Steps:
After your workup (typically completed in a few weeks), we’ll schedule a follow-up appointment to review results, discuss medications and consider options like IUI or IVF if necessary. We’ll also recommend lifestyle changes to help support your fertility.
Ready to schedule?
Call us at 630-428-2229 or fill out this request form to get started.
About Dr. Laurence Jacobs
Dr. Laurence Jacobs is a Mayo Clinic fellowship-trained Reproductive Endocrinologist with over 45 years of experience helping thousands of families build their dreams through personalized fertility care.
Board-certified in Obstetrics and Gynecology, Dr. Jacobs brings deep expertise in IVF, PCOS, male and female infertility and second opinions for complex cases. After decades in leadership and practice, he is proud to provide consultations at Charles E. Miller, MD & Associates | CCRM Fertility’s Naperville office. Known for his compassionate approach and trusted by both patients and peers, Dr. Jacobs has been recognized nationally as a Top Infertility Doctor and consistently honored for his patient-centered care.
Patient Story- Chloe- Asherman's Syndrome
Today we are featuring Chloe’s patient journey with intrauterine adhesions. According to Dr. Miller, these adhesions are one of the hardest things to deal with in infertility. Chloe sought Dr. Miller’s help after a pregnancy loss and being diagnosed with Asherman’s syndrome, a condition where adhesions form inside the uterus. Dr. Miller performed surgery to remove the adhesions and Chloe participated in a clinical trial aimed to prevent the return of these adhesions. The surgery was successful and Chloe recently welcomed her daughter, Charlotte. We are so happy to have played a part in helping Chloe become a mother.
Check out Chloe’s story:
In September 2021 we found out that we were pregnant with our first baby and we were over the moon. Fast forward to January 2022 and we lost our little boy when I was 23 weeks pregnant. We were distraught and didn’t know what to do. On top of losing our baby I was then diagnosed with Asherman's Syndrome. According to the Cleveland Clinic, Asherman’s syndrome is an acquired condition where scar tissue (adhesions) form inside your uterus. The scar tissue can build up, decreasing the amount of open space inside your uterus. Women with Asherman’s syndrome may experience light or no periods, pelvic pain or infertility.
We weren’t very educated on this syndrome at the time, but later on found out that it would be difficult to get pregnant with Asherman's syndrome. I was told that I would need a hysteroscopy to get rid of these adhesions. A hysteroscopy is a procedure in which a surgeon inserts a thin, lighted telescope to see inside the uterus. Adhesions can be removed at this time.
I knew that I wanted to make sure I had the best doctor performing this procedure since my ability to have kids depended on it. I learned about Dr. Miller from my husband's cousin, who is a nurse in Park Ridge. At the end of 2022 I scheduled an appointment. Dr. Miller ended up performing the hysteroscopy and lysis of adhesions in March 2023. I took part in a clinical trial to get rid of my adhesions. The trial looked at the effect of a soft gel-like material, called Juveena™ Hydrogel, inserted into the uterus after the removal of adhesions to reduce the formation of adhesions again.
After my procedure the nurse told me that my adhesions were some of the worst she had ever seen. However, they felt like they had gotten all of them. I had a follow up a few months later where I was told everything looked good and I was ready to try for another baby.
In November 2023 I found out that I was pregnant again. My husband and I were very excited, but also nervous after everything we had previously gone through. Dr. Miller and his team were great from the moment I told them that I was pregnant. They got me in for a visit right away and started monitoring me until they felt I was in the safe zone.
In June we welcomed a sweet little girl named Charlotte into the world. We are so in love with our baby and so thankful to Dr. Miller and his team. If it wasn’t for him I truly don’t believe we would have Charlotte. I know if I have any issues in the future Dr. Miller would be the first person I would reach out to.
IVF Patient Journey- Karen
“I took time to educate myself about the IVF process. I started following some fertility accounts on Instagram and realized how big this community is. It’s the worst club to be a part of, but it has the best members!”
Today we are excited to introduce a new type of patient story to you. We will be sharing Karen’s journey and her efforts to become a mother. Karen had no reason to suspect she would have trouble conceiving until she tried for almost a year with no success. Now she is preparing to go through IVF and is ready to share the good, bad and the emotional with you. It is important to remember that each patient case is unique and Dr. Miller personalizes each treatment plan based on the patient’s age, medical history and test results. Here is Karen’s story:
My name is Karen and I am 38 years old, I have been married to my husband for four years and we live in Lombard with our sweet 5-year-old boxer mix, Cali. When my husband and I started trying for a family in 2021 and it wasn’t happening as quickly as I thought, I got worried. We both live a very healthy lifestyle, have clean bills of health and never thought we would have any issues trying to conceive. I had a ton of girlfriends that got pregnant very quickly, but then I also had several that went through IVF or were currently going through it. I didn’t know much about IVF because I tried not to let my mind think that would ever be an option for us. But then reality started to hit me. After eight months of no success, we decided that we needed to look into the IVF process and find a doctor.
I found Dr. Miller by doing some research on local doctors online through RE doctor websites. My friends who went through IVF all had different stories and different outcomes, with doctors all over the suburbs. My main concern was finding a clinic that didn’t make me feel like just a number. I wanted a doctor that had years of experience, would take the time to understand what we were going through and not push us through the consultation process. I also wanted to make sure there was a supportive nursing team that would be there for us during our journey. After our first meeting with Dr. Miller, I said to my husband, “Wow, this man is going to help get us our baby, I like him!”
After all the bloodwork, baseline ultrasound, HSN and semen analysis, we found out that my husband and I are both factors. Obviously my age was a huge factor and my husband had abnormal morphology, which made Dr. Miller suggest that we should go straight to IVF with ICSI (a method that involves injecting sperm directly into an egg to induce fertilization and pregnancy).
Actually hearing those words brought me to tears after we got off the call. I couldn’t believe we were going to have to go through this. A ton of questions went through my mind of why can’t I just be like everyone else, why can’t this be easy for us? I took time to educate myself about the IVF process. I started following some fertility accounts on Instagram and realized how big this community is. It’s the worst club to be a part of, but it has the best members! Finding girls that are currently going through the exact same process is a blessing. They totally know what you are going through and they feel your pains, the struggles and the wins.
Fast forward to October of 2022, and we were ready for our first round for egg retrieval. I started stims and was on a very basic protocol- menopur, follistim, ganirelix and double trigger shot. Once I got that big box of meds delivered, I was a little overwhelmed. Organizing, setting up my area where I was going to do the shots and going through the consultation with Nurse Patty, gave me the confidence that I was ready to take on the shots. I watched a ton of videos online of girls that were going through stims on Instagram to hype me up.
I had talked about the shots with my husband and showed him videos to get him ready for what I was going to be doing. I asked him (even though I knew I was going to be giving myself the shots) if he wanted to give me the shots and he said he would do them if I didn’t think I could. I let him know that he was off the hook with the stim shots, but that he would have to step up to give me the PIO shots once we got to that point in our journey.
To be honest, the shots were not that bad. Mixing and getting the shots prepped is the most hassle. I usually put on some music to sing along to as I am doing the shots to take my mind off what is going on!
I did ten days of shots and had my egg retrieval on November 3. I got six eggs! It was one more than I thought I was going to get. Results came the next day, that four matured and two fertilized with ICSI. Then we waited six more days to hear how those two did. On day 6, we received a message that only one made it to blast and a biopsy was being sent off for PGT-A testing.
We went through another long two week wait. I received the result that our only embryo was low mosaic- trisomy 1. It was heartbreaking to hear that our only embryo from our first egg retrieval had these results. We didn’t really understand what this meant, so we scheduled a follow up call with Igenomix with a genetic counselor to review the results. I am so glad we did, because after finding out what low mosaic really meant, we decided that we indeed were going to keep this embryo frozen. There might be some hope with this little embaby. After processing all this news, we knew that we had to get right back into another egg retrieval. When we first started this process, we were prepared with the possibility that we were going to have to do multiple egg retrievals based off of my test results.
At the end of November, we had our follow up consultation with Dr. Miller to review what happened and get his thoughts. He told us that this next round was going to be different and we are going to switch up the protocol now that we know what worked and what didn’t work. He gave us so much hope during that call, making sure to remind us that we are going to get our baby! Since I knew we would be starting the process again sometime in January, my husband and I just took the time to enjoy the holidays and not focus on IVF. It was a nice distraction.
Heading into round 2, I am excited and nervous. I am looking forward to seeing the end results with this retrieval since we are switching up my protocol. Even though I have been through this process once and I know what to expect, I have a feeling this path will be different and that’s ok. The main thing is that I have my support group to cheer me on, sending me positive vibes and prayers. Here we go round 2!
Stay tuned to follow Karen’s journey as she prepares for her second egg retrieval . She is excited to share her story with you and shed some light into the IVF process.
Patient Story- Breda
“Not everyone will understand IVF or be able to relate, so it’s important to surround yourself with support. More people than you realize struggle with infertility.”
Today’s patient story is from Breda. After not finding success or feeling comfortable at another fertility clinic, Breda came to us. We are all glad she did! Dr. Miller was able to diagnose her with endometriosis and after surgery and IVF, she was able to get pregnant. Breda is due in January!
Breda writes:
I met my husband later in life and we got married when I was 38. I was and still am wary of the stigma of older mothers, even though being older is accepted. I’ve always wanted a family and we started trying right away, but I had three miscarriages in a year and a half. I was at a different fertility clinic for a year, but didn’t feel comfortable there. My husband’s colleague recommended we see Dr. Miller and what a difference!
We first met online during COVID and Dr. Miller told us, “You’ll be a mother, kiddo.” He was so kind, didn’t rush us, and he explained everything. He learned I was an English teacher and told me a story that put me at ease. He never stopped his storytelling, and I welcomed his personable demeanor after some bad experiences at the previous clinic. Dr. Miller found issues that the previous doctor did not, including endometriosis.
After a biopsy, Dr. Miller found abnormalities in my uterus and I was diagnosed with Level 1 endometriosis. During surgery, he removed five spots on my uterus. I also had the Endometrial Receptivity Assay biopsy to determine the receptivity of the uterus to implantation. Soon after, we had an egg retrieval and two transfers.
Throughout this process, Dr. Miller and his staff explained everything so thoroughly and never seemed irritated or disinterested when I had questions. I also got to know Dr. Miller and the nurses because they talked to me during appointments. I always felt people cared and were invested in our success. I felt so secure going into our procedures and never felt anxiety or stress visiting the office.
Even though our first transfer failed, a second embryo implanted and I will never forget that experience. Dr. Miller, Courtney, and Melody were present for the transfer, and made me feel so comfortable. Dr. Miller even told us a funny story about meeting an actor from Will & Grace. While we waited after the transfer, my husband and I held hands and prayed, and we also talked about how wonderful it would be if it worked. Many times, we dreamed of finishing our nursery and being able to move forward with our plan. The transfer worked, and our baby is due January 8, 3.5 years after we began IVF and what seems like a million doctor appointments.
I was very nervous the first 12 weeks of my pregnancy and braced myself for bad news, but at every ultrasound Courtney reassured me with her positivity. We are so grateful for everyone at the Naperville office.
It took until I was about 20 weeks pregnant for me to relax and realize we’re finally going to be parents! I’ve cried many happy tears for a change! Not everyone will understand IVF or be able to relate, so it’s important to surround yourself with support. More people than you realize struggle with infertility. Meditation and journaling are helpful (as well as long walks with our dog, my first baby). Finally, never stop hoping and praying, even if you’re an older mother!
Patient Story- Molly
“We have been so blessed that I know all the pain and suffering we endured was worth it.”
We’re featuring Molly’s story today! Molly’s story is unique because she was diagnosed with unexplained infertility. This is a tricky diagnosis, because even after testing a cause cannot be determined. When this is the case, there is a lot of trial and error in order to achieve pregnancy. But as Dr. Miller always says: “Trust the process.” That’s just what Molly did and now she has two beautiful sons. Read her story below.
I first became a patient of Dr. Miller’s in 2012 when I had a myomectomy, a surgical procedure to remove uterine fibroids. After getting married and trying for several months to get pregnant, a co-worker suggested I see Dr. Miller, but this time as a fertility specialist. At our first appointment, Dr. Miller ordered blood work and a hysterosonogram which is an ultrasound exam that provides images of the inside of the uterus to help diagnose the cause of abnormal vaginal bleeding. However, everything came back fine. I was told I had unexplained fertility. This wasn’t the news I wanted to hear! It would have been easier to have a specific reason for why I could not get pregnant.
I was put on medication for thyroid and prolactin issues. After a month on the medication, it was advised we try an IUI. We failed all three attempts. Dr. Miller said IVF would need to be our next step. Soon after, my retrieval resulted in 26 eggs! My husband and I were so excited, our dream of having a baby was one step closer.
However, we were unable to do a fresh transfer at that time because I was borderline for Ovarian Hyperstimulation Syndrome (OHSS). This occurs when a woman’s ovaries swell and leak fluid into the body. This condition is temporary and occurs in less than 5% of women who receive fertility treatments. Instead, we ended up freezing 8 embryos. About two months later one embryo was successfully transferred. It was a strange feeling, because I was so happy and terrified at the same time.
After graduating from Dr. Miller’s office, my OB/GYN monitored me closely and that little embryo was born at 34 weeks gestation. Again, I was happy and terrified at the same time. Thankfully our little boy was healthy and strong.
After our son turned 18 months, we decided to start the process to have another child. We decided to follow the same protocol as before and do a transfer in three months. Unfortunately, it failed. After meeting with Dr. Miller again, he advised us to do a trial cycle with an Endometrial Biopsy (EMB). An EMB tests whether the uterine lining is preparing itself adequately for implantation of the embryo. If the lining is out of phase, it can prevent implantation from occurring or result in an early miscarriage. Because the results of my EMB were abnormal, I was treated with progesterone. The following month we had another transfer and it was successful! We welcomed our second baby boy this June./p>
Our two little boys are thriving! We are so happy we found Dr. Miller and are so grateful for everyone in the office as well as Dr. Deutch who did our last transfer. Our advice to other couples going through infertility is to know that you are strong, brave and deserve to be parents. Don’t ever give up! We have been so blessed that I know all the pain and suffering we endured was worth it.
Patient Story- Julia
“This is why you keep fighting; so that you can have peace. Whatever outcome will bring you peace, that is what you fight for.”
Julia is a patient that our office has known for quite some time. She recently welcomed her third baby boy and we have enjoyed getting updates and pictures throughout the years. A seasoned IVF veteran, Julia has been through it all and yet she is incredibly candid about her experience. This openness has led her to volunteer to answer calls for the Resolve support line twice a month. While there aren’t many calls, she is so grateful when she gets to speak to someone and give them some hope. We are so grateful that Julia has shared her story.
She writes:
The other day, I took my two older boys to the fire station open house. It was absolutely packed, it seemed like everyone from our town was there. I looked around at all of the children, moms, dads, siblings, grandparents, etc. and had a moment of self-doubt.
“I don’t belong here,” I thought to myself. “This event is for families.”
As if on cue, my middle son reached up to hold my hand, and my older son ran ahead and called out for me. “MOM! This way, follow me!”
I was instantly brought back to reality, my feelings of insecurity disappearing and belonging restored. I am a mom (of three boys!), and I DO belong at family events, school drop-off, parent-tot classes, parks and baby pools, and in the club that is Parenthood.
The lingering grief and pain of infertility can rear its ugly head at the strangest moments, like it did that Saturday morning. I remember the feeling of fear so well; the fear that I would never become a mom. I know all too well how painful the treatments and the unknowns are as I fought long and hard for my boys. However, I also know the peace that comes from a dream achieved. I want to instill hope in anyone who has that fear and pain, who is in the throes of fertility treatment, who is struggling with self-doubt and the unknown.
I have three beautiful and healthy boys. They are almost perfectly spaced apart; 2.5 years. From the outside looking in, we are a very typical family. And in most senses, that is correct – except for how our family was created.
We waited four years for our first son. I worked for one year with my ob-gyn and Clomid. I then had six stimulated rounds with my first fertility specialist and one miscarriage. When I met Dr. Miller, I had two more failed IVF rounds before we chose to use a donor egg. I had a polyp removal surgery. I did three trial cycles to determine the optimal window for an embryo transfer. We lost our first donor due to poor response to stimulation while I was on hormones alongside her. With our second donor, my first transfer was a blighted ovum that ended in two separate D&C surgeries. After extensive blood work, I was diagnosed with MTHFR, a genetic blood-clotting disorder that can affect implantation.
On November 9, 2016, my 13th cycle, I became pregnant with my first son.
Charlie was cycle 13. James was cycle 15. John was cycle 16.
I share the details of my journey not to overwhelm you, but to give you strength. Maybe your journey will be shorter than mine. Maybe it will be longer. It often felt daunting, hopeless at times, and never-ending. I remember the receptionist at Dr. Miller’s office pulled out my file. It looked like several copies of the Yellow Pages stacked on top of each other. During one of my meetings with Dr. Miller, he put his hand on top of that file and said, “Julia. We haven’t been through this much, for you to not get pregnant. I WILL get you pregnant.” I trusted him and pushed forward despite the fear and pain.
This is why you keep fighting; so that you can have peace. Whatever outcome will bring you peace, that is what you fight for. And you will know when that time comes. People ask me how I did it. They want to know how I managed the appointments and driving, the shots and tests, the physical side effects and emotional trauma, the disappointment and the grief.
I tell them the truth; you just do it. You have to keep going so that you can have your peace.
I promise that the grief and fear will fade with time. It might make an appearance here and there after you have achieved your dream, but that is just a little bit of PTSD from the journey. It will fade. You will hold your little miracle, you will walk with your child at the fire station open house, or into that parent-tot gym class, or to the first day of preschool, or story hour at the library and you will belong. You will feel peace.
Believe in Dr. Miller. Believe in his nurses, the ultrasound techs, the phlebotomist, his entire staff. Throw in some prayers, push forward, and wait for your time to come.
Her Own View: A Patient's Journey Through IVF (Days 4-11) Shots, Shots and More Shots
I have a few things to update. I started ovarian stimulation and had my first two monitoring appointments. The first appointment was 6 days ago and they took an ultrasound of the uterus to see what’s going on in there. They saw about 18 follicles on that first ultrasound, so they decided to start me on the Menopur (two vials), Follistim (150 units), Lovenox (one pre-filled injection) in addition to the Lupron. Yes, my friends, that’s four shots that I’m injecting into my belly every day! Some women want their husbands to do it, but I decided I wanted to do it myself. I think the mental aspect of taking four shots a day is a lot, and if you must coordinate with your husband to do these shots two times a day, it really adds another layer of complication--so, I stick myself! It’s kind of empowering, believe it or not!
Ok, the shots are NOT BAD! For the Menopur, I have to mix two vials of powder and one ML of solution. There are loads of tutorials on how to do this, so it’s not hard at all. This one does burn a little, but again, not too bad! Follistim is a pen, no mixing with this one. Burns a little, but again, it’s not bad. The Lovenox is by far the worst one. It burns going in. The first time I injected this one, it was PAINFUL! But, since that first injection, my expectations were set and I knew it was going to hurt. And now I’m used to it. If you make it this huge deal, then yes, it will be a huge deal. If you think of it as just part of your day, it’s no big deal. Wash your face, brush your teeth, give yourself your shot….done and done! Move on to the next thing! Also, I’ve not really felt any side effects. I’m bloated, but that could have just been the brownie I ate last night!
On the second ultrasound, they saw over 20 follicles, but all under 10mm. That means they are all small, and they need to keep stimulating me. After the appointment, they increased my Follistim to 300 units from the 150 I was originally on.
Dan and I also had to start an antibiotic to reduce the risk of infection at the time of retrieval. My next appointment is tomorrow, so I will update next week!
Thanks so much for reading!
-Katie
*Please note that each patient’s case is unique and Dr. Miller creates individual care plans for each couple based on their medical history.
Her Own View: A Patient's Journey Through IVF (Day 1-3)
Today we’re excited to share with you a new blog series about Katie, a patient of Dr. Miller’s, who has experienced difficulty conceiving. She will be sharing her fertility journey with us in her own words. Katie’s goal for journaling her journey, is that you might find comfort and strength in hearing from someone who is also going through the process as well, whether you are going through it now, or are pregnant after months (or years) of trying. Her struggle may be different, but her hopes and dreams of reaching the end goal, that bundle of joy, are the same. Although the outcome is unknown, Dr. Miller and his staff are excited to work together with Katie and her husband, Dan, as their partner and guide.
Hello Everyone!
My name is Katie and I would like to welcome you to my very first patient blog post! I’m excited to take this fertility journey with you. To give you some background, my husband, Dan and I are 31. After getting married in 2011, both Dan and I went to graduate school, which wasn’t the ideal time to start a family. Finally, at the end of 2015, we were ready to start our family. We officially started trying to conceive (TTC) in December 2015. To our surprise, we got pregnant the very first month of trying! Unfortunately, in March 2016, we lost the baby at twelve and a half weeks, a few short days after we told close family and friends. Since I had the miscarriage at home, we were not able to test for genetic abnormalities. My OB said over 50% of miscarriages happen because of genetic abnormalities, so that was most likely the reason. The entire experience was truly heartbreaking!
We were told by my OB to wait one cycle before TTC again. Since I had a D&C*, I didn’t get my first period until May 2016. In July 2016, we were pregnant again, which resulted in a chemical pregnancy* at 4.5 weeks. My OB decided to do a Recurrent Pregnancy Loss (RPL)* testing. Those tests indicated that I might have a blood clotting disorder; however, those tests were inconclusive.
My OB suggested we try again since my tests didn’t indicate any real red flags, but to take baby Aspirin for the possible blood clotting issue to be on the safe side. So we did try again, and we were pregnant again in October 2016, which resulted in another chemical pregnancy at 5 weeks. At that time, my OB agreed we should see a Reproductive Endocrinologist (RE).
After performing extensive online research, Dan and I decided to schedule a consultation with Dr. Miller in November 2016. I chose to see Dr. Miller because of his excellent reputation and success rates. Before he came in to see Dan and me, Dr. Miller reviewed my case. He said since I have an unknown reason for my recurrent losses, he would like everything tested-- from semen to genetics to blood. You name it, he’s testing it! Since I’m an HMOI patient, and Dr. Miller uses a lab outside the network, the tests had to be done through my OB.
The tests indicated that I have a MTHFR gene mutation*. This mutation does not allow synthetic folic acid to be absorbed into my body, so Dr. Miller gave me a prescription that would allow my body to absorb folic acid. I was hopeful that maybe this could be the answer.
During this time, Dr. Miller also had us do a Clomid* 50mg test cycle to see how my body would respond, but let us know that we would not be TTC just yet. We found that my progesterone was 15 Mg/Ml, lower than the 20 he likes to see with a medicated cycle. Perhaps this was another clue?
In early May 2017, we had our follow up appointment with Dr. Miller, and he talked us through all our options. He said the reasons for my recurrent losses are most likely due to a blood clotting issue or genetic abnormalities. He said we had three options:
- Clomid 100mg with Lovenox*
- IVF/ICSI* with Lovenox (50% live birth rate/ 16% chance of loss)
- IVF/ICSI with Lovenox and Preimplantation Genetic Screening (PGS)*. (70% live birth rate/ less than 5% chance of loss)
We decided to go for option 3! IVF with PGS!
So, here we are! We will do the egg retrieval in June and transfer in July! I’m currently on Lupron * 10 units, which I’ve been taking since May 23rd. Surprisingly, this injection is not bad at all. The needle is tiny and it’s relatively pain-free. I just got my period (finally!), making my cycle 32 days (very long for me as my average in 27 days). I’ll be starting my stimulation shortly here after an ultrasound in the coming days! The plan is to continue the Lupron and add Menopur* and Follistim*. The IVF nurses are really good at keeping me informed on next steps, and I also have a clear written protocol from the office.
I am cautiously excited about the next two months, but I’m not trying to get ahead of myself. I think the most important thing is to take it one step at a time, and not get too into my head about the whole process!
I’ll be updating on my IVF journey a frequently as I have new things to report!
-Katie
Katie's TCC Timeline
- 2011 – Married! Excited about life together!
- December 2015 – Removed the goalie! Let’s try to have a baby!
- March 2016 – 1st miscarriage at twelve and a half weeks. Heartbreaking. Maybe just an unfortunate fluke? Genetic abnormalities? Unknown. D&C to follow.
- July 2016 – Pregnant again! Chemical pregnancy 4.5 weeks. What’s going on here?
- August through September 2016 – Recurrent Pregnancy Loss (RPL) testing. Maybe a blood clotting issue?
- October 2016 – Pregnant again, and you guessed it…another loss at 5 weeks.
- November 2016 – Started seeing Dr. Miller. Discovered MTHFR gene mutation.
- March 2017 – Test Clomid cycle. Low progesterone.
- May 2017 – Starting IVF/ICSI with Lovenox and Preimplantation Genetic Screening (PGS). Taking Lupron 10 units since 5/23/17
- June 2017 – Got my period, waiting to go in for a baseline ultrasound and starting simulation for the retrieval!
Glossary
D&C: also known as dilation and curettage, a surgical procedure in which the cervix is opened (dilated) and a thin instrument is inserted into the uterus. This instrument is used to remove tissue from the inside of the uterus (curettage). ACOG
Chemical Pregnancy: occurs when the pregnancy hormone is elevated (i.e. beta hCG), but there are no other signs of pregnancy and it is too early to be detected via ultrasound (ivf.drcharlesmiller.com)
Recurrent Pregnancy Loss (RPL) Testing: examines genetics, infection, autoimmune testing, thrombophilia (blood clotting issues), the structure of the uterus and hormonal concerns (ivf.drcharlesmiller.com)
Clomid: Clomiphene stimulates the release of hormones needed to cause ovulation. Clomiphene therapy is typically used for 5 consecutive days early in the menstrual cycle, for 3 to 6 monthly cycles. It may take several cycles to find the right dose to stimulate ovulation. After that dose is determined, a woman will take the drug for at least 3 more cycles. If she does not become pregnant after 6 cycles, it is unlikely that further clomiphene treatment will be successful (ivf.drcharlesmiller.com)
Lovenox: Injections used to help prevent micro-clotting associated with Thrombophelia and or auto-immune deficiencies (ivf.drcharlesmiller.com)
IVF/ICSI: refers to a procedure designed to overcome infertility and produce a pregnancy as a direct result of the intervention. In general, the ovaries are stimulated by a combination of fertility medications and then one or more oocyte(s) are aspirated from ovarian follicles. These are fertilized in the laboratory (“in vitro”), after which, one or more embryo(s) are transferred into the uterine cavity. These steps occur over about a two-week interval of time, which is called an IVF cycle. (ivf.drcharlesmiller.com)
Preimplantation Genetic Screening (PGS): performed on cell(s) removed from a preimplantation embryo or a polar body from an oocyte. The goal is to identify de-novo aneuploidy in embryo(s) of couples presumed to be chromosomally normal. Theoretically, avoiding transfer of aneuploid embryos will reduce the risk of pregnancy failure and improve the probability of conceiving a viable pregnancy (ivf.drcharlesmiller.com)
Lupron: injection given below the skin, subcutaneous injection. These medications are used to enable the body to produce a higher number of quality eggs. These medications are also designed to prevent the mid-cycle hormonal surge which can result in a cancelled cycle. (ivf.drcharlesmiller.com)
Menopur: (menotropins for injection) is a prescription medicine that contains hormones. MENOPUR contains follicle stimulating hormone and luteinizing hormone activity. These hormones stimulate healthy ovaries to make eggs. (Ferring Pharmaceuticals)
Follistim: medicine that contains follicle-stimulating hormone (FSH) to help healthy ovaries to develop (mature) and release eggs; and as part of treatment programs that use special techniques (skills) to help women get pregnant by causing their ovaries to produce more mature eggs (Merck)
*Please note that each patient's case is unique and Dr. Miller creates individual care plans for each couple based on their medical history. Not all patients who have the MTHFR gene mutation will be treated with Lovenox.